Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs

Treatment of Medial Instability of the Carpometacarpal and Tarsometatarsal Joints Using the Isolock® System in Two Dogs

This case report describes a novel procedure using the Isolock Intrauma® implant system for treating medial instability of the carpometacarpal and tarsometatarsal joints, as demonstrated in in two dogs. A 9-year-old spayed female Spanish greyhound presented with a non-weight-bearing right hindlimb following a trauma. The clinical and radiological findings confirmed medial tarsometatarsal instability consistent with valgus deviation of the tarsus and the opening of the joint line on the medial aspect from the first to the third tarsometatarsal joints. A 4-year-old female Drahthaar presented with a non-weight-bearing left forelimb, swelling of the carpus and valgus instability. Radiological examination revealed a widening of the spaces between the intermedioradial carpal bone, second carpal bone and metacarpal bone II, confirming the medial carpometacarpal instability. In both cases, the Isolock system, an implant including ultra-high-molecular-weight polyethylene suture (UHMWPE), was used to reinforce the medial joint structures. Minor short-term complications were observed, such as swelling of the tarsal surgical site and hyperextension of the carpus, but these resolved spontaneously. No lameness or major complications were reported five months postoperatively. Carpometacarpal and tarsometatarsal instabilities are rare diseases in dogs as compared to subluxations of the other joints of the carpus and tarsus. There are no previous reports regarding the use of a UHMPWE implant for the treatment of these rare joint injuries, though the present case report suggests the validity and efficacy of the Isolock Intrauma® implant for restoring carpal and tarsal stability and preserving joint mobility.

Outcomes for 15 cats with bilateral sacroiliac luxation treated with transiliosacral toggle suture repair

OBJECTIVE

To report a surgical technique and outcomes of transiliosacral toggle suture repair to treat feline bilateral sacroiliac luxation/fracture (SILF).

STUDY DESIGN

Retrospective study.

ANIMALS

Fifteen client-owned cats.

METHODS

The medical records of cats with bilateral SILF treated using a transiliosacral toggle suture repair were reviewed. Short- and medium-term outcomes were assessed through standard postoperative clinical evaluation and radiographs, including measurements of angle of deviation (AoD), percentage of reduction (PoR), and pelvic canal width ratio (PCWR). Long-term functional follow up was obtained from a questionnaire derived from the Feline Musculoskeletal Pain Index (FMPI).

RESULTS

Fifteen cats were enrolled retrospectively, among which 13 survived to discharge. One minor wound complication, treated by secondary intention healing, was encountered. No major complication was reported. Immediately postoperatively, the mean absolute PoR values were 88.1 ± 11.2% and 91 ± 11.6% on the right and left side, respectively. The mean absolute AoD was 3.1 ± 2.8°, and the mean PCWR was 1.24 ± 0.08. The medium-term radiographic follow up at a median of 205 (71-682) days postsurgery revealed the good stability of the repair. Excellent functional outcomes were identified upon the analysis of 12 long-term questionnaires at a median of 365 (119-798) days postsurgery.

CONCLUSION

Anatomic reduction was satisfactory and comparable with previously described techniques with good implant placement documented. Functional outcomes based on FMPI-derived questionnaires were good to excellent in our population.

CLINICAL SIGNIFICANCE

Transiliosacral toggle suture stabilization of bilateral SILF was associated with good outcomes in cats. Further studies are required to compare biomechanical properties and outcomes between this technique and previously described transiliosacral stabilization.

Biomechanical comparison of canine median sternotomy closure using suture tape and orthopedic wire cerclage

OBJECTIVE

To compare the mechanical properties of suture tape and orthopedic wire cerclage in an ex vivo canine median sternotomy model.

STUDY DESIGN

Ex vivo.

ANIMALS

Twelve large-breed canine cadaveric sternums.

METHODS

Median sternotomies were performed, leaving the manubrium intact. The specimens were randomly assigned to group W (20-gauge stainless steel orthopedic wire cerclage in a figure-of-eight pattern) or group ST (suture tape in a figure-of-eight pattern). Each specimen was laterally distracted until failure using an electrodynamic materials-testing system.

RESULTS

No differences were observed for displacement, yield load, maximum load, implant failure between the groups. The orthopedic wire construct was stiffer than the suture tape construct.

CONCLUSION

Suture tape was biomechanically similar to orthopedic wire cerclage for sternotomy closure in dogs, although wire constructs were stiffer.

CLINICAL SIGNIFICANCE

Suture tape may represent an alternative to cerclage wire for sternotomy closure in dogs. Additional studies evaluating its clinical use are needed.

Ex vivo biomechanical evaluation of extracapsular stabilization with quasi-isometric points in canine cranial cruciate ligament-deficient stifles

BACKGROUND

Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs. The extracapsular stabilization (ECS) utilizing bone anchors and monofilament nylon leader was an alternative treatment for CCL-deficient (CCLD) dogs. However, the biomechanical response of the canine stifle to such a surgical repair strategy in conjunction with the use of recently reported quasi-isometric anchoring points remains unclear. The objectives of the study were to evaluate the mobility and stability of CCL-intact, CCLD, and CCLD stifles repaired with ECS at two different pairs of quasi-isometric points (quasi-IPs).

METHODS

Twelve stifle specimens from 7 dogs underwent mobility and stability tests under 4 different conditions, namely, CCL-intact, CCLD, and ECS-repaired at 2 different pairs of quasi-IPs (referred to as ECS-IP1 and ECS-IP2). The mobility tests evaluated 6 degrees-of-freedom stifle kinematics during flexion and extension. The stability tests involved cranial drawer and tibial internal rotation (IR) tests at various stifle opening angles and quantifying the cranial tibial translation (CTT) and tibial IR angles under constantly applied loadings.

RESULTS

The ECS repaired at quasi-IPs was shown to restore cranial instability of the stifles with averaged CTT magnitudes < 1.4 mm. During the tibial IR test, the ECS treatments resulted in significantly less tibial IR compared to those in intact CCL stifles. The mobility tests showed similar results.

CONCLUSION

The 2 chosen pairs of quasi-IPs were shown to effectively correct the excessive CTT caused by CCLD stifles, whereas the excessive tibial external rotation in comparison to those of intact stifles should be considered for its subsequent influence on joint alignment and the contact pressure applied to the stifle joint.

The Effect of Location of a Unicortical Defect on the Mechanical Properties of Rabbit Tibiae: A Model of the Distal Jig Pin Hole in Tibial Plateau Levelling Osteotomy

OBJECTIVE

 The aim of this study was to determine the effect of a unicortical defect at either the mid-diaphysis (MD) or distal metaphysis (DM) on the torsional properties of tibiae in an in vitro rabbit model, and to further examine optimal distal jig pin position for the canine tibial plateau levelling osteotomy (TPLO) procedure.

STUDY DESIGN

 Thirty-eight tibiae from 19 skeletally mature female New Zealand White rabbits were assigned to one of three groups; Group 1: intact, Group 2: MD defect and Group 3: DM defect. Defects were created using a 1.6 mm Ellis pin. Pure torsion was applied to each sample and peak torque and angular displacement recorded.

