Clinical Communication 65
© 2007 Schattauer GmbH
Arthroscopic treatment of osteochondritis
dissecans of the shoulder in 126 dogs
M. Olivieri1, E. Ciliberto2, D. A. Hulse3, A. Vezzoni4, F. Ingravalle5, B. Peirone2
1
Malpensa Small Animal Veterinary Clinic, Samarate – Varese, Italy
2
Department of Animal Pathology, University of Turin, Italy
3
Texas A&M University, Texas, USA
4
Small Animal Veterinary Clinic, Cremona, Italy
5
Istituto Zooprofilattico del Piemonte e della Valle d’Aosta, Turin, Italy
Summary
Osteochondritis dissecans of the shoulder joint was
treated by arthroscopy in 126 dogs. Twenty-four dogs
had bilateral surgery, making a total of 150 joints
treated. The OCD flaps were removed in small pieces
through the cannula or in a single piece through a stab
incision. The lameness resolved completely within
seven-60 days following arthroscopy in 137 out of 150
affected limbs. Within a subset of 47 dogs with unilat-
eral OCD, it was found that lesions located on the
caudo-medial region of the humeral head had a better
functional outcome than those lesions located in the
caudo-central region of the humeral head.
Keywords
Dog, shoulder, osteochondritis dissecans, arthroscopy
Vet Comp Orthop Traumatol 2007; 20: 65–69
Received November 30, 2004
Accepted May 16, 2006
Introduction
Osteochondritis dissecans (OCD) of the
humeral head is a frequent cause of shoulder
lameness in young, medium-large breed
dogs. In most of these cases a diagnosis of
OCD may be obtained from the history, and
the clinical and radiological examinations.
However, in dogs with undiagnosed shoulder
pain, the use of arthroscopy allows an accu-
rate diagnosis of shoulder OCD to be made,
while concurrently excluding the existence
of other intra-articular pathology (1). The
treatment of choice for OCD of the shoulder
is surgery (2). Normally the osteochondral
flap is removed and curettage of the rim of
the lesion is performed by means of arthrot-
omy or arthroscopy. The size of OCD
lesions, found on radiographic examination,
was shown to be significantly correlated
with the presence of pain and lameness in
dogs (3). The aim of our retrospective study
was to evaluate the association of lesion lo-
cation, and other clinical signs, with func-
tional outcome following arthroscopic treat-
ment of shoulder OCD in dogs.
Materials and methods
Inclusion criteria
The clinical records of 126 dogs that had
been treated by arthroscopy for OCD of the
shoulder joint at the Veterinary Teaching
Hospital of the University of Turin and Mal-
pensa Veterinary Clinic of Samarate, Va-
rese, Italy, between January 1996 and Janu-
ary 2002 were studied retrospectively. The
criteria for inclusion of animals into the
study were: a complaint of either sub-acute
or chronic shoulder lameness, together with
the presence of a shoulder OCD lesion con-
firmed by arthroscopy. Furthermore, we
only included animals in which the OCD
lesion of the humeral head was sub-
sequently found to extend cranially to the
level of the caudal one third of the medial
gleno-humeral ligament, and caudally to the
caudal margin of the humeral head. Any
dogs with smaller or larger OCD lesions
were excluded from the study.
The recording of the history, along with
physical examination, gait evaluation and
orthopaedic examination of the affected
forelimb had been carried out at the time of
the initial examination, and the findings
placed in the clinical records for all the dogs
included in the study. Each shoulder joint
had been evaluated in order to detect the
presence of pain: on hyperextension, hyper-
flexion, internal rotation and external ro-
tation, as well as with the biceps flexion test.
After physical examination of the affected
forelimb, any dogs found to have other clini-
cally significant orthopaedic diseases were
excluded from the study. A radiological
examination of both shoulder joints using
the standard medio-lateral and pronated
medio-lateral views (4), and the ventro-dor-
sal view had been obtained soon after the
physical examination, while the dogs were
sedated or anaesthetized.
