Leonardo Augusto Lopes Muzzi

Background: Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs, leading to joint instability and severe progressive osteoarthritis. Some dogs have an excessively inclined tibial plateau angle (TPA) which represents a predisposing anatomical factor for CCL disease. Surgical correction is widely recommended, with tibial corrective osteotomies frequently used. Among the corrective techniques, the CORA-Based Leveling Osteotomy (CBLO) technique reduces cranial tibial thrust through a radial osteotomy centered at the CORA of the proximal tibia. The objective of this study is to report the use of the CBLO technique in two dogs with CCL disease and excessive TPA. Case: The two dogs were presented to the University Veterinary Hospital for evaluation and treatment. The first case involved a 9-year-old Jack Russell weighing 10,8 kg, presenting with a 30-day history of bilateral lameness, predominantly affecting the right pelvic limb. Following clinical and radiographic examinations, a diagnosis of bilateral CCL disease was established. The second case involved a 5-year-old, mixed-breed dog weighing 11.5 kg, presented with left pelvic limb lameness after climbing stairs, which diagnostic examinations confirmed unilateral CCL disease. In both cases, radiographic examinations enabled the measurement of TPA. In the first dog, the TPA was measured at 35º in the right pelvic limb, while in the second dog, the TPA was measured at 37º in the left pelvic limb. In both cases, these values were considered indicative of an excessive TPA. Surgical treatment using the CBLO technique was chosen and both dogs underwent the same anesthetic protocol and surgical procedure. In the first case, the CORA angle was calculated at 31.5°, and a bone rotation of 5,4 mm was planned to achieve an ideal postoperative TPA of approximately 10°. In the second case, the CORA angle was calculated at 34°, and a bone rotation of 7,0 mm was planned to achieve an ideal postoperative TPA of approximately 10°. In the surgical procedure, medial arthrotomy was performed to allow joint inspection, which revealed lesions in the medial menisci. Partial meniscectomy was carried out, followed by capsulorrhaphy. Radial osteotomies were performed using saw blades with radii of 10mm and 12mm, respectively. Following cranial rotation of the proximal tibial segment, the bone segments were stabilized using pre-contoured CBLO plates (2.4 mm and 2.7 mm) and locked screws. A headless compression screw was also used to reinforce the stabilization. The muscle fasciae, subcutaneous tissue, and skin were routinely sutured. The immediate postoperative radiographs showed that final TPAs of 11° in the first dog and 9° in the second. Postoperative care included analgesics, anti-inflammatory drugs, and antibiotics for 7 days, soft bandage for 5 days, and restricted activity for 2 months. At the 30-day postoperative reassessment, both dogs showed good weight-bearing on the operated pelvic limb, with slight lameness. On radiographic examination, the implants were well positioned, and there were signs of initial bone healing at the osteotomy site. Both dogs showed progressive improvement in limb function, with reports of complete recovery within three months. Discussion: In some cases of dogs with CCL disease and excessive TPA, a combination of surgical techniques may be employed in the treatment of these conditions; however, combining techniques can increase the rate of postoperative complications. The results of these two reported cases demonstrate that the only CBLO technique was effective in treating CCL disease in dogs with excessive TPA. This approach appears to be a viable option for patients with these conditions in the stifle joint and that it is possible to correct them using only one corrective tibial osteotomy technique.