RESULTS

 All tibiae fractured in a spiral configuration. Fracture lines involved the defect in 33% of the MD samples and 0% of the DM samples. No differences were detected for peak torque and stiffness between groups. However, energy (mean ± standard deviation) was significantly reduced (p = 0.028) in the MD group (0.18 ± 0.07) relative to the intact tibia group (0.31 ± 0.14). Angle was also significantly reduced (p = 0.040) in the MD group (0.17 ± 0.05) compared with the intact group (0.23 ± 0.07). Placement of a DM defect had no significant effect on mechanical properties of the rabbit tibiae.

CONCLUSION

 Defects placed in the MD significantly reduced energy and angle in comparison to intact samples. No significant difference in peak torque or stiffness was observed between groups. If canine tibiae were similarly affected, our findings suggest jig pin placement in the DM to have a lesser effect on the torsional properties of the tibiae.

Complications and postoperative non-steroidal anti-inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment

OBJECTIVE

To report complications and postoperative non-steroidal anti-inflammatory use associated with fabellotibial suture, Tightrope and Ligafiba Isotoggle procedures performed on dogs of varying weights within a general practice setting.

MATERIALS AND METHODS

Clinical records of eligible patients from 2009 to 2018 were retrospectively extracted from five general practice clinics. Data for signalment, patient weight, surgery performed, complications, postoperative use of non-steroidal anti-inflammatory drugs, and timing thereof were extracted and analysed using multinomial logistic regression. Predicted probability tables were generated for complications and non-steroidal anti-inflammatory drug use.

RESULTS

The study included 370 surgeries, with 97 fabellotibial suture, 158 Tightrope and 42 Ligafiba Isotoggle procedures in patients less than 15 kg, and 43 fabellotibial suture, 16 Tightrope and 30 Ligafiba Isotoggle procedures in patients at least 15 kg. The proportion of patients that can be expected to have no complications was greatest for older dogs (9 years) weighing less than 15 kg (fabellotibial suture, 91%; Tightrope/Ligafiba Isotoggle, 88%), and the highest major medical and surgical complication risks were expected in young dogs (1 year) weighing over 15 kg (fabellotibial suture, 28%; Tightrope/Ligafiba Isotoggle, 59%). The predicted risk of requiring repeated non-steroidal anti-inflammatory drug prescriptions in the 18-month postoperative period for an 15 kg patient was 37% to 39%.

CONCLUSION

Weight and age were significant factors influencing complications and postoperative non-steroidal anti-inflammatory drug use in fabellotibial suture, Tightrope and Ligafiba Isotoggle surgical patients in a general practice setting.

CLINICAL SIGNIFICANCE

Clinicians should consider the possibility of complications and requirement for ongoing non-steroidal anti-inflammatory drug use before performing extracapsular procedures in patients weighing more than 15 kg.

Traumatic Coxofemoral Luxation in Cats Treated with Hip-Toggle Stabilization Using the Mini Tightrope® Fixation System

The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of 21 cats that underwent coxofemoral toggle stabilization using the Mini TightRope® Fixation System (mTR®). Data were compiled from client-owned cats with traumatic hip luxation. Each cat underwent the same protocol including orthopedic assessment, preoperative radiographic evaluation, surgical procedure, postoperative management and clinical re-examination at 14 days, 8 weeks and 12 months following surgery. Age, body weight, implants and osteoarthritis progression were recorded. A lameness score 0-4 was assigned to each cat. Pain upon hip extension was not quantified but as pain reaction or no pain reaction. Major complications and osteoarthritic (OA) changes were recorded. Osteoarthritic changes were classified on a 0-4 scale. Twenty-one cats were included in the study. Coxofemoral luxations were stabilized using a mTR®. At 8 weeks, weight bearing was considered normal (grade 0) in all cats and no pain reaction was elicited during hip extension. One year after surgery, orthopedic examination was within the normal limits and according to the owners, all animals exhibited a normal physical activity. No complications were recorded. Evidence of slight OA changes were observed in 5 out of 21 cats. The final outcome was considered excellent in 16/21 patients and good in 5/21 cats. The application of the mTR® system can be considered a suitable surgical treatment in cats affected by traumatic hip luxation.

Orthosis in the Conservative Treatment of Cranial Cruciate Ligament Rupture in Dogs – Clinical Observations

Orthoses are increasingly frequently applied orthopedic devices in veterinary medicine. Injury to the knee joint with a rupture of the cranial cruciate ligament is one of the main indications for the use of orthoses in dogs. This study aimed to present the results of treatment of 30 dogs with injured cranial cruciate ligaments using a knee orthosis and describe the reasons for the conservative treatment of cranial cruciate ligament deficiency. The study was conducted between 2017 and 2019 and involved 30 dogs of various breeds aged 7 to 15, weighing from 2.5 kg to 45 kg, diagnosed with cranial cruciate ligament rupture. In the study, a stifle knee orthosis by the Polish manufacturer Admirał (Pl) was used in 29 dogs and, in one case, an orthosis by Balto (USA) was applied. In each case, the orthosis was selected individually, based on the measurements taken. In the twelfth week of treatment using orthoses, the owners of 25 dogs were satisfied with the results of conservative treatment with the application of orthoses. The caretakers of four dogs observed difficulties in the form of slight lameness at rest after prolonged exertion on the previous day. Running difficulty was observed in one dog. In the conducted study, the knee orthosis demonstrated good therapeutic effects in dogs up to 25 kg. In the majority of dogs, a slight increase in the flexion angle of the treated knee joints was observed, X-ray examinations did not show the degenerative disease progress during the studied period.

Long-term clinical and goniometric follow-up of lateral suture surgery in dogs with cranial cruciate ligament rupture

The aim of this study was to evaluate the complications and the short-, medium-, and long-term outcomes following treatment of cranial cruciate ligament (CCL) rupture in dogs using the lateral fabello-tibial suture technique. The patients were ten dogs of various breeds, 62.5 ± 18.8 months of age, weighing 30.2 ± 3.3 kg, with unilateral CCL rupture. At 2, 6, 12, 24, and 52 weeks after surgery, the dogs were re-evaluated with clinical examination, gait and pain analysis, and radiography. A major complication was identified in one dog (10%), requiring second surgery due to implant failure and destabilisation of stifle joint. Minor complications occurred in two dogs postoperatively (one late meniscal injury and one case of seroma formation). The short-term outcome at two and six weeks postoperatively was considered good in six dogs and satisfactory in four dogs, while the mid-term outcome (between 12 and 24 weeks) was good to excellent in eight dogs and satisfactory in two dogs. All ten dogs had a good to excellent outcome 52 weeks after surgery. The lateral suture technique is generally safe and given the major benefits, such as lower costs, lower technical difficulty, and minimal requirement for specialised equipment, will probably remain a popular and alternative method for treatment of CCL insufficiency in dogs with good degree of owner satisfaction.

Biomechanical comparison of screw and suture fixation for temporary transarticular tarsocrural immobilization in canine cadavers

OBJECTIVE

To biomechanically evaluate an ultrahigh-molecular-weight polyethylene (UWMWPE) suture for temporary tarsocrural immobilization as a potential alternative to the existing surgical method, which uses a 4.5 AO/ASIF calcaneotibial cortical screw.

STUDY DESIGN

Randomized in vitro biomechanical study.

ANIMALS

Pelvic limbs (n = 20) from 10 euthanized adult dogs (average bodyweight of 29.9 kg ± 1.9 kg).