For the purpose of our study, the severity
of lameness and shoulder pain for the limbs
affected by OCD was retrospectively graded
by interpretation of the information rec-
orded in the clinical files. Lameness during
walking was classified into five grades ac-
cording to the scheme of Fayolle (5):
Vet Comp Orthop Traumatol 1/2007
66
Olivieri et al.
● Grade 0 = normal gait;
● Grade 1 = mild lameness with the af-
fected limb always weight-bearing;
● Grade 2 = noticeable lameness with the
affected limb mostly weight-bearing;
● Grade 3 = severe lameness with occa-
sional weight-bearing on the affected
limb;
● Grade 4 = not bearing weight on the af-
fected limb.
Pain was classified into four grades accord-
ing to the scheme of Moreau et al. (6):
● Grade 0 = pain absent;
● Grade 1 = mild pain, dog turns head in
recognition;
● Grade 2 = moderate pain, dog pulls limb
away or wants to move away;
● Grade 3 = severe pain, dog vocalises and
becomes aggressive.
Shoulder arthroscopy
Bilateral shoulder arthroscopy was per-
formed, either during the same anaesthetic
session or during staged procedures, on the
dogs with radiographically evident bilateral
OCD lesions only when the dogs showed
evidence of pain and lameness bilaterally. In
all of the other cases, only the painful joints
were treated by arthroscopic surgery.
Following the induction of general an-
aesthesia for shoulder arthroscopy, cefazo-
lin was administrated intravenously at a do-
sage of 20 mg/kg body weight. After aseptic
preparation of the forelimb for surgery, syn-
ovial fluid was aspirated and bupivacaine (1
mg/kg) was infiltrated intra-articularly into
the affected joint. In order to reduce varia-
bility amongst the different surgeons in-
volved in the study, the positioning of pa-
tients, arthroscopic access ports (7) and
arthroscopic equipment were the same for
all of the examinations. The dogs were posi-
tioned in lateral recumbency with the af-
fected limb uppermost in a neutral position.
Diagnostic and operative arthroscopy was
performed using a 2.7 mm, 30 degree for-
ward oblique arthroscope in a 4 mm diam-
eter arthroscopic sleeve, a 175 watts xenon
light source, a camera with zoom, a high de-
tail monitor, a medical recorder (Sony) and
printer.
Vet Comp Orthop Traumatol 1/2007
A)
B)
Fig. 1 A) Localization of the type 1 osteochondritis dis-
secans lesion caudo-centrally on the humeral head. B) Arth-
roscopic image of type 1 lesion (1: glenoid; 2: humeral
head; 3: caudo-central osteochondritis dissecans flap).
Arthroscopy of the shoulder was per-
formed using a lateral approach as pre-
viously described (7). In brief, this consisted
of the insertion of a 1.1 mm hypodermic
needle in a caudo-medial direction between
the acromion and the greater tubercle of the
humerus, into the shoulder. Following arth-
rocentesis, the joint was distended by the in-
fusion of 10–20 ml of Ringer’s solution. An
arthroscopic portal was created 1–1.5 cm
distal to the acromion and the arthroscope
was introduced through the cannula. After
conducting a complete arthroscopic explo-
ration of the joint, an instrument portal was
created 2–4 cm caudal to the arthroscopic
portal. The OCD flaps that were removed in
small pieces were extracted through the in-
strument cannula, whereas intact OCD flaps
that were extracted as a single piece were re-
moved using grasping forceps through the
instrument portal, without the cannula. The
edges of the defect were probed to deter-
mine if the remaining adjacent articular car-
tilage was firmly adhered to the subchon-
dral bone. All loose cartilage was removed
and the edge of the lesion debrided with a
curette or a shaver, leaving the final carti-
lage edge perpendicular to the subchondral
bed. In those shoulder joints that did not
have any cartilage flap overlying the osteo-
chondral defect, a complete arthroscopic
exploration was performed and the joint was
lavaged with approximately three litres of
Ringer’s solution.
