How the PAUL procedure effects limb alignment in dogs with elbow dysplasia

Canine elbow dysplasia frequently results in loss of the articular surface cartilage (osteoarthritis) on the inside of the elbow joint. This is known as Medial Compartment Disease and can lead to long term elbow pain and lameness. The PAUL (Proximal Abducting Ulnar Osteotomy) procedure aims at unloading the medial compartment by aligning the limb and thus alleviating lameness, stiffness, and joint pain.

The current study demonstrates that limb alignment after PAUL is more coaxial compared to the pre-operative situation.


To determine the effect of PAUL using KYON’s PAUL plate on frontal plane thoracic limb alignment in standing and recumbent positions.


Ex vivo cadaveric study on canine thoracic limbs (n=15 limb pairs)


A limb press was used to obtain standing and recumbent caudocranial radiographs before and after PAUL. Foot lateralization and rotation were directly measured in standing position. Mechanical joint angles were determined using full limb radiographic montages and the center of rotation of angulation (CORA) method for pre-PAUL (Pre) and post-PAUL. ALPS PAUL-I plates with steps of 2mm and 3mm were compared.


Five of 12 limb alignment values in standing and recumbent positions were significantly different pre-PAUL and post-PAUL (standing position):Effect of PAUL on limb alignment angles in dogs




Amadio A, Corriveau K, Norby B, Stephenson T, Sauders W
Effect of proximal abducting ulnar osteotomy (PAUL) on frontal plane thoracic limb alignment: An ex vivo canine study.
Veterinary Surgery. 2020;1–12 . DOI: 10.1111/vsu.13425


With over 20 years in the market, we understand there is little room for mistakes when treating patients. We offer better solutions and best quality. Without compromise.

Learn more