VCOT May 2026 – Ortho Part 2: Elbow Congruity, Hip Laxity & Hidden Tendon Disease

In this Simini Small Animal Surgery Podcast episode, we continue our orthopedic coverage from the May 2026 issue of Veterinary and Comparative Orthopaedics and Traumatology (VCOT) by exploring three studies that reveal how hidden pathology often lies beneath seemingly normal clinical findings. 

From subtle elbow incongruity in medial coronoid disease to standardizing stress radiography for hip dysplasia and identifying silent gastrocnemius tendon injuries in canine athletes, these papers emphasize the importance of looking beyond what is immediately visible.

In this episode:

✅ Scharpf et al. — Used CT imaging to evaluate radioulnar congruity in dogs with medial coronoid disease (MCD). Although the medial compartment often appeared anatomically congruent, the authors identified significant lateral and central radioulnar incongruity, suggesting that many cases of MCD may actually represent a joint-wide biomechanical disorder rather than an isolated medial lesion. These findings help explain why some dogs continue to experience lameness despite technically successful arthroscopic treatment focused solely on the medial compartment. 

✅ Vandekerckhove et al. — Quantified the force required during passive stress radiography to accurately assess canine hip laxity. Under standardized sedation, 90% of hips reached maximal diagnostic laxity at approximately 80.5 Newtons (about 8.2 kg of force). The study provides an objective benchmark that may improve consistency between clinicians while reducing false-negative screening examinations caused by inadequate applied force. 

✅ Vannini et al. — Investigated gastrocnemius tendon origin (TGMO) injuries in actively competing Border Collies. Despite owners reporting no lameness, more than half of the dogs demonstrated pain during palpation, while ultrasonography revealed tendon abnormalities in approximately 85% of cases. The study showed that direct palpation of the lateral fabella was the most clinically useful screening tool, emphasizing that many athletic dogs may develop significant tendinopathy long before overt lameness appears. 

Together, these studies reinforce an essential orthopedic principle: successful diagnosis depends on recognizing pathology before it becomes clinically obvious.

🎓 Journal Articles Discussed

• Scharpf et al. — Assessment of the Conformation of the Radioulnar Joint Comparing Dogs with and without Medial Coronoid Disease
• Vandekerckhove et al. — Quantifying the Stress in Stress Radiography to Determine Sufficient Laxity of the Coxofemoral Joint in Sedated Dogs
• Vannini et al. — Prevalence of Tendinopathy of the Gastrocnemius Muscle Origin in a Cohort of Sound Border Collie

📚 From the May 2026 issue of VCOT

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Transcript

SPEAKER_02 0:04

Hi, I'm Carl Demiani, and this is the Simony Small Animal Surgery Podcast, your fast, focused update on what matters most from the latest small animal surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into surgical insight you can use today, not someday. This episode continues our orthopedic coverage from issue 3, 2026 of Veterinary and Comparative Orthopedics and Traumatology, featuring three studies that challenge the way we think about diagnosis, biomechanics, and injury detection in canine orthopedic patients. First, we'll explore a study by Sharp et al. examining the conformation of the radioulnar joint in dogs with medial coronoid disease. Using CT imaging, the authors identify subtle joint malformations that may help explain why some dogs continue to struggle despite arthroscopic treatment, offering a fresh perspective on the pathogenesis of elbow dysplasia. Next, we'll review Vandekirkove et al. who quantify exactly how much force is needed during stress radiography to accurately assess hip laxity in sedated dogs. Their findings provide practical guidance for canine hip dysplasia screening while helping standardize one of the most important orthopedic diagnostic techniques. Finally, Venini et al. investigate gastrocnemius tendon injuries in agility border collies. Their work suggests that this condition may be far more common than previously recognized, with many seemingly sound athletic dogs already showing clinical or ultrasonographic evidence of tendinopathy before obvious lameness develops. Three studies. One common theme, looking beyond what we can see clinically to better understand the hidden biomechanical and structural changes that influence orthopedic disease, diagnosis, and long-term outcomes.

SPEAKER_03 2:02

Let's dive in. Welcome to today's deep dive. We are on a mission to, you know, extract some pure actionable surgical intelligence from a recent veterinary study so you can literally use it in the OR tomorrow. So, okay, let's unpack this.

SPEAKER_04 2:18

Right. Let's uh let's get right into it.

