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Schmutterer JM, Augat P, Greinwald M, Meyer-Lindenberg A. Evaluation of Meniscal Load and Load Distribution in the Sound Canine Stifle at Different Angles of Flexion. Vet Comp Orthop Traumatol 2024; 37:230-235. [PMID: 38626887 PMCID: PMC11405098 DOI: 10.1055/s-0044-1782682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
OBJECTIVES The aim of the study was to investigate the contact mechanics and kinematic changes in the stifle in different standing angles. STUDY DESIGN We performed a biomechanical ex vivo study using pairs of canine cadaver hindlimbs. Motion sensors were fixed to the tibia and the femur for kinematic data acquisition. Pressure mapping sensors were placed between the femur and both menisci. Thirty percent bodyweight was applied to the limbs with the stifle in 125, 135, or 145 degrees of extension. RESULTS Stifle flexion angle influences femoromeniscal contact mechanics significantly. The load on both menisci was significantly higher for 125 and 135 degrees in comparison to 145 degrees. Additionally, the center of force was located significantly more caudal when comparing 125 to 145 degrees in the medial meniscus as well as in both menisci combined. CONCLUSION The angle of knee flexion significantly impacts the contact mechanics between the femur and the meniscus. As the knee flexes, the load on both menisci increases.
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Affiliation(s)
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Greinwald
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
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Gollnick HR, McCarthy J, Muir P. Tibial fracture associated with use of Arthrex self-tapping screws during tibial plateau leveling osteotomy in dogs and development of transcortical tibial fracture. Vet Surg 2024; 53:1009-1018. [PMID: 38923543 DOI: 10.1111/vsu.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/21/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Medical records for dogs treated with tibial plateau leveling osteotomy (TPLO) using Arthrex 3.5 mm self-tapping screws (STS) were evaluated to determine the incidence rate of transcortical tibial fractures (TCTF) and development of complications. STUDY DESIGN Retrospective case report. STUDY POPULATION A total of 78 dogs. METHODS Dogs that underwent a TPLO performed from March 2022 to August 2023 were reviewed. Postoperative TPLO radiographs were examined for evidence of a TCTF with Arthrex 3.5 mm STS. Records were reviewed for complications up to 14 weeks after surgery. RESULTS Evidence of a TCTF was found in 42% of cases (33 of 78) and 14% (36 of 250) of STS screws distal to the osteotomy. TCTFs were only identified distal to the osteotomy. Three dogs had radiographic evidence of more than one TCTF. Of the dogs with radiographic TCTF, 6% of patients (2 of 33) developed a major complication that required surgical stabilization of a tibial fracture associated with screw angulation relative to the plate. CONCLUSION Use of Arthrex 3.5 mm STS for TPLO is associated with risk of TCTF. TCTF can compromise the structural properties of the tibia and cause complete tibial fracture requiring major revision surgery. CLINICAL SIGNIFICANCE Development of TCTF after use of STS for TPLO has been recognized, in contrast to use of non-self-tapping screws, and was considered a benign complication. Our findings suggest TCTF associated with Arthrex 3.5 mm STS use in TPLO can contribute to major complications after surgery, including complete tibial fracture, particularly if screws are not placed perpendicular to the plate.
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Affiliation(s)
- Hailey R Gollnick
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jessica McCarthy
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Peter Muir
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Sun CY, Lin CC, Wu CH. Ex vivo biomechanical investigations of combined extra- and intracapsular stabilization in canines with cranial cruciate ligament deficiency. Front Vet Sci 2024; 11:1336797. [PMID: 38933704 PMCID: PMC11199530 DOI: 10.3389/fvets.2024.1336797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Intracapsular reconstruction (ICR) has long been recommended as a treatment for cranial cruciate ligament deficiency (CCLD) in dogs, but it has fallen out of favor due to its inferior long-term functional outcomes. These outcomes may be attributed to the poor stiffness and strength of the graft in the early period before ligamentization is completed. Additional placement of extracapsular sutures to mechanically protect the graft during the ligamentization process may be a viable method to address this problem. However, the biomechanical effect of this combined surgical approach remains unknown. This study aimed to evaluate the 3D kinematics of the CCLD stifle in dogs in response to ICR and combined extra- and intracapsular reconstruction (CEICR). Twelve hindlimbs were collected from nine cadavers of mature dogs. The limbs were tested using a custom-made testing apparatus that reproduces their sagittal plane kinematics during the stance phase. Four statuses of stifle joints were tested, namely, (a) cranial cruciate ligament (CCL) intact; (b) CCLD; (c) CCLD stifle stabilized by CEICR; and (d) CCLD stifle stabilized by ICR only. Three-dimensional stifle kinematics at the 5 instances of the stance phase were measured with an optoelectronic system. The results showed that ICR marginally corrects the increased adduction, internal rotation, and caudodistal stifle joint center displacement that occur as a result of CCLD. CEICR led to better restoration of the stifle kinematics, especially with respect to the internal rotation and cranial translation stabilities. Furthermore, CEICR only resulted in minor excessive restraints on other motion components. The findings indicated that the additional lateral fabellotibial suture offers immediate stability to the stifle, consequently lowering the risk of graft over-elongation in the short term postoperatively. Considering the propensity for the extracapsular suture to degrade over time, further in vivo studies are warranted to explore the long-term effects of the CEICR procedure.