METHODS

Tarsocrural joints were immobilized either with a 4.5 AO/ASIF screw or a 1 mm diameter UHMWPE suture. Limbs were loaded with 60 N, 120 N, and 180 N, each for 100 cycles. After cyclic loading, immobilizations were loaded until failure. Load at failure and mode of failure were recorded.

RESULTS

Both immobilization methods remained intact during loading with 60 N, 120 N, and 180 N. Mean and standard deviation (± SD) failure loads were higher for the cortical screw (524.9 N ± 148.7 N) than for the UHMWPE suture (387.8 N ± 105.6 N), P = .0084. The stiffness of both systems was equivalent.

CONCLUSION

Both techniques were suitable for transarticular tarsocrural immobilization in large-breed canine cadavers. While load at failure was higher for the screw compared to the suture construct, stiffness of both methods was comparable based on the laboratory settings in this in vitro study.

CLINICAL SIGNIFICANCE

Based on the results of this study, both the cortical screw and the UHMWPE suture stabilized the tibiotarsal joint at clinically relevant loads. However, when exposed to high loads, the cortical screw provides increased tibiotarsal stability. Comparative data need to be collected prior to widespread use of UHMWPE sutures in clinical cases.

The Effect of Cranial Cruciate Ligament Rupture on Range of Motion in Dogs

Range of motion (ROM) is a measure often reported as an indicator of joint functionality. Both the angle of extension and that of flexion were measured in 234 stifle joints of dogs with cranial cruciate ligament (CCL) rupture. The aims of this study were to investigate the correlation between CCL rupture and alterations in the range of stifle joint motion and to determine whether there was a prevalence modification of one of the two angles. All the extension and flexion angles were obtained from clinical records and were analysed in various combinations. A significant relationship was found between normal angles and abnormal angles; concerning the reduction in the ROM, a significant prevalence in the alteration extension angle was found. Of the 234 stifles, 33 (13.7%) were normal in both angles. These results could offer important insights regarding the influence of CCL rupture on compromising the ROM. This awareness could be a baseline for understanding the ability of surgical treatment to restore one angle rather than another angle, to address the choice of treatment and to help physiotherapists in their rehabilitation program.

In vivo three-dimensional isometry analysis of suture attachment sites for extracapsular suture stabilization of the canine stifle

BACKGROUND

The study aimed to perform isometry analysis of a selection of suture attachment points for extracapsular stabilization with three-dimensional (3D) measurements and normal gait kinematics of the stifle joint.

METHODS

Thirteen client-owned dogs were recruited. Fluoroscopic images of the stifle during treadmill walking and computed tomography of the same joint were acquired. Stifle kinematics were reconstructed using 3D model-based fluoroscopic analysis. Variability of the distance between the femoral and tibial attachment sites across gait cycles was evaluated. The maximum length variation (MLV) and maximum length percent variation (MLPV) were quantified and used to determine the level of isometry of the attachment site combinations.

RESULTS

A selection of combinations with lower mean MLV (<2.5 mm) or MLPV (<8%) was identified from 315 combinations, and all the combinations involved femoral attachment sites near the distal pole of the lateral fabella. The combinations also involving tibial attachment sites near the proximal tibial crest showed improved isometry, with an MLPV < 6%.

CONCLUSION

Combinations using attachment sites around the distal pole of the lateral fabella and proximal tibial crest or caudal to the long digit extensor groove appeared to have improved isometry.

Patellar Bone-Tendon-Bone Autografts versus Quadriceps Tendon Allograft with Synthetic Augmentation in a Canine Model

Patellar bone-tendon-bone (pBTB) autografts are often considered the "gold standard" for complete anterior cruciate ligament (ACL) reconstruction and are also associated with significant complications and early-onset knee osteoarthritis (OA). A novel quadriceps tendon allograft with synthetic augmentation, or "internal brace" (QTIB), has been reported to have potential advantages for ACL reconstruction based on animal model data. In this preclinical canine comparison study, we hypothesized that QTIB allograft compared with pBTB autograft would provide superior durability for knee stability, function, and prevention of OA. Under approval from our Institutional Animal Care and Use Committee, adult purpose-bred research hounds (n = 10) underwent arthroscopic complete transection of the ACL followed by either an arthroscopic-assisted all-inside ACL reconstruction using the QTIB allograft (n = 5) or pBTB autograft (n = 5). Contralateral knees were used as nonoperated controls (n = 10). Radiographic and arthroscopic assessments were performed at 2 and 6 months, respectively, after surgery. Anterior drawer, internal rotation, lameness, kinetics, pain, effusion, and comfortable range of knee motion were measured at 2, 3, and 6 months. Biomechanical and histologic assessments were performed at 6 months. All reconstructed knees were stable and had intact ACL grafts 6 months after surgery. At 6 months, QTIB reconstructed knees had significantly less lameness, lower pain, less effusion, and increased range of motion when compared with BTB knees (p < 0.05). BTB knees had significantly higher radiographic OA scores than QTIB knees at 6 months (p < 0.05). Superior outcomes associated with QTIB allograft may be due to the lack of donor site morbidity, the use of a robust tendon graft, and/or protection of the graft from the synthetic augmentation. Robust tendon grafts combined with a synthetic internal brace and platelet-rich plasma (PRP) may allow for more rapid and robust tendon-bone healing and graft "ligamentization," which protects the graft from early failure and rapid OA development that can plague commonly-used allografts.

Intra-articular replacement of a ruptured cranial cruciate ligament using the Mini-TightRope in the dog: a preliminary study

BACKGROUND

The TightRope System is a device developed to provide extracapsular stabilization of the cranial cruciate ligament (CCL) rupture in canine stifles. I was then also employed for the extra-articular treatment of shoulder instability and for the intra-articular treatment of hip luxation in dogs and cats.

OBJECTIVES

To evaluate the feasibility of the Mini-TightRope (mTR) System for the intra-articular treatment of CCL rupture in small breed dogs.

METHODS

A cadaveric canine model was used to record the steps of the surgical procedure. Five client owned dogs weighing from 8 to 10 kg and from 2 to 12 years of age were enrolled in the prospective study in which the mTR device was implanted in the stifle joint to replace the ruptured CCL. The dogs were graded using the Bologna Healing Stifle Injury Index (BHSII) and radiographic osteoarthritis (OA) scores.

RESULTS

The outcomes obtained at the time of the surgery (T0) and for the following 12 months (T12) showed an improvement in the functional parameters (BHSII from a median of 74.3 [range, 58.1-82.4] at T0 to 95.6 [range, 94.1-99.3] at T12]). The OA did not change in 3 dogs and increased by only 1 point in 2 dogs.

CONCLUSIONS

In this preliminary study, the mTR was a successful and repeatable intra-articular surgical procedure for all dogs. Additional studies related to the clinical application of the technique in medium-large dogs should be encouraged.

Comparison of a novel extracapsular suture technique with a standard fabellotibial suture technique for cranial cruciate ligament repair using a custom-made limb-press model in cats

OBJECTIVES

The aim of our study was to compare the standard fabellotibial suture with Mini TightRope fixation for the treatment of a cranial cruciate ligament (CCL) rupture using a feline custom-made limb press.