Background: Medial compartment disease (MCD) is characterized by the degeneration of the articular cartilage in the medial compartment of the elbow joint. Various surgical interventions are employed to manage this condition, with the proximal abducting ulnar (PAUL) osteotomy representing a biomechanically driven technique aimed at altering the load distribution across the elbow joint. This procedure is intended to offload the medial compartment, alleviate pain, and decelerate the progression of osteoarthritis. Despite its theoretical benefits, the long-term outcomes, efficacy, and potential complications associated with PAUL osteotomy remain incompletely understood. The present report describes the application of PAUL osteotomy in the surgical treatment of a dog with MCD, utilizing a specialized bone plate. Case Description: A 2-year-old male dog was referred to the University Veterinary Hospital with a history of chronic thoracic limb lameness. Upon physical examination, moderate lameness was noted in both forelimbs, accompanied by shortening of the stride, a narrowed base of support, slight pronation of the forearms, and mild adduction of the left elbow. Radiographic evaluation of both forelimbs revealed advanced osteoarthritic changes, with similar alterations observed in both elbows, supporting the diagnosis of medial compartment disease. Initial conservative management, including physical therapy, was instituted; however, the patient exhibited intolerance to the prescribed regimen and failed to show significant improvement over a 6-month follow-up period. Consequently, the decision was made to proceed with PAUL osteotomy. Preoperative radiographs revealed a mechanical medial elbow angle (mMEA) of 84.8º. The surgical approach involved a caudo-lateral incision over the left ulna, with osteotomy performed distally at the midshaft of the ulna. A bone plate was applied, with a 3 mm step at the proximal fragment. Postoperatively, partial weight-bearing was observed within 24 hours, with moderate lameness. Clinically, there was notable improvement in weight-bearing capacity and a reduction in both elbow adduction and forearm pronation by 30 days post-surgery. A satisfactory clinical outcome was achieved by 120 days postoperatively. Follow-up radiographs at 90 days demonstrated an improved mMEA of 88.5º. Radiographic healing of the osteotomy site was evident at 180 days, and no complications were observed through 280 days post-surgery. During the 4-year follow-up, radiographic evaluation revealed complete consolidation of the osteotomy and marked improvement in the articular surface of the operated elbow. Notably, there was reduced osteophyte formation in the region of the medial epicondyle, and no progression of osteoarthritis was detected, indicating a favorable long-term outcome. The dog demonstrated excellent weight-bearing on the affected limb, with no signs of lameness. Discussion: The results of this case suggest that PAUL osteotomy, performed without concomitant elbow arthrotomy, is an effective surgical treatment for MCD, leading to significant improvements in both clinical outcomes and quality of life. Notable improvements were observed in the lameness score, reduction of joint pain, and an increase in the range of motion. The owner reported high satisfaction with the procedure, and radiographic evidence demonstrated no progression of osteoarthritis during the 4-year evaluation period. Importantly, distal placement of the osteotomy and the implant did not adversely affect the clinical or radiographic outcomes. These findings support the potential of PAUL osteotomy as a viable long-term solution for managing MCD in dogs, particularly in cases unresponsive to conservative treatments.