SPEAKER_03 2:20

Yeah, so picture this. You have a dog on the table with medial coronoid disease or um MCD. You go in, you perform a flawless arthroscopy, but then six weeks later, the dog is still limping. Which is, I mean, it's incredibly frustrating. Oh, totally. And why does that happen? Well, it turns out you might be fixing the localized symptom, but completely ignoring the actual, you know, overall shape of the joint.

SPEAKER_04 2:43

Exactly. I mean, we tend to focus entirely on the immediate side of the disease, but when that refractory lameness persists, we really have to ask if our standard focus is actually blinding us to the real problem.

SPEAKER_03 2:54

Right. Which brings us to the study by Sharp et al. 2026.

SPEAKER_04 2:58

Yeah.

SPEAKER_03 2:58

Reading through this, it struck me that treating MCD by only looking at the medial side is, well, it's like trying to fix a misaligned door by sanding down the hinges.

SPEAKER_04 3:06

Yeah, when the entire door frame is warped, that's a perfect way to visualize it.

SPEAKER_03 3:09

Aaron Powell And they wanted to see if the whole frame was warped, right?

SPEAKER_04 3:11

Yeah, exactly. To figure that out, the researchers look at transverse plain CT stands of 101 elbow joints. And these were all with arthroscopically confirmed MCD.

SPEAKER_03 3:23

Wow, 101? That's a really solid sample.

SPEAKER_04 3:26

It really is. And they compared those against 20 completely sound control joints. They were specifically hunting for structural malformations across the whole joint space, not just the medial side, like the whole thing.

SPEAKER_03 3:38

So they weren't just looking under the streetlight for their lost keys, so to speak.

SPEAKER_04 3:41

Right. They turned the floodlights on.

SPEAKER_03 3:43

Yeah.

SPEAKER_04 3:43

And what they found is huge for how we actually plan the surgery.

SPEAKER_03 3:47

Yeah. So what does this all mean when you're uh looking at that CT data? Because I was seeing a fundamental flaw in how we approached this.

SPEAKER_04 3:54

Oh, absolutely. The medial sections actually showed normal congruity.

SPEAKER_03 3:59

Wait, really? The medial side was normal structurally.

SPEAKER_04 4:01

Yes. The bones there still fit together perfectly, you know, like puzzle pieces, but the lateral side is a completely different story. Aaron Powell Okay.

SPEAKER_03 4:10

So what was going on over there?

SPEAKER_04 4:11

Aaron Ross Powell Well, the data shows significantly decreased radial nerve ratios in the lateral, central lateral, and central sections.

SPEAKER_03 4:17

But a p-value of 0.044.

SPEAKER_04 4:19

Exactly. And physically, that decreased ratio means the joint space on the outside is widening and malformed.

SPEAKER_03 4:26

So because the lateral side is warped, it like fundamentally shifts the biomechanical load.

SPEAKER_04 4:31

Aaron Powell Yes, which then grinds down the medial side. The medial disease you see is actually just a symptom of a lateral collapse.

SPEAKER_03 4:37

Okay, wait, I have to push back here. If the diagnosis is literally medial coronoid disease, why should a surgeon care about lateral malformation? And I mean, why aren't they catching it?

SPEAKER_04 4:49

Well, it comes down to standard equipment limitations. Standard medial arthroscopic evaluation simply cannot access or assess the central and lateral sections of the joint.

SPEAKER_03 4:58

Just because of the camera angle.

SPEAKER_04 4:59

Yeah. Camera angle limitations and uh anatomical constraints. You physically cannot see the lateral malformation from a medial vantage point. So surgeons unknowingly underestimate the true extent of the lesion.

SPEAKER_03 5:12

Aaron Powell Which totally explains why the arthroscopic treatment sometimes fails. You're treating the consequence you can see, but ignoring the mechanical cause you can't.

SPEAKER_04 5:20

Exactly. It is a literal anatomical blind spot.

SPEAKER_03 5:23

That is wild. And you know, relying entirely on standard procedures often leaves us blind to hidden risks like this. It actually naturally transitions into something like infection control at the point of closure.

SPEAKER_04 5:35

Aaron Powell Oh, absolutely. It's the same underlying principle of mitigating unseen risks. Just as standard medial arthroscopy misses structural lateral lesions, standard saline lavage misses microscopic threats in the wound bed.