After removal of OCD flaps and comple-
tion of the debridment, we classified the lo-
cation of each OCD lesion as being a type 1
(caudo-central) (Fig. 1) or type 2 (caudo-
medial) (Fig. 2). The location of the OCD
lesion was defined on the basis of its rela-
tionship to the caudal margin of the glenoid.
In type 1 lesions, the entire caudal articular
surface of the glenoid was in contact with
the subchondral bed exposed by flap re-
moval. Type 2 lesions were more medial
with respect to the caudal margin of the gle-
noid, and only a small lateral margin of the
subchondral bed was in contact with the
caudal articular surface of the glenoid. In
type 2 lesions, the majority of the humeral
head in contact with the glenoid was cover-
ed with normal articular cartilage.
The subchondral bed remaining after re-
moval of the cartilage flap was inspected
visually and palpated with a probe. Sub-
chondral lesions that were covered by appar-
ently normal fibrocartilage were left un-
treated, whereas those lesions only partially
covered by fibrocartilage regeneration were
perforated with small holes by means of
micro-picking until bleeding from the bone
occurred. Subchondral lesions that appear-
ed to consist entirely of bone were gently cu-
retted until bleeding occurred, as described
previously (2).
Postoperative care
After surgery, cefazolin was administered
by intramuscular injection at a dosage of 20
mg/kg BID for three days. Carprofen was
administered orally at a dosage of 2 mg/Kg
SID for seven–21 days, as apropriate for the
severity of lameness and the degree of syn-
ovitis observed arthroscopically.

In the postoperative period, all of the pa-
tients were kept at rest for two to three weeks.
All of the owners were instructed to perform
passive joint movements for five minutes,
five to six times a day for 20 days, followed
up by a gradual resumption of activity on the
leash. In the cases operated on bilaterally dur-
ing the same anaesthetic session, absolute
rest and passive movements of the shoulder
were prescribed for one month. In the cases
of bilateral arthroscopies performed as
staged procedures, the second arthroscopy
was performed on the contralateral shoulder
after remission of lameness of the first limb.
If lameness was evident on gait evaluation,
the patient was released with instructions for
leash walks only and rechecked at two weekly
intervals until the lameness resolved; at that
time arthroscopic surgery was performed on
the second shoulder.
Finally, in the last year of the study, 23
patients with type 1 flaps were treated with
passive joint movement in conjunction with
the application of a carpal flexion bandage
for three weeks.
Outcome
Standard clinical follow-up by gait evaluation
and orthopaedic examination of the affected
limbs was performed seven, 30 and 60 days
after surgery. Additional follow-up was
necessary in dogs with persistent lameness.
The determination of functional outcome was
evaluated by the gait evaluation and ortho-
paedic examinations. When the dog showed
signs of pain and lameness at the last follow-
up, it was considered to be affected by persist-
ent lameness and therefore ‘not sound’.
Statistical methods
For the purpose of analysis, functional outcome
was treated as a dichotomous variable (yes =
sound on limb; no = persistent lameness). The
statistical analysis was carried out on data from
the shoulder joints of only 47 dogs in the study
because of the exclusion of data pertaining to
the following animals:
● 30 dogs in which the OCD flap was no
longer located in its original site at the
time of surgery.
67
Arthroscopic treament of shoulder OCD
● 24 dogs that had bilateral arthroscopic
surgery.
● 23 dogs in which a carpal flexion ban-
dage had been applied postoperatively.
● Two dogs in which the OCD flap could
not be extracted arthroscopically, and
subsequently had an arthrotomy for flap
removal.
The c2 test and Fisher correction were ap-
plied to evaluate the association between
A) functional outcome and each variable [age
(< 12 months or ≥ 12 months), bodyweight
(< 25 kg or ≥ 25 kg), degree of preoperative
joint pain (non-painful – grade 0 or painful –
grades 1 to 3), localization of the lesion
(type 1 or type 2)]. To do this analysis, vari-
ables were considered as dichotomous vari-
ables. Values of P < 0.05 for the c2 test were
considered significant. The odds ratio (OR),
with 95% confidence interval (95%CI),
were calculated for each of the variables.