METHODS

Cadaveric hindlimbs of 10 cats were inserted in the limb press at predefined joint angles and loads of 10% and 30% body weight (BW) were applied. Mediolateral radiographs were taken and three-dimensional coordinates were recorded using a microscribe digitiser, with intact and transected CCLs and after either fabellotibial suture or Mini TightRope fixation were performed. Different distances and angles from radiographs or microscribe coordinates were analysed.

RESULTS

Radiographic distances from the femoral condyle to the cranial edge of the tibia (X1-X2) were higher in CCL-deficient stifles than in intact stifles at 10% and 30% BW loads. All fabellotibial sutures and Mini TightRope fixations neutralised excessive cranial tibial thrust. A significant difference in the distance between the patella and tibial tuberosity (D2) was observed between CCL-deficient limbs and Mini TightRope-fixed limbs at 10% BW load (P <0.04). A significant difference in the distance between the tibial tuberosity and lateral collateral ligament of the femur (D3) was observed between the intact and transected CCLs on the left legs at 10% BW load (P <0.003) and on both legs at 30% BW load (P <0.002). Furthermore, we observed significant differences between CCL-deficient left legs and Mini TightRope-treated legs at 10% BW load (P <0.003). With regard to fabellotibial suture-treated legs, we observed significant differences between transected limbs and fixed limbs at 30% BW load (P <0.004). W1 (craniocaudal angle) and W2 (mediolateral angle) showed significant differences between intact and transected CCLs and between transected and fixed limbs at 30% BW load (P <0.004).

CONCLUSIONS AND RELEVANCE

Fixation of CCL-deficient stifles with lateral fabellotibial suture, as well as Mini TightRope tightened with a 20 N load, produces good biomechanical stability, as detected via radiographic assessment.

Long-term outcome and progression of osteoarthritis in uncomplicated cases of cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy in dogs

The object of this study is to evaluate the long-term outcome of hind limb weight-bearing function and progression of stifle osteoarthritis (OA) after tibial plateau leveling osteotomy (TPLO). Groups were classified by the degree of cranial cruciate ligament (CrCL) damage and presence or absence of medial meniscus damage as macroscopically evaluated during surgery. Weight-bearing function was assessed via the peak vertical force (PVF), and OA progression was assessed via the radiographic OA score (OAS) preoperatively and 1, 3, 6, 12, 18, 24, and 36 months postoperatively. In all stifles, PVF was significantly higher within 6 months postoperatively than preoperatively, and this high ratio was maintained for 36 months. The OAS was significantly higher 24 months postoperatively than preoperatively in stifles with a partial CrCL tear, and significantly increased at each timepoint after 3 months postoperatively in stifles with complete CrCL rupture. The OAS remained consistently lower in stifles with a partial CrCL tear and no treatment of the medial meniscus than in stifles with complete rupture. Thus, after TPLO, the weight-bearing function improved in the early postoperative period and was maintained for as long as 36 months. Although OA progressed over time after TPLO, the progression was more gradual in stifles with partial tears than in those with complete rupture. Canine patients would benefit from earlier surgical intervention through development of technology that enables early detection of ligament degeneration.

Validation of an optical, computer-assisted technique for intraoperative tracking of 3-dimensional canine stifle joint motion

Background:

Cranial cruciate ligament (CCL) rupture is the most common orthopedic pathology in dog and in men. In human, optical computer-assisted technique is considered as a repeatable and reliable method for the biomechanical assessment of joint kinematics and laxity in case of CCL surgery.

Aim:

To evaluate the repeatability and reliability afforded by clinical tests in terms of laxity measured by means of a computer-assisted tracking system in two canine CCL conditions: CCL-Intact, CCL-Deficient.

Methods:

Fourteen fresh frozen canine stifles were passively subjected to Internal/External (IE) rotation at 120° of flexion and Cranial drawer test (CC). To quantify the repeatability and the reliability, intra-class correlation coefficient (ICC) and the mean percent error were evaluated (Δ r %).

Results:

The study showed a very good intra-class correlation, before and after CCL resection for kinematics tests. It was found a minimum ICC = 0.73 during the IE rotation in CCL-Intact and a maximum value of ICC = 0.97 for the CC displacement in CC-Deficient. IE rotation with CCL-Intact is the condition with the greatest Δ r % = 14%, while the lowest Δ r % = 6% was obtained for CC displacement in CCL-Deficient.

Conclusion:

The presented work underlined the possibility of using a computer-assisted method also for biomechanical studies concerning stifle kinematics and laxity.

Ex vivo mechanical properties of a 2.5-mm bone anchor for treatment of cranial cruciate ligament rupture in toy breed dogs

OBJECTIVE

To determine the mechanical pull-out properties of a 2.5-mm bone anchor implanted in ex vivo femurs of toy breed dogs and to determine whether there is a difference between knotted and knotless configurations.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Eight paired harvested femurs.

METHODS

Femurs were assigned to knotted or knotless configuration. Equal numbers of right and left femurs were tested. The caudolateral femoral condyle at the distal pole of the lateral fabella (F2 site) was drilled. The assigned configuration with braided suture combined with the bone anchor was implanted into the F2 site. Each configuration was positioned into a mechanical testing machine to measure yield load, load at 3-mm displacement, ultimate load, stiffness, and mode of failure at the beginning of the canine standing phase angle (150°).

RESULTS

Mean ultimate load was 100.14 and 88.69 N (P = .798), mean yield load was 59.72 and 55.85 N (P = .708), load at 3-mm displacement was 46.72 and 43.33 N (P = .656), and stiffness was calculated to be 43.06 and 47.09 N/mm (P = .548) for knotted and knotless configurations, respectively. Mode of failure occurred primarily by anchor pull-out.

CONCLUSION

The bone anchor withstood deformation at the estimated forces applied on the native cranial cruciate ligament (CCL) of toy breed dogs in both configurations.

CLINICAL SIGNIFICANCE

This bone anchor may constitute a useful alternative for stabilization of the CCL deficient stifle in toy breed dogs. However, before it can be recommended for widespread use in dogs, closely monitored clinical trials must be conducted to assess outcome and complications associated with this implant.

Evaluation of cranial tibial translation in dogs: Diagnostic accuracy of radiographic method using a simple device

A hand-made, radiolucent, custom-designed device having a mobile and a non-mobile platforms was used to objectively quantify the in vivo cranial tibial translation, in order to assess the functional status of cranial-cruciate-ligament (CrCL) in dogs. The hypothesis was that changes in CrCL integrity would result in detectable changes in tibial translation. To validate the diagnostic method, data from injured (PA, n = 32), contralateral (CO, n = 32) and healthy stifles (HE, n = 32) were compared. Normalized tibial translation (Δ_N) of each stifle was measured in medio-lateral radiographic projection obtained before and during standard thrust force application, in PA (43.59±12.97%), CO (20.32±6.69%) and HE (12.22±3.77%). Comparing PA with HE and CO (Δ_N cut-off value: 29.73%), diagnosis could be issued with very high probability. Comparing HE with CO (Δ_N cut-off value: 14.80%), high performance was obtained. The translator device could be a useful tool to objectively quantify the in vivo tibial translation in dogs with CrCL rupture, before surgery and during post-operatory follow-up.

Investigation of a novel prosthesis technique for extracapsular stabilization of cranial cruciate ligament-deficient stifle joints in adult cattle

OBJECTIVE

To evaluate a novel prosthesis technique for extracapsular stabilization of cranial cruciate ligament (CCL)-deficient stifle joints in adult cattle.