SPEAKER_03 5:48

Right, because saline leaves what, like 42% of bacteria behind?

SPEAKER_04 5:51

Exactly. 42%. That is a massive invisible risk lingering after a procedure.

SPEAKER_03 5:56

Aaron Powell Yeah, which is why there's a growing shift toward using targeted non-antibiotic treatments like Simon D protect lavage.

SPEAKER_04 6:04

Right, right.

SPEAKER_03 6:04

It's an objective evolution in the standard of care.

SPEAKER_04 6:07

Yeah.

SPEAKER_03 6:07

Just reinforcing the protocol to remove the bacteria that Saline misses, leaving 0% behind without disrupting the surgical workflow.

SPEAKER_04 6:16

Precisely. Whether you are dealing with warped bone or wound-bed bacteria, you have to acknowledge and treat the blind spots your standard tools simply cannot reach.

SPEAKER_03 6:25

That is such a crucial point. So here is your 10-second clinical takeaway for the OR tomorrow. In MCD, the medial side does not tell the whole story.

SPEAKER_04 6:35

It really doesn't.

SPEAKER_03 6:36

Lateral and central malformations are quietly compromising your surgical success rate by shifting the mechanical load of the joint.

SPEAKER_04 6:43

And I will leave you with this final thought to ponder.

SPEAKER_03 6:45

Go for it.

SPEAKER_04 6:46

If a supposedly localized medial disease is actually driven by a joint-wide incongruity on the complete opposite side, what other localized orthopedic conditions are we currently mismanaging simply because we aren't looking at the opposite side of the joint?

SPEAKER_00 7:04

Here's another useful insight from the literature.

SPEAKER_04 7:12

Picture this.

SPEAKER_03 7:22

Right, or did you just generate a false negative because you didn't want to overtork it?

SPEAKER_04 7:26

Exactly. For decades, we've just been, you know, guessing how hard to push during passive stress radiography. Welcome to the deep dive. Today our mission is to extract pure, actionable clinical intelligence for you, the veterinary surgeon, to take straight to the clinic tomorrow.

SPEAKER_03 7:43

Aaron Ross Powell Yeah, we're cutting right through the noise today.

SPEAKER_04 7:45

Aaron Ross Powell We really are. We're looking at a highly anticipated study, Vanderkrocov et al. 2026. Okay, let's unpack this. We all use tools like the Vidzoni device, but where is the actual mechanical breakdown happening in these screenings?

SPEAKER_03 7:59

Aaron Ross Powell Well, the breakdown is really in the physical force applied. I mean passive stress radiography is our gold standard for detecting coccifemoral joint laxity. But the exact force required to adequately subluxate that joint has historically been a massive blind spot.

SPEAKER_04 8:14

Oh, a total blind spot.

SPEAKER_03 8:15

Right. We've essentially been relying on like tactile guesswork. And that inevitably leads to inconsistent screening results from one clinician to the next.

SPEAKER_04 8:24

I have to admit though, as surgeons, we rely so heavily on proprioception and feel. Does pinning down an exact Newton measurement genuinely change anything on the clinic floor? Or is this just, I don't know, an academic exercise?

SPEAKER_03 8:37

Aaron Powell Oh, it absolutely changes the game. It completely replaces that subjective feel with a hard objective baseline. The researchers found that 90% of hip joints achieve sufficient laxity, meaning they hit at least 90% of their maximum laxity index at exactly 80.45 newtons of force.

SPEAKER_04 8:55

Wait, exactly.

SPEAKER_03 8:57

Yep, 80.45 newtons.

SPEAKER_04 8:59

Now let's put that directly into the surgeon's hands, so to speak. That is roughly 8.2 kilograms of force. So to visualize that mechanically, it's not a full body lean over the exam table.

SPEAKER_03 9:09

No, definitely not.

SPEAKER_04 9:09

It's basically the effort needed to lift a medium-sized bag of dog food, or you know, the same tension you'd use when firmly seating a medium-sized orthopedic plate.

SPEAKER_03 9:18

Yeah, that's a great analogy.

SPEAKER_04 9:19

Right. So it's firm, it's deliberate, but it's generated entirely from the wrists and forearms, not the shoulders.

SPEAKER_03 9:24

Exactly. And what's fascinating here is that 80.45 newtons is actually a significant drop from what we thought we knew. It's about 15 newtons lower than the target forces established by previous cadaver studies.

