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VSCD profiles interesting and instructive cases and use of techniques
as they present.
Technique: Arthroscopy
Name: Abnormal Joints
Breed: Any Dog Breed
Age: Young
and Geriatric
Condition:Congenital
Conditions (Dysplasia) & Acquired Conditions (CCL rupture)
Since the first reports of arthroscopy as a method of canine
joint exploration in 1978, arthroscopy has evolved as a treatment
for surgical conditions of the hip, shoulder, elbow, carpus and
hock. (1) In present-day referral surgical practice, arthroscopy
is not only commonplace, but has become the gold standard for
the investigation and the treatment of many developmental orthopedic
conditions such as fragmentation of the medial part of the coronoid
process (FMCP) and osteochondritis dessicans (OCD) of the elbow,
and OCD of the shoulder. (2)
Arthroscopy has many advantages over
traditional arthrotomy: significantly less tissue trauma; more
complete exploration of the joint; greater precision and accuracy
in diagnosis of joint pathology; and more rapid and superior
short term functional post-operative recovery. (1, 2, 3)
While the merits of arthroscopy as a therapeutic modality (less trauma and morbidity
than arthrotomy) are obvious, arthroscopy is also a powerful
diagnostic tool.
Specifically:
- There is a subset of dogs with
elbow disease (FMCP/OCD) that have clinical lameness referable
to the albow joint, but that do not display any radiographic
evidence of elbow joint pathology. In these cases, only scintigraphy,
advanced imaging (CT/MRI) and arthroscopy can accurately localize
the pathology to- and within- the elbow joint. (4) Arthroscopy
posesses the further benefit, that treatment can often be effected
at the same time as definitive diagnosis.
- Neither radiography
nor computed tomography (CT) can directly identify cartilage
erosion (see footnote). Arthroscopy of the canine elbow allows
the direct observation and evaluation of articular surfaces,
and can therefore be considered the ''gold standard'' technique
for clinical evaluation of cartilage lesions. (5)
- Meniscal
injury occurs secondary to CrCL disease in up to 70% of cases,
and is a major factor affecting quality of life and financial
costs. (6) Compared to arthroscopy,
the incidence of late/ subsequent/ postliminary meniscal tears
is approximately four times greater if an arthrotomy was performed
(or if not joint exploration was performed) for joint exploration
at the time of surgery for CrCL disease.
(6) This alarming disparity is
because the accurate identification of medial meniscal tears
is significantly greater with arthroscopy than arthrotomy. (3)
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Arthroscopy is currently available to canine patients with
shoulder, elbow and stifle pathology through both the Berkeley
and Dublin locations. With the arrival of our new 1.9mm small
joint arthroscope, we will soon be offering arthroscopy to
our feline patients and to dogs with carpal or hock pathology.
If you have any questions about arthroscopy, or would like
to schedule a hospital visit to see a demonstration of our
arthroscopy capabilities:
please email: Arthrscopy@vscdsurgerycenters.com
Footnote:
Modified Outerbridge Scoring System Used for Arthroscopic Evaluation
of Cartilage Pathology:
0 - Normal
1 - Chondromalacia (assessed by use of an arthroscopic probe)
2 - Partial thickness fibrillation
3 - Deep fibrillation
4 - Full thickness cartilage loss
5 - Subchondral bone eburnation
References:
- Hoelzler M, et al. Results of Arthroscopic Versus Open
Arthrotomy for Surgical Management of Cranial Cruciate Ligament
Deficiency in Dogs. Veterinary Surgery 33:146-153, 2004
- Jardel
N, et al. Anatomical and safety considerations in establishing
portals for canine elbow arthroscopy. VCOT 23: 75 - 80, 2010
- Pozzi
A, et al. Comparison of Arthroscopy and Arthrotomy for Diagnosis
of Medial Meniscal Pathology: An Ex Vivo Study. Veterinary
Surgery 37:749-755, 2008
- Punke J, et al. Arthroscopic Documentation
of Elbow Cartilage Pathology in Dogs with Clinical Lameness
without Changes on Standard Radiographic Projections. Veterinary
Surgery 38:209-212,
2009
- Moores A, et al. Computed Tomography Versus Arthroscopy
for Detection of Canine Elbow Dysplasia Lesions. Veterinary
Surgery 37:390-398,
2008
- Thieman K, et al. Effect of Meniscal Release on Rate
of Subsequent Meniscal Tears and Owner-Assessed Outcome in
Dogs with Cruciate Disease Treated with Tibial Plateau Leveling
Osteotomy. Veterinary Surgery 35:705-710, 2006
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