Objective-To report clinical, radiographic, and arthroscopic findings in dogs with thoracic limb lameness attributed solely to disease of the medial aspect of the coronoid process (MCP). Study Design-Case series. Animals-Dogs (n ¼ 263) with MCP disease (MCD; 437 elbows). Methods-Clinical records (January 2000-July 2006) and radiographs were reviewed and pertinent data recorded. Radiographic interpretation included measures of periarticular osteophytosis, gross assessment of MCP integrity, and measurement of ulnar subtrochlear sclerosis (STS). Statistical analysis was performed to evaluate associations between data; confidence interval was set at 95%. Results-Labrador Retrievers were 50.2% of all dogs with MCD. Mean age at diagnosis was 32 months and duration of lameness was 14.5 weeks. Thirteen elbows (3%) were considered radiographically normal. Osteophytosis was identified on the anconeal process (70.2%), radial head (37.3%), and lateral epicondyle (56.5%), and STS was identified in 86.7% of elbows. Median osteophytosis score was 1; mean absolute osteophytosis score was 1.7. Arthroscopic findings included: fissuring (18.3%) and fragmentation (64.1%) of the MCP and kissing lesions (49.0%) of elbows. Median-modified Outerbridge score of the MCP was 2 and the humeral condyle, 0. Weak or moderate correlations were found between osteophytosis and modified Outerbridge scores and weak correlation between modified Outerbridge scores of the MCP and medial humeral condyle. Conclusions-Wide ranges in clinical, radiographic, and arthroscopic findings are recognized in dogs with MCD but correlations between such factors are generally weak. Radiographic and arthroscopic findings do not correlate with owner-reported duration of lameness. Clinical Relevance-Radiographic measures of osteophytosis are poor predictors of severity of arthroscopic pathology for MCD. r

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Objective-To determine medium-term clinical efficacy of sliding humeral osteotomy (SHO) for treatment of lameness and elbow pain associated with clinically diagnosed elbow disease featuring cartilage eburnation of the medial elbow compartment (medial compartment disease-MCD). Study Design-Case series. Animals-Dogs (n ¼ 49) with severe or persistent lameness attributable to MCD. Methods-Signalment, lameness history, and preoperative imaging findings were recorded. A custom, locking, stepped SHO plate was applied to the medial aspect of the humerus, stabilizing a middiaphyseal transverse osteotomy, medially translating the distal segment relative to the proximal segment. Three variants of technique of application were used and outcomes compared between respective patient groups. Outcome measures included lameness scoring, anatomic measures, VAS scoring of elbow pain, and owner assessment of function. Measures recorded preoperatively, 12, and 26 weeks postoperatively were compared. Results-Of 59 limbs that had SHO, 39 had preoperative focal treatment of the diseased medial aspect of the coronoid process. Mean AE SD dog age was 45.5 AE 37.48 months and body weight ranged from 13.6 to 46.7 kg. Mean preoperative duration of lameness was 14.7 AE 18.50 months. Lameness improved for all limbs by 26 weeks, and resolved in 21/32 limbs. Significant improvements in postoperative elbow pain scores and most owner assessments of function were observed. Incidence of major complications requiring surgical intervention was 17.2%, 22.2%, and 4.8% for each of the 3 technique variants described. Histologic examination of 2 elbows at 412 months revealed fibrocartilage cover of medial aspect of humeral condyle. Conclusions-Canine SHO with or without focal treatment of the diseased medial aspect of the coronoid process ameliorates lameness and pain associated with MCD at medium-term follow-up. Application technique is critical to minimizing morbidity. Clinical Relevance-SHO is appropriate for clinical management of pain and lameness in select cases of canine MCD. r

Even in dogs with clinical features typical of the condition most commonly termed IOHC, fissure formation and propagation can occur after ossification is complete.