SPEAKER_04 9:36

Oh wow. 15 newtons is a big difference. We're so used to really throwing our weight into these laxity tests. Why is the threshold so much lower than those previous benchmarks?

SPEAKER_03 9:47

Well, because those old numbers were artificially inflated by uh incomplete muscle denaturation in the cadaveric models.

SPEAKER_04 9:54

Oh, that makes sense. Rigor mortis, essentially.

SPEAKER_03 9:56

Precisely. When you have a live patient under an optimized deep sedation protocol, specifically the combination of dexmetatomidine, pitorphenol, and midatolamine that they use in this study, the profound muscle relaxation drastically reduces the physical resistance.

SPEAKER_04 10:11

So they're just completely relaxed.

SPEAKER_03 10:13

Exactly. You simply don't have to fight the periarticular musculature to reach maximum laxity.

SPEAKER_04 10:18

That is a huge clinical takeaway. Nail the pharmacology and the mechanical effort drops. And you know, looking through the data, I was actually struck by what didn't alter that 80 newton threshold.

SPEAKER_03 10:31

Yeah, the negative findings are just as important here.

SPEAKER_04 10:33

They really are. When you're in the clinic, there are a lot of variables you just don't need to overthink. The required force and the maximum laxity index were remarkably stable across the board.

SPEAKER_03 10:43

Right. They weren't significantly thrown off by the dog's gender, which side you're testing, or you know, even the presence of mild osteoarthritis.

SPEAKER_04 10:50

Which is surprising, right? You'd think mild OA would stiffen things up.

SPEAKER_03 10:54

You would, but the data says otherwise. It's an incredibly robust screening technique.

SPEAKER_04 11:00

So what does this all mean for the surgeons scrubbing in tomorrow?

SPEAKER_03 11:04

The immediate takeaway is that the target force is highly manageable. When you're assessing a dog under optimized deep sedation, you really only need to apply around 8.2 kilograms of force. You just don't have to overdo it to get an accurate diagnostic laxity index.

SPEAKER_04 11:18

We are finally replacing tactile guesswork with actual mechanical precision.

SPEAKER_03 11:23

Exactly. Work smarter, not harder.

SPEAKER_04 11:25

I love that. But I will leave you with a final provocative thought pulled directly from this research to Mullover.

SPEAKER_03 11:32

Oh, here we go.

SPEAKER_04 11:33

We know mild osteoarthritis didn't change the force needed today, but what happens over a dog's lifetime?

SPEAKER_03 11:40

Right. The chronic cases.

SPEAKER_04 11:42

Exactly. Does the progressive capsular fibrosis caused by severe long-term osteoarthritis eventually change the force required to subluxate that hip? Next time you're evaluating an older patient's joint, ask yourself how that changing internal landscape might actually be fighting against your hands.

SPEAKER_03 12:09

So what if I told you that the best diagnostic tool for catching a hidden um career-ending injury in an agility dog isn't some $50,000 gate analysis mat.

SPEAKER_04 12:21

Right. Or even like a high-res ultrasound.

SPEAKER_03 12:24

Exactly. Actually, just your own thumb.

SPEAKER_04 12:26

It sounds totally counterintuitive, I know. But uh, when it comes to the canine athlete, relying on high-tech screens over good old-fashioned hands-on palpation might actually be causing us to miss some pretty catastrophic tendon failures. Trevor Burrus, Jr.

SPEAKER_03 12:39

Yeah. And that's exactly what we're getting into today for this deep dive. We're looking at Venini et al. 2026. And our mission here is to just bypass all that dense methodology. We want to extract the actionable surgical and clinical insights that will literally change how you practice tomorrow.

SPEAKER_04 12:54

Aaron Powell Well, the main clinical problem that Venini and the team highlight is this massive disconnect between a handler's perception of their dog and the actual physiological reality. I mean, they looked at 34 actively competing border collies. Trevor Burrus, Jr.

SPEAKER_03 13:07

And these were supposed to be a perfectly healthy dogs, right?

SPEAKER_04 13:09

Yeah. Yeah, exactly. According to the handlers, these dogs had zero lameness, like they were running clean. But the clinical exams showed that 18 of them, so over half, had abnormal findings at the tendon of the gastrocnemius muscle origin, or TGMO.

SPEAKER_03 13:25

Over half.

