Joint stability after canine cranial cruciate ligament graft reconstruction varies among femoral fixation sites

Intra-Articular Surgical Reconstruction of a Canine Cranial Cruciate Ligament Using an Ultra-High-Molecular-Weight Polyethylene Ligament: Case Report with Six-Month Clinical Outcome

The intra-articular reconstruction of the cranial cruciate ligament (CrCL) by an organic graft or a synthetic implant allows the restoration of physiological stifle stability. This treatment is still marginal in routine practice. A Rottweiler presented an acute complete CrCL rupture treated using an ultra-high-molecular-weight polyethylene (UHMWPE) implant. The latter was positioned under arthroscopic guidance and fixed with interference screws through femoral and tibial bone tunnels. The dog was weight-bearing just after surgery and resumed normal standing posture and gait after one month, with mild signs of pain upon stifle manipulation. At three months postoperatively, minimal muscle atrophy and minimal craniocaudal translation were noted on the operated hindlimb, with no effects on the clinical outcome. The stifle was painless. At six months postoperatively, standing posture and gait were normal, muscle atrophy had decreased, the stifle was painless, and the craniocaudal translation was stable. On radiographs, congruent articular surfaces were observed without worsening of osteoarthrosis over the follow-up, as well as stable moderate joint effusion. Replacement of a ruptured CrCL with a UHMWPE ligament yielded good functional clinical outcome at six months postoperatively. This technique could be considered an alternative for the treatment of CrCL rupture in large dogs, but it needs confirmation from a prospective study with more dogs.

Evaluation of canine adipose-derived multipotent stromal cell differentiation to ligamentoblasts on tensioned collagen type I templates in a custom bioreactor culture system

OBJECTIVE

To evaluate differentiation of canine adipose-derived multipotent stromal cells (ASCs) into ligamentoblasts on tensioned collagen type I (Col1) templates in a perfusion culture system.

SAMPLES

Infrapatellar fat pad ASCs from healthy stifle joints of 6 female mixed-breed dogs.

PROCEDURES

Third-passage ASCs (6 × 10⁶ cells/template) were loaded onto suture-augmented Col1 templates under 15% static strain in perfusion bioreactors. Forty-eight ASC-Col1 constructs were incubated with ligamentogenic (ligamentogenic constructs; n = 24) or stromal medium (stromal constructs; 24) for up to 21 days. Specimens were collected from each construct after 2 hours (day 0) and 7, 14, and 21 days of culture. Cell number, viability, distribution, and morphology; construct collagen content; culture medium procollagen-I-N-terminal peptide concentration; and gene expression were compared between ligamentogenic and stromal constructs.

RESULTS

ASCs adhered to collagen fibers. Cell numbers increased from days 0 to 7 and days 14 to 21 for both construct types. Relative to stromal constructs, cell morphology and extracellular matrix were more mature and collagen content on day 21 and procollagen-I-N-terminal peptide concentration on days 7 and 21 were greater for ligamentogenic constructs. Ligamentogenic constructs had increased expression of the genes biglycan on day 7, decorin throughout the culture period, and Col1, tenomodulin, fibronectin, and tenascin-c on day 21; expression of Col1, tenomodulin, and tenascin-c increased between days 7 and 21.

CONCLUSIONS AND CLINICAL RELEVANCE

Ligamentogenic medium was superior to stromal medium for differentiation of ASCs to ligamentoblasts on suture-augmented Col1 scaffolds. Customized ligament neotissue may augment treatment options for dogs with cranial cruciate ligament rupture.

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.

Long-term arthroscopic assessment of intra-articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog

OBJECTIVE

To assess the 12-month survival of intra-articular, decellularized allografts for the treatment of cranial cruciate ligament disease (CCLD) in dogs.

STUDY DESIGN

Prospective case series.

ANIMALS

Twenty client-owned dogs with spontaneous CCL rupture.

METHODS

Affected stifles were treated solely by implantation of an intra-articular, decellularized, deep digital flexor tendon allograft. Functional outcome was evaluated at baseline and at 6 and 12 months after surgery with the Liverpool Osteoarthritis for Dogs questionnaire and force platform gait analysis. At 12 months after surgery, dogs underwent arthroscopy to visually assess the allografts.

RESULTS

Scores on owner questionnaires (improved 62.5%; P = .005) and ground reaction forces (improved 34.4%; P = .017) were improved in all dogs 12 months after surgery. Dogs with an intact graft (IG) were more likely to have a successful outcome compared with dogs with a torn graft (P = .011). According to arthroscopy, 45% of grafts seemed to survive at 12 months after surgery.

CONCLUSION

About half of intra-articular allografts survived 12 months after implantation in CCL-deficient stifles. Dogs with IG had successful outcomes at 12 months after surgery according to assessment by force platform gait analysis.

CLINICAL SIGNIFICANCE

These results preclude immediate clinical application but provide evidence to justify further investigation of intra-articular grafts as a repair option for CLLD.

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.

ESTUDO DA TÉCNICA INTRACAPSULAR ASSISTIDA POR ARTROSCOPIA PARA O TRATAMENTO DA RUPTURA DO LIGAMENTO CRUZADO CRANIAL EM CADÁVERES DE CÃES

Resumo O objetivo foi estudar e aprimorar a técnica intracapsular de reparação do ligamento cruzado cranial assistida por artroscopia em cadáveres de cães com a confecção dos túneis tibial e femoral e utilização de autoenxerto osso-tendão patelar-osso. Foram utilizados 10 membros pélvicos de cães > 20kg. Os túneis ósseos foram confeccionados de forma independente e na posição anatômica original dos locais de inserção do ligamento cruzado cranial. Foram realizados estudo radiográfico e tomográfico para avaliar a articulação. A coleta das porções ósseas do enxerto foi feita com osteótomo e martelo. Ocorreram fratura em três patelas e em três tuberosidades tibiais. Os enxertos apresentaram comprimento médio 7,56cm. Os túneis tibiais e os túneis femorais foram confeccionados no local de inserção do ligamento cruzado cranial em 80% e 90% das articulações, respectivamente. Os túneis tibiais apresentaram ângulo médio de 62,95º mensurado por tomografia computadorizada. Os túneis femorais foram confeccionados em posição 13hs para o joelho esquerdo (100%) e 11hs para o direito (100%). Ao final do procedimento, obteve-se gaveta negativo em 100% das articulações. Pode-se concluir que a técnica proposta é viável de ser realizada no cão, porém faz-se necessário instrumental específico devido ao pequeno tamanho da articulação canina para obter melhor acurácia.