B)
Fig. 2 A) Localization of the type 2 osteochondritis dis-
Results
secans lesion caudo-medially on the humeral head. B)
There were numerous breeds of dogs in-
Arthroscopic image of the type 2 osteochondritis dissecans
cluded in our study, with Retrievers and
lesion caudo-medially on the humeral head. Due to the
position of the lesion on the humeral head, it is better re- Rottweilers being the most frequently af-
cognised on the pronated medio-lateral X-ray view (1: gle- fected breeds (Table 1). There were 71
noid; 2: caudo-central part of the humeral head; white males and 55 females. Their ages ranged
arrow: caudo-medial flap).
from five to 20 months and their body-
weight from eight to 48 kg. According to the
case histories, 21 dogs had sub-acute onset
Table 1 Breeds of dogs with osteochondritis dissecans of forelimb lameness in the week preceding
the shoulder treated by arthroscopy. the clinical examination and the lameness
was reported to be chronic for the remaining
Breed Cases 105 dogs. Inspection and palpation of the
Labrador Retriever 22 shoulder revealed marked muscular atrophy
Rottweiler 18 in chronic cases, and moderate or no atrophy
in the other sub-acute cases.
Golden Retriever 15
Gait evaluation showed grade 1 lameness
Boxer 13 in 29 limbs, grade 2 lameness in 103 limbs,
Border Collie 12 and grade 3 lameness in 18 limbs. Pain of
German Shepherd 09 grade 3 severity was detected unilaterally in
Newfoundland 08 85 dogs, and bilaterally in 24 dogs. Pain of
English Setter 08
grade 2 severity was found unilaterally in 14
dogs, and bilaterally in three dogs. The other
Bernese Mountain Dog 07
shoulders were not painful. The biceps
Great Dane 06 flexion test was positive in 108 shoulders.
Mixed breed 05 Radiological examination showed that a
Doberman 03 radiolucent, subchondral bone lesion with
irregular margins in the region of the caudal
Vet Comp Orthop Traumatol 1/2007
68
Olivieri et al.
Table 2 Association of function outcome (lame or sound) at time of last follow-up in 47 dogs with unilateral shoulder os-
teochondritis dissecans treated by arthroscopy.
Variable* Chi-square
P value
Age 0.270
Bodyweight 0.068
Shoulder pain 0.501
Localization 0.042
*For the purpose of analyses, data for each variable were classified into two dichotomous variables according to the criteria described in the text. Values of P < 0.05
were considered to be significant.
or caudo-medial portion of the humeral
head was present unilaterally in 56 dogs and
bilaterally in 61 dogs. There were not any
abnormalities evident radiographically in
either of the shoulder joints of nine dogs.
Shoulder arthroscopy was performed
unilaterally in 102 dogs, and bilaterally in
24 dogs, making a total of 150 joints treated
by surgery. Bilateral arthroscopy was per-
formed during the same anaesthetic session
in 11 dogs, and as staged procedures in 13
dogs. An OCD cartilage flap was identified
and removed in 139 shoulders. However, the
OCD flap was not located at the original
OCD lesion site in 19 of these shoulders. It
was dislodged and found elsewhere within
these joints; eight flaps were in the caudal
recess, six were medial and five were in the
bicipital groove. The edges of the original
OCD lesion were regular in 17 shoulders
and irregular in the other two. In 11
shoulders, it was not possible to find an
OCD flap, even after a thorough inspection
of the entire joint cavity. In these shoulders
in which an OCD flap could not be found,
six of the lesions had a subchondral bed
covered by regeneration of fibrocartilage
and there was mild inflammation of the syn-
ovial membrane. In three of the lesions the
fibrocartilage regeneration was poor, and
small holes were made in the OCD lesion
until bleeding occurred. The subchondral
bed of two lesions contained sclerotic bone
and it was curetted. The location of the OCD
lesion was classified as being a type 1 in 97
shoulders and type 2 in 53 shoulders.