SPEAKER_04 13:26

Yeah.

SPEAKER_03 13:27

So if the dogs look perfect in the ring, what is actually happening at the cellular level that keeps them running without, you know, an overt limp?

SPEAKER_04 13:34

Aaron Ross Powell So think of the tendon attachment like the anchor point of a suspension bridge. The cables or the tendon fibers, they don't all just snap at once.

SPEAKER_03 13:41

Right, it's gradual.

SPEAKER_04 13:42

Exactly. You get these silent micro-tears at the anchor plate, which redistribute the load to healthy fibers until the whole system basically reaches a tipping point. The tissue fails to heal properly, but um the overall structure holds together for a while.

SPEAKER_03 13:55

Aaron Powell Which just masks that chronic repetitive trauma at the enthesis. So it delays any overt signs of lameness until the degeneration is just severe.

SPEAKER_04 14:03

Aaron Powell Spot on. And since handlers are missing this entirely, we have to really look at our diagnostic tools.

SPEAKER_03 14:08

Aaron Powell Which is where you'd think advanced pressure sensor gate analysis would come in, right? Like to catch those microasymmetries before the bridge collapses.

SPEAKER_04 14:16

Aaron Powell You would think so, but uh gate analysis actually proved way too nonspecific. I mean, it caught asymmetry, but it couldn't reliably pinpoint the cause.

SPEAKER_03 14:24

Oh, interesting. What about ultrasound then?

SPEAKER_04 14:26

Ultrasound was even trickier. It showed abnormal tendon echogenicity in a staggering 85% of the dogs. But the structural imaging didn't reliably correlate with actual pain.

SPEAKER_03 14:39

Wait, so if the dog isn't visibly limping, and the ultrasound looks awful, but the dog feels fine, aren't we just treating the scan if we inter like why should a busy surgeon even care if the patient is asymptomatic?

SPEAKER_04 14:51

Aaron Powell That is the perfect question. Because structurally, messy tissue isn't always inflamed tissue. Ultraso is highly sensitive to structural changes, so it lights up at the very first sign of collagen disorganization. Aaron Powell Right.

SPEAKER_03 15:04

So you can have a dog with an ugly ultrasound moving perfectly.

SPEAKER_04 15:07

Exactly. And conversely, you know, a dog with mild imaging changes who's in real pain, treating the scan is exactly what we want to avoid doing. And that's why the true gold standard finding wasn't on a screen at all.

SPEAKER_03 15:18

Which brings us right back to the thumb.

SPEAKER_04 15:20

Yes. Direct digital pressure over the lateral fabella. If palpation triggered a clear, repeatable pain response compared to the opposite limb that was the most reliable indicator of clinical TGMO.

SPEAKER_03 15:33

I feel like that totally shifts the dynamic in the exam room. The moment you find that localized fabellar pain, you're no longer doing a standard wellness check. You're basically intercepting a surgical rupture.

SPEAKER_04 15:43

You really are. The tendon is actively degenerating, even if the dog is still competing at a high level. Identifying that pain response lets you immediately change how you advise the owner on, you know, training, load management, and joint preservation.

SPEAKER_03 15:56

You transition from just observing a supposedly healthy dog to actively preventing an acute exacerbation. That proactive shift is huge for any surgeon listening.

SPEAKER_04 16:06

It is. But there's also a really provocative thought hidden at the end of this research. TGMO is increasingly being recognized even in non-sporting border collie.

SPEAKER_03 16:15

Wait, really? Non-sporting ones too.

SPEAKER_04 16:18

Yeah. Which forces us to ask: are we looking at a purely mechanical overuse injury from, you know, high impact A-frames and jumps? Or is there a hidden genetic trigger at play in this specific breed?

SPEAKER_03 16:31

Oh, wow. That definitely changes how you look at the next border collie in your waiting room.

SPEAKER_04 16:35

It really does. But for now, the immediate clinical application is crystal clear. Make lateral fabler palpation a deliberate mandatory step in your next orthopedic exam. Don't let that suspension bridge collapse on your watch.

SPEAKER_03 16:48

Great advice. And to our listeners, you can find the full article links for Venini et al. 2026 in the show notes.

SPEAKER_01 16:58

That's it for this episode of the Simini Small Animal Surgery Podcast. This show is brought to you by Semini Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. Listening, and we'll see you in the next episode.