Objective-To document clinical outcomes after subtotal coronoid ostectomy (SCO) for treatment of medial coronoid disease (MCD). Study Design-Prospective clinical study. Animals-Dogs (n ¼ 263) with MCD. Methods-MCD was treated by a combination of SCO via mini-arthrotomy, cage confinement (6 weeks), leash restricted exercise (12 weeks) and pentosan polysulfate administration. Outcomes were assessed by clinical examination in the short-term (324 elbows), owner questionnaires (146 dogs), clinical examination (90 dogs), subjective assessment of gait (110 elbows) and radiographic examination (180 elbows), 4 months to 7 years 7 months after surgery. Results-One intraoperative complication occurred (1 elbow with fissuring of the ulna) and 8.2% elbows had immediate postoperative complications, the most common being wound infection (7%). Improvement in subjective lameness assessment to a score of 0 was noted at 5 weeks in 74.4% of elbows (veterinary) and 45.6% (owner) and at 12 weeks in 71.5% (veterinary), and 91.2% (owner). Subjective assessments of outcomes in the medium-term revealed 81.9% dogs remained sound, with significantly (Po.05) improved daily function scores compared with preoperative values, 83.5% of dogs received no NSAID. Clinical examination revealed good limb function and subjective assessment showed 51% of limbs were free from lameness. Radiographic progression of osteophytosis occurred on average by one grade. Conclusion-Management of MCD using the described management regime, including SCO via mini-arthrotomy, deserves consideration and comparison with existing treatment methods. Clinical Significance-Management of MCD by SCO can be considered when gross fissuring or fragmentation of the MCP is not evident. This technique does not require specialized instrumentation. r Copyright 2009 by The American College of Veterinary Surgeons INTRODUCTION D ISEASE OF the medial aspect of the coronoid process (MCP) of the ulna, medial coronoid disease (MCD), is a component of elbow dysplasia and includes gross fissuring and fragmentation of the MCP, pathology of the overlying cartilage and/or subchondral bone. MCP disease has been reported as a frequently diagnosed cause of thoracic limb lameness in medium to large breed dogs 1,2 and is a common cause of elbow osteoarthritis (OA). The exact cause of MCD is debated but elbow incongruence has been reported as a primary contributor to pathogenesis of MCD. [3][4][5][6] Management of MCD remains controversial and currently no universally agreed approach exists. Results from reported studies vary but in general, describe a [233][234][235][236][237][238][239][240][241][242][243][244][245] 2009 return to normal function in the short-term with progression of OA in the medium-and long-term. 1,4,[7][8][9] Some authors report that surgical intervention does not alter the long-term prognosis and favor solely nonsurgical management. 9Surgical techniques reported for MCD broadly adopt one of two approaches: osteotomy or focal treatment of the MCP, either by arthrotomy or arthr...

Objective-To report clinical experience with autogenous bone grafting, with and without metallic implants, for treatment of lameness attributed to incomplete ossification of the humeral condyle (IOHC). Study Design-Case series. Animals-Dogs (n ¼ 8; 9 elbows) with IOHC. Methods-A transcondylar humeral bone core was removed and the resultant socket grafted using autogenous bone harvested as either free cancellous bone or a corticocancellous dowel using an osteochondral autograph transfer system. In 8 elbows, additional support for the humeral condyle was provided with metallic implants. Postoperative outcome was assessed by clinical, radiographic, computed tomographic (CT) and owner questionnaire examinations in the short and medium term. Results-Eight dogs (9 elbows) were treated surgically for IOHC. Graft types were free cancellous graft (n ¼ 2) or corticocancellous dowel (7). Condylar augmentation was performed using epicondylar cross pins (1); transcondylar Acutrak TM (AT) screw and epicondylar cortical screw (1); and a single transcondylar AT screw (7). Lameness resolved in 1-12 weeks. Bone bridging was documented in 7 of 8 elbows assessed by CT examination. Owner questionnaires (6 dogs) assessing daily functions were available for 7 of 9 elbows (follow-up, 6-45 months). Relevant follow-up function scores were significantly improved compared with preoperative values. One dog was intermittently lame and was administered nonsteroidal antiinflammatory medication. Conclusion-Use of autogenous bone grafting techniques leads to resolution of lameness attributed to IOHC. Augmentation of grafts with implants like the AT screw is recommended. Clinical Relevance-Autogenous bone grafting techniques represent a viable alternative or adjunct to existing techniques for clinical management of IOHC in the dog. r

Implantation of ITAP to the distal limb of dogs is feasible and can result in favorable functional outcomes. Biological integration of osseous and dermal tissues with ITAP is reliable and robust.

Reinforced augmentation of the DAR using a SOP™ plate and PMMA cement may facilitate placement of acetabular THR component implantation in dogs with severe DAR insufficiency.