In 137 out of 150 affected limbs, the
lameness resolved completely within
seven–60 days following arthroscopy. With-
in the subset of 47 dogs with unilateral OCD
Vet Comp Orthop Traumatol 1/2007
Odds Ratio and 95% Confidence Intervals
Lower OR
0.353 3.231
missing pairs of values are present
0.115 0.667
0.893 8.118
lesions that were evaluated statistically, 23
had a type 1 lesion and 24 had a type 2
lesion. The lameness resolved completely
within seven–60 days in 17/23 dogs with
type 1 lesions and in 23/24 dogs with type 2
lesions. The seven dogs that were lame at 60
days actually continued to exhibit lameness
180 days after arthroscopy. Among all the
variables examined statistically, only lesion
localization had a significant association
with functional outcome (Table 2). The pro-
portion of dogs with a positive functional
outcome was significantly greater in dogs
with type 2 localization (95.8%, 95%CI:
78.9% – 99.9%) than those with type 1 lo-
calization (73.9%, 95%CI: 51,6% – 89.8%)
(P = 0.042). The difference in these propor-
tions was emphasized by the high OR value
(8.118); but this value was not statistically
significant (95%CI: 0.893 – 73.814).
Discussion
The results of the survey found that arth-
roscopy was a good modality for the imaging
of shoulder OCD because it confirmed the
diagnosis in 141 shoulder joints with posi-
tive radiological signs of OCD, and it also
allowed the diagnosis of OCD to be made in
an additional nine cases of shoulder lame-
ness where the radiological examination did
not prove to be diagnostic. Failure to make a
diagnosis by radiology in these joints might
be attributed to error in positioning, but also
to the fact that radiographs do not offer a
three dimensional view of the humeral head.
There are only a few studies reported,
with only a small number of treated cases
reporting outcome of dogs undergoing arth-
roscopic treatment of OCD of the shoulder
(8, 9). The findings of the study reported
herein indicate that the outcome of this pro-
Upper cedure is very favourable because there was
29.582 complete remission of clinical signs of
lameness in 137 out of 150 limbs (about
03.876 91%) undergoing arthroscopy. Within the
73.814
subset of 47 dogs that were statistically ana-
lysed, 40 dogs become completely sound
and seven were affected by persistent lame-
ness. The findings of this study support the
hypothesis that lesion location is important,
because a poor outcome with persistence of
lameness was significantly associated with
the OCD lesion being located caudo-cen-
trally on the humeral head (type 1). There
was also a trend for bodyweight to be associ-
ated with functional outcome (0.068). The
superimposition of 95% CI for proportions
and the non-significant OR for the other
variables might have been a result of the low
statistical power of the analyses because of
the small number of operated animals.
Although we began with 126 dogs in the
study, our decision to exclude dogs with
confounding variables resulted in a small
sample size.
A previous study suggested that size of
OCD lesions was significantly correlated
with pain and lameness (3). However, one
should remember that that study population
comprised a considerable variety of breeds
(Border Collie, Great Dane), so that lesion
size should not be considered separately, but
rather in relation to the size of the dog. To be
as objective as possible about lesion size,
the extension of the subchondral bone lesion
was measured after the flap had been re-
moved and in relationship to joint’s ana-
tomical landmarks, they being fixed. Dogs
that had smaller or larger OCD lesions were
eliminated from the study. This was done in
order to reduce the effect of lesion size on
functional outcome. There are several dif-
ferent ways of measuring the size of OCD
lesions, including radiology, computed to-
mography, magnetic resonance imaging,
and direct visualization. Since many OCD
flaps that are removed fragment, assessment
of OCD lesion size from the excised carti-
lage flap is not consistently reliable.
