Three-Dimensional Joint Kinematics in a Canine Elbow Joint with Medial Coronoid Disease before and after Bi-Oblique Dynamic Proximal Ulnar Osteotomy

Abstract

Objective The aim of this study was to report the humeroulnar joint kinematics in a dog with medial coronoid process disease (MCPD) before and after dynamic proximal ulnar osteotomy (DPUO).

Study Design A 15-month-old female Labrador Retriever with advanced MCPD was treated by DPUO and fragment removal. Bi-planar fluoroscopic kinematography of the affected joint was performed before and 12 weeks after DPUO along with computed tomography. Static axial radioulnar incongruence (sRUI), dynamic relative proximodistal radioulnar motion (dynamic RUI), axial humeroulnar rotation, as well as humeroulnar joint contact at the medial coronoid process (MCP) were calculated.

Results Static axial radioulnar incongruence was reduced from 2.3 to 1.5 mm after DPUO but dynamic RUI remained unchanged (0.2 vs. 0.3 mm). Mean humeroulnar rotational amplitude increased from 2.6° (standard deviation 0.4) to 4.5° (standard deviation 2.0). Joint contact area at the MCP became substantially increased as well as broadly distributed among the MCP following DPUO (52.5 vs. 63.0%; p = 0.0012).

Conclusion Dynamic proximal ulnar osteotomy failed to restore the radioulnar congruence and increased the humeroulnar rotational instability. No effect was observed on dynamic RUI. Nevertheless, joint contact area at the MCP was increased and became more homogeneously distributed, which might explain the beneficial effect of clinical outcome in this case.

Keywords

coronoid process - kinematography - elbow - ulnar osteotomy - canine

Author Contributions

All authors contributed to conception of study, study design, acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.

