Fitzpatrick Referrals
Orthopaedics + Neurosurgery

Elbow Dysplasia 2

Osteochondrosis (OC) / Osteochondritis dissecans (OCD)

How can osteochondrosis be treated?

Various treatment options are available. The best treatment option for each dog can only be recommended following thorough assessment of the severity of disease, particularly on clinical examination, x-rays and arthroscopy.

1.Non-surgical management

Non-surgical management may allow some improvements in lameness or pain in the short term, although it is very rarely recommended for dogs with OC except where the risks of a general anaesthetic or surgery are considered excessive (e.g. severe heart disease, immune conditions).
Four basic methods are usually recommended:

• Body weight management
• Exercise modification and physiotherapy
• Anti-inflammatory / pain relief medications
• Nutraceutical supplements (e.g. glucosamine, chondroitin sulphate, pentosan polysulphate, Green-lipped Mussel extract)

2.Surgical removal of cartilage flap / débridement

Surgical removal of the cartilage flap in OCD allows the cartilage defect to heal by scar cartilage formation over the course of several weeks. Scar cartilage (fibrocartilage) is less robust than healthy joint (hyaline) cartilage, so although this allows some of the joint inflammation to resolve in the short-term, the joint will remain abnormal with ongoing development of osteoarthritis and cartilage wear. We currently recommend this surgery for very small or shallow disease lesions and this can be done arthroscopically (keyhole).

3.Osteochondral Autograft Transfer System (OATS)

Over recent years, we have adopted the OATS™ (Arthrex, Naples, FL) system for use in the canine elbow. This system has been used for many years in human joints to resurface cartilage lesions including OCD, with positive long-term results. It involves collection of a cylinder of bone and cartilage from a non-contact area of a healthy joint (usually the knee) and transplanting it into a joint affected by OCD in order to resurface the cartilage defect with healthy hyaline cartilage. We often combine this procedure with an ulnar osteotomy (cutting one of the bones in the forearm) to protect the new cartilage cap, and we have achieved excellent results in a large number of dogs by this technique.

More recently, we have modified this technique to allow transplantation of synthetic polyurethane cylinders instead of bone and cartilage cylinders, avoiding the need to collect the cylinder from the knee joint and reducing surgical time.

4.Total Elbow Replacement (TER)

In some dogs with long-standing elbow OCD (usually those also affected by other forms of elbow dysplasia as well as OCD), osteoarthritis may be extremely severe with little healthy cartilage. In this circumstance, the procedures above may be unable to restore comfortable, functional joint use. Total Elbow Replacement is a “salvage” procedure (i.e. it is performed as a last resort where other treatments will be ineffective) and involves replacing the entire elbow joint surface with metal and plastic implants.