Background: A insuficiência do ligamento cruzado cranial (ILCCr) é uma das causas mais comuns de claudicação em cães. Esta condição debilitante comumente afeta cães adultos de raças grandes. Há um subgrupo de cães onde a ILCCr ocorre na presença de deformidade tibial proximal no plano frontal (varo ou valgo tibial), torção tibial, ângulo excessivo do platô tibial ou luxação patelar. Há uma elevada frequência de relatos de pacientes com a luxação medial de patela (LMP) concomitantemente com a ILCCr. O objetivo deste trabalho é relatar o uso das técnicas combinadas de TPLO modificada e osteotomia em cunha de fechamento medial para tratamento da ILCCr associada à LMP e desvio valgo proximal da tíbia em um cão. Case: Um canino, sem raça definida, fêmea, castrada, com 4 anos de idade, pesando 9,5 kg, foi atendido no Hospital Veterinário da Universidade Federal de Lavras com histórico de claudicação há 30 dias do membro pélvico esquerdo (MPE). No exame físico a paciente apresentava impotência funcional com claudicação sem apoio do MPE. No exame ortopédico da articulação do joelho constatou-se a ILCCr por meio dos testes de gaveta e de compressão tibial positivos. Também foi observado clique meniscal durante o teste de compressão tibial. Além disso, era possível luxar a patela medialmente, sendo classificada como grau 2. Foram realizados exames radiográficos do membro pélvico esquerdo em diferentes projeções para identificação de achados radiográficos sugestivos de ILCCr e avaliação dos desvios angulares da tíbia e do fêmur. Na avaliação radiográfica da articulação do joelho foi observado um deslocamento cranial da tíbia em relação ao fêmur, sugerindo a ILCCr. O ângulo do platô tibial (APT) foi calculado e aproximado para 29º. No exame radiográfico da tíbia em projeção craniocaudal observou-se desvio valgo proximal da tíbia, com aumento do ângulo mecânico medial tibial proximal (mMPTA), sendo este de 101º. Como técnica cirúrgica para estabilização da articulação com ILCCr e correção da LMP e do desvio valgo proximal da tíbia, optou-se pelo uso da técnica de TPLO modificada associada à osteotomia em cunha curva com fechamento medial. Iniciou-se a cirurgia por um acesso medial da articulação do joelho para avaliar a integridade dos meniscos, constatou-se a presença de lesão em alça de balde no polo caudal do menisco medial, sendo realizada a meniscectomia parcial. Em seguida prosseguiu-se para as osteotomias corretivas. Para tratamento do desvio valgo proximal da tíbia foi realizada uma osteotomia tibial em cunha crescente com fechamento medial usando uma serra oscilatória semicircular, objetivando um mMPTA de 93º. Em seguida, foi realizada uma rotação caudal e translação medial do segmento proximal da tíbia para o realinhamento do mecanismo extensor do quadríceps, estabilizando a patela no sulco troclear femoral. O segmento tibial proximal foi girado para atingir o APT alvo pós-operatório de aproximadamente 5º. Em seguida foi realizada a estabilização da osteotomia com placa bloqueada de TPLO. Foram realizadas radiografias no pós-operatório imediato para avaliar o posicionamento dos implantes e mensuração dos novos ângulos alcançados. Foi atingido um APT de 5º e um mMPTA de 91º. No retorno com uma semana após a cirurgia já foi possível observar melhora significativa da claudicação, com apoio parcial do membro operado. Discussion: De forma geral, os resultados deste caso mostram que a combinação das técnicas de TPLO modificada e osteotomia em cunha de fechamento medial realizadas em um único procedimento cirúrgico foi eficaz no tratamento da ILCCr, deformidade valga proximal da tíbia e LMP em um canino, e demonstra ser uma opção viável para pacientes com essas comorbidades na articulação do joelho.

Objective The objective of this study was to assess the stability of the femoral component of a hip resurfacing arthroplasty prosthesis in canine cadaveric bone using a biomechanical test. Study Design Twenty adult dog cadavers were utilized, from which both femoral bones were extracted and preserved for experimentation. For each pair of femurs from the same animal, one femur underwent implantation of the hip resurfacing arthroplasty prosthesis, while the contralateral femur remained intact. All femoral specimens underwent flexo-compression biomechanical testing, with variables including maximum load (ML), load at collapse (LC), displacement at maximum load (DML), displacement at collapse (DC), and stiffness (k) being analysed. Subsequent to the biomechanical evaluation, the femoral specimens were radiographed to assess failure behaviour. Results The prosthesis group showed a reduction of 22% (p ≤ 0.050) for the ML variable and 27% (p ≤ 0.05) for LC values. The prosthetic group supported a mean ML equivalent to six times the body weight of the animals whose bones were tested. No significant disparities were detected between the groups for the other analysed variables (DML, DC, and k). Similar failure patterns, such as fractures in the femoral neck region, were observed in specimens from both groups. Conclusion The hip resurfacing arthroplasty prosthesis demonstrated biomechanical performance with no differences in DML, DC, and k but showed inferior performance in ML and LC when compared with intact femurs in the ex vivo setting.