• References

• 1 Cook JL. Forelimb lameness in the young patient. Vet Clin North Am Small Anim Pract 2001; 31 (01) 55-83
• 2 Fitzpatrick N, Smith TJ, Evans RB, Yeadon R. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg 2009; 38 (02) 213-223
• 3 Gemmill TJ, Clements DN. Fragmented coronoid process in the dog: is there a role for incongruency?. J Small Anim Pract 2007; 48 (07) 361-368
• 4 Kirberger RM, Fourie SL. Elbow dysplasia in the dog: pathophysiology, diagnosis and control. J S Afr Vet Assoc 1998; 69 (02) 43-54
• 5 Puccio M, Marino DJ, Stefanacci JD, McKenna B. Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity. J Am Anim Hosp Assoc 2003; 39 (05) 473-478
• 6 Krotscheck U, Kalafut S, Meloni G. , et al. Effect of ulnar ostectomy on intra-articular pressure mapping and contact mechanics of the congruent and incongruent canine elbow ex vivo. Vet Surg 2014; 43 (03) 339-346
• 7 McConkey MJ, Valenzano DM, Wei A. , et al. Effect of the proximal abducting ulnar osteotomy on intra-articular pressure distribution and contact mechanics of congruent and incongruent canine elbows ex vivo. Vet Surg 2016; 45 (03) 347-355
• 8 Eljack H, Böttcher P. Relationship between axial radioulnar incongruence with cartilage damage in dogs with medial coronoid disease. Vet Surg 2015; 44 (02) 174-179
• 9 Samoy Y, Van Ryssen B, Gielen I, Walschot N, van Bree H. Review of the literature: elbow incongruity in the dog. Vet Comp Orthop Traumatol 2006; 19 (01) 1-8
• 10 Rohwedder T, Fischer M, Böttcher P. In vivo fluoroscopic kinematography of dynamic radio-ulnar incongruence in dogs. Open Vet J 2017; 7 (03) 221-228
• 11 Rohwedder T, Fischer M, Böttcher P. In vivo axial humero-ulnar rotation in normal and dysplastic canine elbow joints. Tierarztl Prax Ausg K Klientiere Heimtiere 2018; 46 (02) 83-89
• 12 Fitzpatrick N, Garcia TC, Daryani A, Bertran J, Watari S, Hayashi K. Micro-CT structural analysis of the canine medial coronoid disease. Vet Surg 2016; 45 (03) 336-346
• 13 Fitzpatrick N, Yeadon R. Working algorithm for treatment decision making for developmental disease of the medial compartment of the elbow in dogs. Vet Surg 2009; 38 (02) 285-300
• 14 Krotscheck U, Böttcher PB, Thompson MS, Todhunter RJ, Mohammed HO. Cubital subchondral joint space width and CT osteoabsorptiometry in dogs with and without fragmented medial coronoid process. Vet Surg 2014; 43 (03) 330-338
• 15 Starke A, Böttcher P, Pfeil I. Radiologic quantification of the elbow conformation with a new method for acquiring standardized x-rays under load. Reference values for medium sized and large dogs without dysplasia of the elbow joint [article in German]. Tierarztl Prax Ausg K Klientiere Heimtiere 2013; 41 (03) 145-154
• 16 Starke A, Böttcher P, Pfeil I. [Comparative radiologic examination of the canine elbow with and without elbow dysplasia under standardized load]. Tierarztl Prax Ausg K Klientiere Heimtiere 2014; 42 (03) 141-150
• 17 Lau SF, Hazewinkel HA, Grinwis GC. , et al. Delayed endochondral ossification in early medial coronoid disease (MCD): a morphological and immunohistochemical evaluation in growing Labrador retrievers. Vet J 2013; 197 (03) 731-738
• 18 Lau SF, Wolschrijn CF, Hazewinkel HA, Siebelt M, Voorhout G. The early development of medial coronoid disease in growing Labrador retrievers: radiographic, computed tomographic, necropsy and micro-computed tomographic findings. Vet J 2013; 197 (03) 724-730
• 19 Griffon D. Surgical diseases of the elbow. In: Tobias KM, Johnston SA. , eds. Veterinary Surgery: Small Animal. St. Louis: Elsevier; 2012: 724-759
• 20 Gilson SD, Piermattei DL, Schwarz PD. Treatment of humeroulnar subluxation with a dynamic proximal ulnar osteotomy. A review of 13 cases. Vet Surg 1989; 18 (02) 114-122
• 21 Preston CA, Schulz KS, Taylor KT, Kass PH, Hagan CE, Stover SM. In vitro experimental study of the effect of radial shortening and ulnar ostectomy on contact patterns in the elbow joint of dogs. Am J Vet Res 2001; 62 (10) 1548-1556
• 22 Ness MG. Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy. J Small Anim Pract 1998; 39 (01) 15-18
• 23 Böttcher P, Bräuer S, Werner H. Estimation of joint incongruence in dysplastic canine elbows before and after dynamic proximal ulnar osteotomy. Vet Surg 2013; 42 (04) 371-376
• 24 Quinn MM, Keuler NS, Lu Y, Faria ML, Muir P, Markel MD. Evaluation of agreement between numerical rating scales, visual analogue scoring scales, and force plate gait analysis in dogs. Vet Surg 2007; 36 (04) 360-367
• 25 Ohlerth S, Tellhelm B, Amort K. , et al. Explanation of the IEWG grading system. 30th annual meeting of the International Elbow Working Group; 2016 ; Vienna, Austria
• 26 Eljack H, Werner H, Böttcher P. Sensitivity and specificity of 3D models of the radioulnar joint cup in combination with a sphere fitted to the ulnar trochlear notch for estimation of radioulnar incongruence in vitro. Vet Surg 2013; 42 (04) 365-370
• 27 Caron A, Fitzpatrick N. Bi-oblique dynamic proximal ulnar osteotomy: surgical technique and clinical outcome in 86 dogs. Vet Surg 2016; 45 (03) 356-363
• 28 Brainerd EL, Baier DB, Gatesy SM. , et al. X-ray reconstruction of moving morphology (XROMM): precision, accuracy and applications in comparative biomechanics research. J Exp Zool A Ecol Genet Physiol 2010; 313 (05) 262-279
• 29 Zeissler M, Maierl J, Grevel V, Oechtering G, Böttcher P. Cartilage thickness and split-line pattern at the canine humeral trochlea. Vet Comp Orthop Traumatol 2010; 23 (05) 343-347
• 30 Gendler A, Keuler NS, Schaefer SL. Computed tomographic arthrography of the normal canine elbow. Vet Radiol Ultrasound 2015; 56 (02) 144-152
• 31 Temwichitr J, Leegwater PA, Hazewinkel HA. Fragmented coronoid process in the dog: a heritable disease. Vet J 2010; 185 (02) 123-129
• 32 Olivieri M. Dynamic proximal ulnar osteotomy. Proceedings, 22nd Annual Scientific Meeting of the European College of Veterinary Surgeons; 2013 ; Rome, Italy