SAMPLE

13 cadaveric bovine stifle joint specimens.

PROCEDURES

In the first of 3 study phases, the most isometric points on the distal aspect of the femur (distal femur) and proximal aspect of the tibia (proximal tibia) were determined from measurements obtained from lateromedial radiographs of a stifle joint specimen maintained at angles of 135°, 90°, 65°, and 35°. During phase 2, 800-lb-test monofilament nylon leader line was cut into 73-cm-long segments. Each segment was secured in a loop by use of 2, 3, or 4 crimping sleeves such that there were 12 replicates for each construct. Each loop was distracted to failure at a constant rate of 1 mm/s. Mean force at failure and elongation and mode of failure were compared among the 3 constructs. During phase 3, bone tunnels were created in the distal femur and proximal tibia at the isometric points identified during phase 1 in each of 12 CCL-deficient stifle joint specimens. The 3-sleeve construct was applied to each specimen. Specimens were distracted to failure at a constant rate of 1 mm/s.

RESULTS

Among the 3 constructs evaluated, the 3-sleeve construct was considered optimal in terms of strength and amount of foreign material. In phase 3, all replicates failed because of suture slippage.

CONCLUSIONS AND CLINICAL RELEVANCE

Use of 800-lb-test monofilament nylon leader line as a prosthesis might be a viable alternative for extracapsular stabilization of CCL-deficient stifle joints in adult cattle. Further in vivo studies are necessary.

Appraisal of the Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery in dogs and cats

The Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery on dogs and cats are evidence-based guidelines for veterinary practitioners. Validation of these guidelines is necessary to ensure quality and implementability. Two validated tools, used for medical guideline appraisal, were chosen to assess the guidelines. The terminology from the GuideLine Implementability Appraisal (GLIA) and the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) were adapted for use by veterinarians. A two-phase evaluation approach was conducted. In the first phase of the evaluation, the GLIA tool was used by two specialist veterinary surgeons in clinical practice. The results of this phase were then used to modify the guidelines. In the second phase, the AGREE II tool was used by 6 general practitioners and 6 specialists to appraise the guidelines. In phase 1, the specialist surgeons either agreed or strongly agreed that the guidelines were executable, decidable, valid and novel, and that the guidelines would fit within the process of care. The surgeons were neutral on flexibility and measurability. Additional clarity around one common surgical procedure was added to the guidelines, after which the surgeons agreed that the guidelines were sufficiently flexible. In phase 2, 12 veterinarians completed the assessment using the AGREE II tool. In all sections the scaled domain score was greater than 70%. The overall quality of the guidelines was given a global scaled score of 76%. This assessment has demonstrated that the guidelines for antimicrobial prophylaxis for companion animal surgery are valid and appear implementable.

Fundamental principles of rehabilitation and musculoskeletal tissue healing

Objective

To review fundamental principles of tissue healing and physical rehabilitation as they apply to dogs recovering from cranial cruciate ligament (CCL) surgery.

Study design

Invited Review.

Sample population

None.

Methods

A multidisciplinary group of specialists in small animal surgery, rehabilitation/sports medicine, and human physical and occupational therapy reviewed the currently available evidence for rehabilitation post‐CCL surgery. Because current evidence is limited, this group proposes guidelines for rehabilitation after CCL surgery based on the fundamental principles of tissue healing and physical therapy.

Results

This Review proposes four fundamental principles of small animal physical rehabilitation based on the foundations of tissue healing and patient‐centric and goal‐oriented therapy. Postoperative rehabilitation programs should be designed such that patient progress is based on individual assessment according to the degree of tissue healing, strength, and achievement of functional goals. Therapists must fully understand phases of tissue healing, reassess the patient frequently, and use clinical reasoning skills to progress treatment appropriately for the individual patient.

Conclusion

Until more robust evidence is available to guide treatment protocols, fundamental principles of rehabilitation should ideally be adhered to when providing rehabilitation, including after CCL surgery.

Clinical significance

While this Review specifically addresses post‐CCL surgery rehabilitation, these fundamental principles should be applied broadly to animals enrolled in rehabilitation programs.

Patella tendinopathy Zoobiquity - What can we learn from dogs?

BACKGROUND

Patella tendinopathy is an overuse condition. Pathogenesis and identification of intrinsic risk factors have largely eluded the orthopaedic world. The cranial cruciate ligament (CrCL) in dogs is the equivalent to the human anterior cruciate ligament (ACL). We report the effect of two canine proximal tibial osteotomy procedures in the veterinary literature on patella tendon moment arm and describe the biomechanical rationale for a tibial tubercle osteotomy for treatment of patella tendinopathy in the human.

METHODS

A literature review of studies reporting clinical complications of TTA and TPLO to form an observational animal cohort study in dogs.

RESULTS

The veterinary literature reports an overall clinical complication rate of up to 61% for TTA and up to 50% for TPLO respectively. Complications associated with the extensor mechanism of the knee are <1% for TTA compared to 1.9-19% for TPLO. Radiographic thickening of the patella tendon and tendinopathy is seen in one to 80% of TPLO cases. The TPLO decreases the moment arm of the extensor mechanism meaning increased force is required in the patella tendon to achieve the same torque when compared to the TTA which increases the efficiency of the extensor mechanism. This difference may account, in part, for the post-operative complications reported to the patella and patella tendon following TPLO.

CONCLUSION

This observational animal cohort study demonstrates a biomechanical rationale for investigating diagnostic and potential treatment options, including a tibial tubercle osteotomy, for patella tendinopathy in humans based on this principle.

Contribution of antirotational pins and an intact fibula to the ex vivo compressive strength of four tibial plateau leveling osteotomy constructs

OBJECTIVE To assess the contribution of antirotational pins (ARPs) and an intact fibula to the compressive strength of 4 tibial plateau leveling osteotomy (TPLO) constructs (bone and implants). SAMPLE 20 hind limbs from 10 canine cadavers. PROCEDURES Each hind limb was assigned to 1 of 4 TPLO constructs (construct in which the ARP was removed, constructs in which 1 or 2 ARPs were left in place, and construct in which the ARP was removed and the fibula was cut). Following TPLO completion, all limbs underwent mechanical testing that included 10,000 cycles of cyclic axial compression followed by testing to failure at a displacement rate of 1 mm/s. Displacement during cyclic testing; load generated at 0.5, 1.0, and 3.0 mm of displacement; ultimate load; and failure type were recorded for each limb. Mean values were compared among the groups. RESULTS None of the specimens failed during cyclic testing. None of the variables assessed during mechanical testing differed significantly among the 4 groups. During testing to failure, the majority (17/20) of specimens failed as the result of a long oblique fracture through the first screw hole in the distal segment. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the axial compressive strength and stiffness of a TPLO construct were not significantly affected by the addition of 1 or 2 ARPs or the presence of an intact fibula. These findings appear to support removal of ARPs during uncomplicated TPLOs, but further research is warranted to assess the effect of ARP removal on bone healing and complication rates.