O colapso de traqueia é uma das causas frequentes de tosse e dispneia em cães na rotina clínica de pequenos animais, especialmente em raças predispostas de pequeno porte e miniaturas. A redução do lúmen traqueal é ocasionada pela flacidez e achatamento das cartilagens, podendo resultar em interferência no fluxo de ar para os pulmões, e consequentemente, os animais podem apresentar como manifestação clínica tosse, dispneia, cianose e síncope. O tratamento conservativo é indicado para pacientes com sinais clínicos brandos e graus considerados leves, como os graus I e II; mas os animais podem ser tornar refratários necessitando de abordagem cirúrgica. Os cães com graus mais acentuados de colapso da traqueia, como os graus III e IV, geralmente necessitam de intervenção cirúrgica. Este manuscrito tem o objetivo de descrever o tratamento cirúrgico em um cão, fêmea, da raça shih-tzu, com 13 anos de idade, pesando 5,5 Kg, apresentando colapso de traqueia grave. O diagnóstico foi confirmado após ser realizado exame radiográfico que constatou assimetria do calibre traqueal com acentuada diminuição do lúmen da traqueia em porção cervicotorácica. A paciente foi submetida ao tratamento cirúrgico com implantação de stent extraluminal espiral de polipropileno na região cervical. O animal teve boa recuperação pós-operatória, com melhora na qualidade respiratória imediata. Na reavaliação de 30 dias após o procedimento, a paciente encontrava-se muito bem clinicamente, sem sinais de rejeição ou infecção, e sem sinais de recidiva do colapso traqueal. A técnica de aplicação de stent extraluminal tem se mostrado efetiva e com poucos riscos.

Introdução: Trauma na coluna vertebral pode levar a fratura vertebral, luxação ou subluxação. Lesões na coluna vertebral podem causar perda parcial ou total das funções neurológicas. Os sinais neurológicos das lesões da coluna cervical podem variar de dor leve a tetraplegia, e em casos de subluxação e instabilidade, o tratamento cirúrgico geralmente é indicado para estabilizar as vértebras. O objetivo deste trabalho é relatar o caso de um cão com subluxação traumática da coluna cervical que foi submetido a tratamento cirúrgico para estabilização das vértebras cervicais. Caso: Um cão da raça Shih-Tzu, de 7 anos de idade, macho, pesando 5,9 kg foi avaliado em clínica veterinária com sinais neurológicos sugestivos de lesão na coluna vertebral. Na anamnese, o proprietário relatou que há cerca de sete meses o animal havia sofrido um trauma doméstico, muito provavelmente devido a uma queda do colo de uma criança. Foi relatado que o animal parou de andar após a queda, e inicialmente o cão foi levado a uma clínica veterinária, onde foram realizados os primeiros cuidados. Na ocasião, foram realizados exames radiográficos da coluna vertebral na região lombar e das articulações do quadril, onde não foi observada nenhuma alteração. Sete meses após o trauma, os sinais neurológicos ainda persistiam, e o proprietário levantou fundos para continuar o tratamento. O exame neurológico revelou plegia nos membros pélvicos e paresia nos anteriores, nocicepção parcialmente preservada e sinais compatíveis com lesão medular na região cervical. Exames radiográficos da região cervicotorácica da coluna demonstraram possível protrusão discal entre as vértebras cervicais C5-C6. Foi realizada tomografia computadorizada da mesma região, que evidenciou instabilidade e subluxação da coluna vertebral, mais acentuada entre as vértebras cervicais C5-C6, promovendo mielopatia compressiva extradural neste segmento medular, indicando necessidade de estabilização cirúrgica. A técnica de aplicação vertebral ventral de parafusos fixados com polimetilmetacrilato (PMMA) foi realizada para estabilização vertebral. Foi realizado acesso à superfície ventral dos corpos das vértebras cervicais C5-C6 e implantados 6 parafusos corticais (1,5 mm de diâmetro), sendo fixados 3 parafusos em cada vértebra cervical. Posteriormente, cimento ósseo PMMA foi aplicado nos parafusos e nas vértebras afetadas. O cão iniciou a reabilitação na segunda semana após o procedimento cirúrgico. Na avaliação fisiátrica a paciente apresentava ataxia e déficit proprioceptivo, ausência de dor superficial e presença de dor profunda em todos os membros. O protocolo de tratamento fisioterapêutico instituído incluiu fotobiomodulação (laserterapia), campo magnético pulsátil e cinesioterapia. Os exercícios realizados inicialmente eram passivos, evoluindo para ativos assistidos, livres e isométricos. Discussão: Tratava-se de uma lesão na região cervical da coluna, com grandes corpos vertebrais e com possibilidade de acesso cirúrgico por via ventral, optando-se, portanto, pela técnica de aplicação ventral de parafusos fixados com polimetilmetacrilato (PMMA). O método cirúrgico foi escolhido devido à sua capacidade de estabilizar as vértebras cervicais de forma eficaz e relativamente simples. O PMMA foi fixado aos parafusos e ao osso vertebral, formando uma estrutura rígida e bem modelada, permitindo a estabilidade da região cervical acometida. Após as sessões de fisioterapia, o paciente apresentou boa evolução com recuperação rápida e progressiva da deambulação, e recuperação adequada da função neurológica e motora após 40 dias da cirurgia. Em conclusão, a técnica cirúrgica utilizada, associada à fisioterapia, mostrou-se eficaz na estabilização da coluna cervical e na recuperação da função neurológica do cão.

