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Orthopaedic Surgery

Wilson DM, Goh CS, Palmer RH.

Colorado State University, Fort Collins, CO, USA.

 Vet Surg 2014;43:734–40.

Rob Rayward’s review: Disease of the medial aspect of the coronoid process is a common cause of forelimb lameness in both the immature and mature dog. A spectrum of changes, including fragmentation, cartilage fissures, chondromalacia, and cartilage fibrillation may affect the medial coronoid process (MCP). These lesions may be associated with focal lesions of the medial humeral condyle, also known as “kissing lesions”, or, alternatively, with concurrent humeral condylar osteochondritis dissecans (OCD) lesions. Pathologic changes affecting the MCP initiate in the subchondral bone with the formation of microcracks, which are characteristic of local fatigue failure. These changes typically occur at one of two anatomic sites, either the craniodistal tip of the MCP or more axially orientated in the region of the radial incisure. Although the precise nature of these phenomena remains unclear, several hypotheses have been proposed to account for the range of recognised pathologies. These include static (persistent) and dynamic (periodic) radio-ulnar length discrepancies, which, if present, would be likely to result in disease of the MCP and could be surmised to predispose to pathological changes to its tip. The causes of pathology that involves the craniolateral segment of the MCP adjacent to the radial head include transverse-plane radio-ulnar incongruity either through bony mismatch between the radial incisure of the MCP and the radial head or a musculotendinous mismatch. It has been proposed that the eccentric location of the fan-shaped insertion of the biceps brachii tendon on the ulnar tuberosity (uBT) could result in a substantial supination force, as well as acting as an elbow flexor. In so doing, the uBT could compress the radial incisure of the MCP against the radial head and generate forces sufficient to cause fragmentation of the MCP. This could give rise to the clinically observed pattern of arcuate fragmentation that is commonly observed radiating from the radial surface of the MCP.

The biceps ulnar release procedure (BURP) has been described as a surgical technique for dogs with early-stage MCP disease in which there is pathology affecting the craniolateral segment of the MCP adjacent to the radial incisure or a rotational instability is suspected. The technique requires complete transection of the uBT. Originally, this technique was proposed to be performed through an open arthrotomy, but it would clearly be advantageous to be able to perform this surgery arthroscopically at the time of joint inspection. This study aimed to assess whether or not arthroscopic BURP could be performed consistently and reliably, and to assess the importance of arthroscopic visual control and the experience of the arthroscopist in completion of the procedure and the avoidance of iatrogenic damage.

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