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Maple, a gorgeous and very bouncy 8-month-old Labrador Retriever, visited Bertie and the Orthopaedics team at The Ralph to further investigate a mysterious persistent right hind lameness. 

Maple had been limping after exercise on and off for several months, and the cause had remained elusive despite her local vets taking a diagnostic set of hind limb X-rays and enlisting the help of a travelling peripatetic orthopaedic service.

Maple did not make localisation of discomfort easy given she was such a boisterous puppy, however she seemed sensitive on manipulation of her right knee (stifle).

Given the excellent set of X-rays Maple’s local vets had already obtained, Bertie decided to proceed with a CT scan of the stifle on suspicion of a more subtle lesion.

The CT scans revealed a large osteochondrosis dissecans (OCD) lesion within the right femoral condyle of the knee joint:

An OCD lesion essentially represents a large pothole in the otherwise perfectly tarmac’d cartilage joint surface and was the cause of Maple’s ongoing lameness. If left untreated, this would lead to devastating arthritis within her knee joint at an early age.

Bertie discussed two different treatment options with Maple’s carers:

1. The ‘traditional’ approach of debriding the cartilage flap surface in the hope that sufficient fibrocartilage would plug the osteochondrosis lesion and provide sufficient comfort.
2. Resurfacing the abnormal joint surface with a synthetic plastic, which is surface-mounted onto a titanium plug, and will eventually integrate with the surrounding bone. This is known as a SynACART implant. 

Maple’s family were happy to proceed with the joint resurfacing procedure which was performed the day after her consultation.

After removing the affected portion of cartilage with a core-reaming device, the SynACART implant was placed into the socket flush with the surrounding joint surface. These intra-operative photos demonstrate the osteochondral lesion before debridement, and the SynACART plug in place before being fully inserted: 

Surgery went well and Maple made a good recovery and was discharged home the following day walking comfortably on her operated leg. We wish Maple well in her recovery from surgery and fingers crossed for a happy, healthy knee joint for years to come!

An update from Maple’s carer, including photos of Maple recovering at home…

“Maple is recovering very well. She was a little sorry for herself the first week but after that she quickly got back to her happy self. We’ve had to be creative in finding ways to keep her entertained during her crate rest. She is enjoying toys that mean she works for a treat like her kong, lick mat and snuffle ball. Maple is a very cuddly dog; she likes us to open her crate door and sit at the door and stroke her. We’re so looking forward to getting her back to her bouncy self as a young pup.”

Thank you for reading Maple’s story. Be sure to sign up to our blog if you haven’t already so that you don’t miss the next one!

Take care,

Team Ralph 🐾