OBJECTIVE: To assess the effect of tibial compression on radiographic cranial tibial translation measurements in healthy dogs and those with cranial cruciate ligament (CCL) rupture and establish specific criteria for the radiographic diagnosis of CCL rupture. ANIMALS: 60 dogs. PROCEDURES: Dogs were divided into 3 groups with 20 dogs each: group 1, healthy adult dogs; group 2, adult dogs with CCL rupture; and group 3, healthy young dogs. For each dog, 2 images of the stifle joint in mediolateral projection were taken, of which 1 was conventional and 1 was under tibial compression. Variables were measured in each radiographic projection: the patellar ligament angle, the patellar ligament insertion angle, the angle of tibial translation measured by 2 different methods, and the linear distance between the points of CCL origin and insertion (DPOI). Additionally, a novel variable, DPOI ratio, was evaluated. RESULTS: Regarding radiographic positioning, tibial compression significantly changed most of the variables in the within-group comparison. The variable DPOI were not different with and without tibial compression in the group of healthy adult dogs but were different for dogs with CCL rupture. Thus, these are important parameters in the diagnosis of CCL rupture. In the analysis of a novel variable, DPOI ratio, dogs with CCL rupture could be distinguished from healthy dogs at a high level of specificity and sensitivity. CLINICAL RELEVANCE: DPOI ratio values above 1.18 were consistently indicative of CCL rupture, thus allowing for a precise radiographic diagnosis of the condition.

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery. Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development. Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life. Keywords: hip dysplasia, juvenile pubic symphysiodesis, hip joint, osteoarthritis, dog. Título: Sinfisiodese púbica juvenil associada à miectomia do pectíneo para tratamento de displasia coxofemoral em cão Descritores: displasia coxofemoral, sinfisiodese púbica juvenil, coxofemoral, osteoartrite.

RESUMO O desenvolvimento de novas ferramentas, como a ecocardiografia bidimensional feature tracking (2D-FTI), permite diagnosticar, de forma precoce, se há disfunção miocárdica em doenças cardíacas, inclusive as congênitas. O defeito septal ventricular (DSV) é a alteração congênita mais observada em felinos, no entanto pouco se sabe sobre a disfunção cardíaca nessa cardiopatia, especialmente em animais assintomáticos. O objetivo deste estudo foi avaliar, por meio do 2D-FTI, a deformação miocárdica ventricular esquerda pela mensuração dos índices ecocardiográficos strain (St) e strain rate (StR) radial, circunferencial e longitudinal, em gatos saudáveis e com DSV. Foram avaliados 12 gatos saudáveis e seis gatos com DSV para obtenção de St e StR em diversos segmentos miocárdicos. No sentido longitudinal, houve diferença estatística (P<0,05) para os segmentos septal basal, mediano e apical epicárdicos (P=0,0017; P<0,0001; P=0,0288), lateral mediano epicárdico (P=0,0327), septal mediano endocárdico (P=0,0035), lateral mediano endocárdico (P=0,0461), St epicárdico (P=0,0250) e St global (P=0,0382). Também houve diferença no segmento lateral mediano circunferencial endocárdico (P=0,0248), lateral mediano radial (St: P=0,0409; StR: P=0,0166) e posterior mediano radial (P=0,0369). O estudo evidenciou que, mesmo em animais assintomáticos com DSV, há redução na deformação miocárdica ventricular principalmente no sentido longitudinal, demonstrando maior vulnerabilidade dessas fibras.