Some of the patients affected by persist-
ent lameness are currently being re-assessed

in long-term follow-up to establish the
cause of failed functional recovery. On the
basis of our experience acquired with arth-
roscopic treatment of OCD, it is proposed
that the direct loading of the subchondral
bone in the first weeks following surgery
has an adverse affect on regeneration of fi-
brocartilage. Constant friction of the caudal
rim of the glenoid cavity, during joint load-
ing, is likely to be more important for
caudo-centrally located OCD lesions (type
1) than for caudo-medial lesions (type 2).
Impaired fibrocartilage regeneration may
possibly predispose to a poor function out-
come. For these reasons it is suggested that
it might be useful to use carpal flexion ban-
dage in the first two to four weeks after sur-
gery in the presence of large caudo-centrally
OCD lesions in order to reduce abrasion by
the glenoid, while still permitting passive
joint movements and other physical therapy
procedures.
The dogs with symptomatic bilateral
shoulder OCD lesions were treated by bilat-
eral arthroscopic surgery during the same
anaesthetic session, early in the study peri-
od. However, persistence of lameness was
observed in three out of 11 patients man-
aged in this way (unpublished observa-
tions). It is therefore suggested that over-
loading of the surgically treated lesions im-
paired healing. Subsequent to this experi-
ence, the remaining 13 bilateral cases were
treated in separate surgical sessions, and a
complete recovery was observed in both
limbs (unpublished observations). For this
reason the authors recommend simulta-
neous bilateral shoulder arthroscopy only if
the more symptomatic joint has a caudo-
medially located lesion.
Displacement of the cartilage flap from
its original location was apparent at the time
of arthroscopy in about 20% of joints, and
two possible causes of this were considered:
shear forces generated by normal loading of
abnormal cartilage or the introduction of the
trocar within the arthroscopic sleeve. How-
ever, the second cause is considered only
when the lesion is found to have irregular
edges. A major advantage of arthroscopy
over arthrotomy is the possibility of per-
forming a complete exploration of the joint
and thereby being able to pinpoint and re-
move fragments displaced into other com-
partments within the shoulder joint.
A standard arthrotomy approach often
requires a more invasive procedure, and be-
sides, if the flap is not found caudally or
medially, it is very difficult to know whether
it has been reabsorbed or whether it is in the
bicipital groove. In this study, about 25% of
the displaced flaps were arthroscopically lo-
cated within the bicipital groove. Without
the benefit of arthroscopy, it would have
been necessary to perform a separate surgi-
cal approach to the biceps tendon to remove
such flaps. Even with thorough inspection
of the joint, the flap was never found in
about 7% of shoulders. Perhaps they had
undergone resorption, or the surgeon simply
failed to find it. One should consider that the
former explanation is more likely because
all 11 subjects were free of lameness within
three weeks following arthroscopy.
The evaluation of the subchondral bed
through the magnification provided by the
optics and the zoom of the camera and by
palpation with a probe, allows the surgeon
to make a subjective assessment of the sub-
chondral bed. One difficulty in making this
assessment is that during arthroscopy the
continuous inflow of fluids imbibes the soft
cartilage of the subchondral bed, modifying
its appearance and making assessment of its
true ‘health status’ somewhat arduous. For
this reason, it would be necessary to conduct
a histological evaluation of regenerated tis-
sue in the depths of the OCD to allow us to
decide whether curettage of the subchondral
bed is truly necessary or not.
69
Arthroscopic treament of shoulder OCD
In conclusion, it was found that arth-
roscopic treatment of shoulder ODC lesion
has a high success rate, and that the location
of the lesion on the humeral head influenced
the functional outcome. Analysis of the
causes of failure of the arthroscopic treat-
ment of OCD lesions could further increase
the percentage of success.
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Correspondence to:
Prof. Bruno Peirone
Department of Animal Pathology
University of Turin
Via Leonardo da Vinci, 44
10095, Grugliasco
Turin, Italy
Phone: +39 011 670 9061, Fax: +39 011 670 9165
E-mail: bruno.peirone@unito.it
Vet Comp Orthop Traumatol 1/2007