Why Owners Choose an Orthosis Over Stifle Surgery for Canine Cranial Cruciate Ligament Deficiency

The objective of this study was to describe the patient population of dogs with cranial cruciate ligament (CrCL) deficiency that were prescribed a stifle orthosis. A total of 215 client-owned dogs with previously diagnosed CrCL deficiency were prescribed a stifle orthosis at a veterinary pain management and mobility clinic. Patient intake data collected included dog signalment, chief medical complaint, home environment and activity description, medical and surgical history, and diagnosing veterinarian. An orthopedic examination was conducted to assess pelvic limb function and determine pelvic limb morphologic measures. Spayed females (57.2%) were most common in our sample. Median age, body weight, and body condition score were 9.00 ± 3.23 years, 32.98 ± 13.37kg, and 6.00 ± 1.04, respectively. Most common breeds prescribed stifle orthoses included Labrador Retriever, Golden Retriever, and German Shepherd. Right and left limbs were equally affected, and 19.5% of dogs previously had stifle stabilization surgery. Primary reasons for seeking a stifle orthosis consultation were surgical concerns, advanced age, and surgery cost. Most common chief complaints included altered gait, decreased weight bearing, and pain following activity. Reduced stifle extension, increased cranial drawer score, and decreased 3-leg stance time characterized the CrCL-deficient stifle. Stifle orthosis represents an alternative approach to surgical stabilization and management of CrCL deficiency. CrCL-deficient dogs prescribed stifle orthoses were generally large breeds of advanced age with above ideal body condition score. Owners commonly sought a stifle orthosis for CrCL deficiency due to reservations regarding surgical management.

Innovative, intra-articular, prosthetic technique for cranial cruciate ligament reconstruction in dogs: a cadaveric study

The purpose of this study was to describe and assess the feasibility of a new intra-articular approach in the treatment of cranial cruciate ligament deficiency in dogs using an artificial ligament and a new bone-anchor system. Twelve canine cadavers weighting 26 to 45 kg were used in this ex-vivo study. Special tibial and femoral screws, two helicoils, and a high resistance artificial fiber compose the implant. Surgery was performed using the cranio-lateral approach to the stifle joint. Helicoil and tibial screw, connected to the fiber, were inserted in the center of the tibial insertion area of the cranial cruciate ligament. The fiber was passed over-the-top, tensioned, and fixed to the femoral screw, previously inserted with the helicoil in the distal part of the femur. Surgery was completed in all the cases. Occasional problems found during the insertion of the helicoils and screws were resolved with simple procedures. Post-operative clinical assessment showed negative cranial drawer test, negative cranial tibial thrust, and normal range of motion. Radiographic evaluation showed an appropriate positioning of both tibial and femoral implants in all the cases. The results of the first surgical appraisal of this new technique are encouraging, although further studies are necessary to demonstrate the in vivo efficacy of this procedure.

Management of cranial cruciate ligament rupture in small dogs: A questionnaire study

Objectives: To survey the current management of cranial cruciate ligament rupture in small dogs (<15 kg) by veterinarians.

Methods: A questionnaire was distributed to veterinarians attending the British Veterinary Orthopaedic Association Spring meeting and British Small Animal Veterinary Association Annual Congress which took place in April 2010. Respondents were surveyed on their management of small dogs with cranial cruciate ligament rupture

Results: Immediate surgical management was chosen by 15.5% of the respondents. Following that, 77.6% of respondents suggested that case management would depend on severity of lameness (81%), age (72.6%), bodyweight (70.4%), degree of instability (64.8%), and duration of lameness (64.0%). Conservative management included non- steroidal antiinflammatory drugs (91.1%), short leash walks (91.1%), weight loss (89.0%), hydrotherapy (53.6%), physiotherapy (41.9%), and cage rest (24.2%). Where surgical management was chosen, 71.4% would perform the procedure rather than refer it to another practice. Surgical techniques included extra-capsular stabilisation (63.4%), corrective osteotomies (32.9%), and intra-articular stabilisation (6.8%). The demographic characteristics of the responding veterinarians had no effect on their initial management of the case. General practice veterinarians were less likely to perform a corrective osteotomy than to refer the case, but were no less likely to perform an extracapsular technique.

Clinical significance: Conservative management is still widely used for treatment of cranial cruciate ligament rupture in dogs weighing less than 15 kg; this is in agreement with previous publications on the management of this condition in small dogs.

Treatment of cranial cruciate ligament rupture in the feline stifle

Objective: To determine whether a lateral suture placed with bone anchors between quasi-isometric points in a cat is superior to a standard fabella-tibial suture for the stabilization of cranial cruciate ligament (CrCL) rupture compared to an intact stifle joint.

Study design: Biomechanical cadaveric study.

Methods: Six stifle joints with intact cruciate ligaments from three skeletally mature cats were placed in a loading mounting set and tested with axial loads of 20N and 60N at three different joint angles (75°,130° and 160°). The procedure was repeated with a transected CrCL; a stabilized stifle joint after a combination of three lateral suture techniques (fabella-tibial suture technique [SFT]; femoro-tibial suture technique 1 [FTS-1] and femoro-tibial suture technique 2 [FTS-2]). Radiographic examination of the relative position of the tibia to the fixed femur was compared.

Results: Stabilization of the stifle joint with lateral sutures had comparable stability to the intact specimens in the cranio-caudal direction (p = 0.2) but not in the proximo- distal direction for the SFT (p = 0.04) and FTS-2 technique (p = 0.03). There was no significant difference between the three stabilization techniques (p >0.05).

Clinical significance: Lateral sutures placed with bone anchors at quasi-isometric points performed better than SFT and FTS-2 in stabilizing the feline stifle after CrCL rupture in the proximo-distal plane. Biomechanical stability in the cranio-caudal plane after placement of a lateral suture across the feline stifle was similar to the intact CrCL.

The effects of a novel lateral extracapsular suture system on the kinematics of the cranial cruciate deficient canine stifle

Objective To evaluate the relative position of the femur and tibia in cranial cruciate ligament- intact stifles, cranial cruciate ligamentdeficient stifles, and cruciate-deficient stifles following lateral extracapsular suture system (LESS) stabilization under load at specific joint angles.

Study design In vitro biomechanical study.

Methods Twenty pelvic limbs from 11 dogs were used to evaluate the relative position of the femur and tibia between three stifle conditions (cranial cruciate ligament-intact, cranial cruciate ligament-deficient, and LESSstabilized) at a load of 30% of body weight and stifle angles of 125°, 135°, and 145° using electromagnetic tracking sensors.

Results Cranial cruciate ligament-deficient stifles had significantly greater (p <0.0001) cranial displacement and internal rotation of the tibia relative to the femur than cranial cruciate ligament-intact or LESS stifles at all stifle angles. Cranial displacement of the tibia relative to the femur for cranial cruciate ligament-intact and LESS stifles were not significantly different from one another at a stifle angle of 125°, but were significantly different at stifle angles of 135° (p = 0.0182) and 145° (p = 0.0012). There was no significant difference in internal rotation of the tibia relative to the femur between the cranial cruciate ligament-intact and LESS stifles at any of the stifle angles.

Clinical significance The LESS procedure effectively decreased cranial tibial displacement and eliminated internal rotation of the tibia relative to the femur in the cranial cruciate ligament-deficient stifles at stifle angles of 125°, 135°, and 145° in vitro.

