The use of lateral arthroscopy portals for the management of bilateral osteochondritis dissecans of the radial head in an English bulldog

Abstract

Objective To report a case of bilateral radial head osteochondritis dissecans (OCD) in a dog treated via lateral elbow arthroscopy portals. Study design Case report. Animals Six month old female spayed English bulldog. Methods The dog was presented for a left thoracic limb lameness localized to the elbow. Computed tomography revealed bilaterally symmetrical mineralized fragments in the lateral compartment of the elbow joint and blunting of the medial coronoid processes. The fragments were associated with a thin donation bed along the caudolateral articular surface of the radial head with moderate surrounding subchondral bone sclerosis. Bilateral elbow arthroscopy was pursued. Arthroscopy was initiated via a standard medial approach, which allowed for abrasion arthroplasty of the radial incisure and medial coronoid process but provided insufficient access to the radial head lesions. A lateral arthroscopic approach was subsequently performed and provided excellent access to the radial head for fragment retrieval and abrasion arthroplasty. Results Histopathology of the radial head fragments revealed mild cartilage degeneration and retention of cartilaginous cores within subchondral bone, consistent with OCD. Complete resolution of lameness and elbow pain were observed on clinical examination 5 months postoperatively. Conclusion Radial head OCD can occur as a rare component of elbow dysplasia in growing dogs, and fragment retrieval with abrasion arthroplasty via lateral arthroscopic portals may be an effective treatment option.

The use of lateral arthroscopy portals for the management of a fragmented lateral coronoid process in an English Bulldog

“…Interestingly, multipartition of the second carpal bone has recently been documented in another English Bulldog. 12 While the likelihood of these lesions having clinical significance is improbable, it is important to recognize that the English Bulldog breed might exhibit a predisposition to their formation. Additionally, these lesions may be encountered incidentally during diagnostic evaluation.…”

“…[5][6][7][8] The definitive diagnosis of MCD is performed through a combination of imaging modalities including radiography, computed tomography (CT), and arthroscopy. 4,[9][10][11][12] Although the relative efficacy of surgical versus nonsurgical treatment modalities remains controversial, surgical treatment typically involves fragment removal and/or abrasion arthroplasty via a standard medial arthroscopic approach. 7,[13][14][15][16] Contrary to MCD, lateral coronoid disease (LCD) has rarely been reported in dogs, typically manifesting as chondromalacia of the lateral compartment secondary to diffuse elbow osteoarthritis.…”

“…18,19 To the author's knowledge, there are no clinical reports on the treatment of lateral coronoid disease (LCD) in dogs. Furthermore, the clinical application of canine elbow arthroscopy via lateral portals has only been described in a single case report 12 for the treatment of bilateral radial head OCD. As such, the objective of this case report was to describe the clinical presentation, diagnostic findings, and outcome of a dog with a fragmented lateral coronoid process treated with abrasion arthroplasty via lateral arthroscopy portals.…”

“…In either scenario, fatigue microdamage to the subchondral bone is associated with secondary degeneration of the associated articular cartilage 5–8 . The definitive diagnosis of MCD is performed through a combination of imaging modalities including radiography, computed tomography (CT), and arthroscopy 4,9–12 . Although the relative efficacy of surgical versus nonsurgical treatment modalities remains controversial, surgical treatment typically involves fragment removal and/or abrasion arthroplasty via a standard medial arthroscopic approach 7,13–16 …”

Review of minimally invasive surgical procedures for assessment and treatment of medial coronoid process disease

“…Lateral portal subsequent to medial portal inspection of the joint has been described in a case report, the former portal specifically for visualization and osteochondral debridement/abrasion chondroplasty of the radial head for the management of bilateral osteochondritis dissecans. 9 The arthroscopic portal was established in the center of a triangle formed by the lateral epicondyle, radial head and olecranon tuberosity with egress established adjacent to the anconeus. A craniolateral instrument portal was established between the lateral epicondyle and radial head approximately 1 cm cranial to the arthroscope portal and caudal to the collateral ligament for osteochondral debridement.…”