A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle

Extra-articular prosthetic stabilization techniques have been used as a method of stabilization of the cranial cruciate ligament (CrCL)-deficient stifle for decades. During extra-articular prosthetic stabilization, the prosthesis is anchored to the femur and tibia, and tensioned in the attempt to resolve femorotibial instability. The position of the anchor points of the prosthesis is crucial for restoring a normal range of joint motion and mitigating alterations in prosthesis tension during motion. Recently developed techniques offer several innovations with potential advantages such as bone-to-bone fixation, prosthetic materials with better mechanical properties, and improved isometry of the anchor points. Whether these innovations provide clinically superior results to the traditional techniques such as lateral circumfabellar-tibial suture techniques has yet to be determined.

Computer-assisted gait analysis of the dog: Comparison of two surgical techniques for the ruptured cranial cruciate ligament

Objectives: To compare the improvement in degree of lameness following surgical repair of cranial cruciate ligament rupture in dogs using computer-assisted gait analysis.

Methods: Two groups of 14 dogs were used. One group was treated by a capsular-fascial imbrication method, and the other group by tibial plateau levelling osteotomy (TPLO). All dogs underwent gait analysis prior to surgery, as well as at four days, four weeks, and four months after surgery. Symmetry indices of vertical ground reaction forces as well as vertical ground reaction forces in % body weight, joint angles and certain gait cycle parameters were evaluated.

Results: Four months after surgery, the degree of lameness expressed as symmetry index for peak vertical force for the TPLO group (5.83%) was not significantly different to the capsular-fascial imbrication group (19.05%). Within the TPLO group, there was a significantly increased ability to extend the stifle joint four months after surgery. The stifle motion pattern of the capsular-fascial imbrication group as well as the range-of-motion in both groups showed very little change at the time of the last gait analysis. The complication rate was greater in the TPLO group than in the capsular-fascial group.

Clinical significance: In conclusion the results suggest that the TPLO method leads to a faster recovery and improved limb function in comparison to the capsular-fascial imbrication method four months after surgery. Further analyses are needed to determine if the TPLO method is superior concerning long-term joint stability.

Online supplementary material: A video of the three-dimensional kinematic model is available online at: http://www.vcot-online.com

Complications of tibial plateau levelling osteotomy in dogs

The tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intraoperative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.

Correction of craniodorsal coxofemoral luxation in cats and small breed dogs using a modified Knowles technique with the braided polyblend TightRope™ systems

Objectives: To report the surgical technique and short-term radiographic and functional outcome data for a series of client owned, small breed dogs and cats treated for traumatic craniodorsal coxofemoral luxation using open reduction and internal fixation with the Arthrex Mini TightRope (mTR) and TightRope (TR) systems.

Methods: Data were collected retrospectively from the clinical case records, including the initial clinical and radiographic findings, surgical technique, and postoperative short-term clinical and radiographic data. Functional data collected after the six weeks reassessment were obtained via owner questionnaire.

Results: Four cats (mTR = 4) and five small breed dogs (mean weight 15 kg; TR = 4, mTR = 1) were included. Median time to postoperative weight bearing was one day. Median lameness score at six weeks postoperatively was 0 out of 5. Coxofemoral joint congruity was radiographically confirmed at the six weeks postoperative visit. Telephone follow-up (at a median of 16 weeks) revealed all animals had returned to their previous level of activity. Complications were minor, and limited to postoperative swelling (n = 1).

Clinical significance: Clinical use of the Arthrex Mini TightRope™ and TightRope™ systems can be recommended for traumatic craniodorsal coxofemoral luxation in this novel application as short-term results are at least comparable to existing surgical techniques. Long-term follow-up studies are needed.

Intertarsal Joint Stabilization in a Bateleur Eagle (Terathopius ecaudatus) Using a Novel Application of a Braided Suture and Titanium Button System

A 32-year-old adult captive male bateleur eagle (Terathopius ecaudatus) with a history of laxity, degenerative joint disease, and varus deviation of the distal left hindlimb for several years was presented for evaluation of left hindlimb lameness and was diagnosed with chronic subluxation of the left intertarsal joint. After failing to improve with conservative management and pain medication, surgical stabilization of the joint was performed using a novel application of a braided suture and titanium button system. Unsatisfactory clinical improvement and postsurgical reevaluation indicated that the initial surgical stabilization was unsuccessful. The surgery was repeated, and the animal showed postsurgical improvement in intertarsal joint stability, weight-bearing, and lameness for a period of several years with use and adjustment of chronic pain medications. The novel surgical technique described in this case report represents an additional treatment option for management of avian intertarsal joint subluxations. Presurgical planning should consider the unique anatomic features and variability of the avian tarsometatarsus to avoid surgical complications.

Comparison of two cold compression therapy protocols after tibial plateau leveling osteotomy in dogs

OBJECTIVE

To evaluate two different protocols of cold compression therapy (CCT) for pain management and functional recovery in dogs undergoing tibial plateau leveling osteotomy (TPLO).

MATERIAL AND METHODS

A total of 27 adult dogs (n = 30 stifles; staged bilateral procedures: n = 3) undergoing routine TPLO were randomly allocated to three groups (n = 10/group). Dogs of group I received CCT once before and immediately after surgery. In dogs of group II CCT was performed postoperatively four times at 6-hour intervals. Dogs of the control group did not receive CCT. Circumference of the stifle joint and the following pain-related parameters were measured by a single blinded observer before surgery and 1, 10 and 42 days after surgery: stifle joint range of motion (ROM), subjective degree of lameness, and score of a modified Glasgow Pain Scale (GPS).

RESULTS

Both CCT groups showed significantly greater ROM and lower GPS scores 24 hours after surgery compared to the control group. Ten days after surgery there was a significantly lower degree of lameness in both CCT groups compared to the control group. Fourty-two days after surgery a significantly greater ROM was observed in both CCT groups compared to the control group. Group II also showed a significant improvement in the degree of lameness and GPS. There were no significant differences in any of the parameters between the two CCT groups at any time point.

CONCLUSION

CCT applied preoperatively and immediately postoperatively showed similar short- and long-term beneficial results compared to a previously established protocol of applying CCT four times postoperatively. This protocol may be more suitable for practical use.

CLINICAL SIGNIFICANCE

The reported data can be used to establish the new protocol of CCT in a clinical surrounding and to support postoperative rehabilitation of the canine patient.

Use of a novel extracapsular bone anchor system for stabilisation of cranial cruciate ligament insufficiency

OBJECTIVES

To evaluate early clinical experiences using the novel extracapsular bone anchor Ruby system for stabilisation of the cranial cruciate ligament deficient stifle in the dog and report short-term outcome and complications for 17 clinical cases.

MATERIALS AND METHODS

Seventeen dogs with cranial cruciate ligament insufficiency were treated using the Ruby system. Dogs were eligible if diagnosed via orthopaedic examination with unilateral or bilateral cranial cruciate ligament instability without any comorbidities. Subjective lameness assessments on a 0 to 4 scale were made pre-operatively and at six to eight weeks post-operatively; complications were also recorded. Lameness was also assessed on a visual analogue scale at six to eight months post-operatively.

RESULTS

All cases had substantial improvement in lameness following surgery. Mean post-operative lameness grade was 1·18 (±0·53) out of 4, compared to a grade of 3·06 (±0·9) before surgery, and owner assessment at six to eight months after surgery was also positive. There were major complications that required surgical intervention in one dog.

CLINICAL SIGNIFICANCE

The Ruby system is a feasible method of extracapsular stabilisation with comparable outcomes and complication rates to previously reported methods of addressing cranial cruciate ligament insufficiency. Further work is required to acquire more data on objective outcome measurement and mechanisms of failure.

Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model

OBJECTIVE To evaluate effects of an orthosis on biomechanics of a cranial cruciate ligament (CrCL)-deficient canine stifle joint by use of a 3-D quasistatic rigid-body pelvic limb computer model simulating the stance phase of gait and to investigate influences of orthosis hinge stiffness (durometer). SAMPLE A previously developed computer simulation model for a healthy 33-kg 5-year-old neutered Golden Retriever. PROCEDURES A custom stifle joint orthosis was implemented in the CrCL-deficient pelvic limb computer simulation model. Ligament loads, relative tibial translation, and relative tibial rotation in the orthosis-stabilized stifle joint (baseline scenario; high-durometer hinge]) were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. Sensitivity analysis was conducted to evaluate the influence of orthosis hinge stiffness on model outcome measures. RESULTS The orthosis decreased loads placed on the caudal cruciate and lateral collateral ligaments and increased load placed on the medial collateral ligament, compared with loads for the CrCL-intact stifle joint. Ligament loads were decreased in the orthosis-managed CrCL-deficient stifle joint, compared with loads for the CrCL-deficient stifle joint. Relative tibial translation and rotation decreased but were not eliminated after orthosis management. Increased orthosis hinge stiffness reduced tibial translation and rotation, whereas decreased hinge stiffness increased internal tibial rotation, compared with values for the baseline scenario. CONCLUSIONS AND CLINICAL RELEVANCE Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.

Partial Cranial Cruciate Ligament Tears Treated with Stem Cell and Platelet-Rich Plasma Combination Therapy in 36 Dogs: A Retrospective Study

Objective

To evaluate outcomes in 36 dogs with a partial cranial cruciate ligament (CCL) tear treated with autologous bone marrow aspirate concentrate (BMAC) or adipose-derived progenitor cells (ADPC) with platelet-rich plasma (PRP) combination.

Materials and methods

Medical records of client-owned dogs diagnosed with an early partial (≤50%) tear of the craniomedial band of the CCL that was treated with BMAC–PRP or ADPC–PRP were reviewed from 2010 to 2015. Signalment, medical history, physical and orthopedic examination, objective temporospatial gait analyses, radiographs, day 0 and day 90 diagnostic arthroscopy findings, treatment, and outcome were among the data collected. A functional owner questionnaire, including the validated Helsinki chronic pain index (HCPI), was sent to owners whose dog was known to not have had a tibial plateau leveling osteotomy (TPLO). Statistical analysis was performed on data, where significance was established at p < 0.05.

Results

Stifle arthroscopy findings at 90 days posttreatment were available on 13 of the 36 dogs. In nine dogs, a fully intact CCL with marked neovascularization and a normal fiber pattern was found with all previous regions of disruption healed. One dog revealed significant improvement and received an additional injection. The remaining three dogs had a >50% CCL tear, and a TPLO was performed. Four additional dogs were known to have had a TPLO performed elsewhere. Baseline and day 90 posttreatment objective gait analyses were available on 11 of the 36 dogs. A significant difference was found between the treated limb total pressure index percent (TPI%) at day 0 and day 90 (p = 0.0124), and between the treated limb and contralateral limb TPI% at day 0 (p = 0.0003). No significant difference was found between the treated limb and contralateral limb TPI% at day 90 (p = 0.7466). Twelve questionnaires were returned, of which eight were performance/sporting dogs. Seven of the eight had returned to sport; the remaining dog had just begun a return to sport conditioning program 6 months posttreatment. All 12 respondents believed that their dog had an excellent or very good quality of life and rated their dog’s procedural outcome as excellent or good.

Conclusion

The use of BMAC–PRP and ADPC–PRP shows promise for the treatment of early partial CCL tears in dogs. Further studies are needed and should be randomized, blinded, and controlled.

Systematic review of surgical treatments for cranial cruciate ligament disease in dogs

Surgery for cranial cruciate ligament disease is often recommended; however, it is unclear if one procedure is superior. The aim of this systematic review was to answer the a priori question, "Is there a surgical procedure that will allow a consistent return to normal clinical function in dogs with cranial cruciate ligament disease and is that procedure superior to others?" A systematic literature search was performed through September 2013. Peer reviewed publication in the English language and 6 mo of postoperative follow-up were required. In total, 444 manuscripts were identified and reviewed, and 34 met the inclusion criteria. Two studies provided level 1, 6 provided level 2, 6 provided level 3, and 20 provided level 4 evidence relative to the study question. The most common surgical procedures included tibial plateau leveling osteotomy (TPLO, n = 14), lateral extracapsular suture (n = 13), tibial tuberosity advancement (n = 6). The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function. It also provided strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture. There was insufficient data to adequately evaluate other surgical procedures.

Suspensory Versus Interference Screw Fixation for Arthroscopic Anterior Cruciate Ligament Reconstruction in a Translational Large-Animal Model

PURPOSE

To compare all-inside cortical-button suspensory fixation in sockets versus interference screw fixation in tunnels with respect to clinical, histologic, and biomechanical assessments of all-soft tissue (AST) tendon autografts used for anterior cruciate ligament (ACL) reconstruction in a canine model.

METHODS

By use of a validated "hybrid" double-bundle ACL reconstruction technique (reconstruction of the anteromedial bundle with preservation of the native posterolateral bundle), dogs were randomly assigned to undergo either suspensory fixation in sockets (n = 6) or interference screw fixation in tunnels (n = 6). Contralateral knees were used as nonoperated controls (n = 12). Quadrupled extensor tendon autografts were used for both ACL reconstruction groups. Dogs were assessed radiographically and functionally and humanely euthanized at 12 weeks after surgery for arthroscopic, gross, biomechanical, and histologic assessments.

RESULTS

Histologic assessments showed significantly (P = .018) better graft incorporation with 4-zone direct healing to bone for the grafts using suspensory fixation in sockets (16.3 ± 1.5) compared with the grafts using interference screw fixation in tunnels (14.2 ± 2.1). Furthermore, graft healing to bone was significantly better at the aperture (P = .05) and mid-socket (P = .01) location for the group that underwent suspensory fixation in sockets (16.1 ± 1.8 and 16.4 ± 1.9, respectively).

CONCLUSIONS

Suspensory fixation of AST grafts in sockets was associated with superior tendon-to-bone healing compared with interference screw fixation in tunnels, with 4-zone direct graft healing to bone seen for femoral and tibial sockets only in the suspensory-fixation group. Biomechanical properties were similar between groups.

CLINICAL RELEVANCE

These data provide evidence suggesting that an all-inside ACL reconstruction technique using adjustable-loop cortical-button suspensory fixation in bone sockets has potential clinical advantages for ACL reconstruction using AST grafts.

Owner Evaluation of a CORA-Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs

OBJECTIVE

To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs.

STUDY DESIGN

Retrospective case series.

ANIMALS

Dogs (n=70).

METHODS

Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dog's function after surgery. Based on owner responses, clinical outcomes were established.

RESULTS

CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related.

CONCLUSION

The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function.