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Affiliation(s)
- Cheng-Yuan Sun
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
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Volz F, Eberle D, Klever J, Zablotski Y, Kornmayer M. Effect of tibial plateau angle < 5° on ground reaction forces in dogs treated with tibial plateau leveling osteotomy for cranial cruciate ligament rupture up to 6 months postoperatively. Vet J 2024; 305:106126. [PMID: 38723995 DOI: 10.1016/j.tvjl.2024.106126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
Tibial plateau leveling osteotomy (TPLO) has been commonly performed in dogs with cranial cruciate ligament disease (CCLD) since the introduction by Slocum and Slocum (1993). To reduce cranial tibial thrust the TPLO technique aims for a postoperative tibial plateau angle (TPA) of 5-6.5°. In recent years studies have shown that a postoperative TPA below 5° could be beneficial regarding stifle stability or meniscal load. Dogs with CCLD that were treated with TPLO, were examined preoperatively, six weeks, three and six months postoperatively with gait analysis and grouped according to their postoperative TPA. The aims of study was (1) to evaluate if dogs with a postoperative TPA below 5° would have a faster limb function recovery up to six months postoperatively as measured objectively with ground reaction forces (GRFs) and (2) to determine whether the postoperative TPA correlates with the outcome measurements. Dogs with TPA <5° showed no faster limb function recovery postoperatively up to six months as measured with peak vertical force (PVF) or vertical impulse (VI) (p > 0.05). No correlation for the postoperative TPA <5° on GRFs was demonstrated. But the postoperative TPA showed a significant correlation with the symmetry indices of PVF (SIPVF) and VI (SIVI) for all dogs (>5° and <5° TPA together), indicating that with lower postoperative TPA dogs had a more symmetrical gait in hindlimbs SIPVF (r = 0.144, p < 0.05) and SIVI (r = 0.189, p < 0.01). The study indicates that a lower postoperative TPA could be beneficial regarding hindlimb symmetry indices of GRFs.
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Affiliation(s)
- F Volz
- Small Animal Clinic, Ludwig-Maximilians University, Veterinaerstraße 13, Munich 80539, Germany.
| | - D Eberle
- Small Animal Clinic Stuttgart Plieningen, Hermann-Fein-Straße 15, Stuttgart 70599, Germany
| | - J Klever
- Royal Veterinary College, University of London, Hawkshead Ln, Brookmans Park, Hatfield AL97TA, UK
| | - Y Zablotski
- Small Animal Clinic, Ludwig-Maximilians University, Veterinaerstraße 13, Munich 80539, Germany
| | - M Kornmayer
- Small Animal Clinic, Ludwig-Maximilians University, Veterinaerstraße 13, Munich 80539, Germany
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Zhalniarovich Y, Mieszkowska M, Morawska-Kozłowska M. Tibial Plateau Leveling Osteotomy following Tibial Tuberosity Advancement Cage Removal: A Case Report. Animals (Basel) 2023; 13:3444. [PMID: 38003061 PMCID: PMC10668716 DOI: 10.3390/ani13223444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The purpose of this case report is to describe the functional and clinical outcome of a tibial plateau leveling osteotomy (TPLO) in a dog with joint instability and persistent lameness following a Tibial Tuberosity Advancement surgery (TTA) Rapid. A six-year-old male Labrador retriever (38 kg) with a tibial plateau angle of 27° and a patella ligament to tibial plateau angle of 102° and persistent lameness lasting six months after TTA Rapid surgery has been examined. During orthopedic examination, the lameness was subjectively graded 3/5 and the positive drawer and tibial compression tests were performed. The TTA Rapid cage and all screws were completely removed from the tibia to have enough room to perform a TPLO radial cut. A lameness score evaluation, client satisfaction and radiographic follow-up were performed at 4 weeks, 8 weeks and 6 months postoperatively. Long-term follow-up showed radiologically excellent healing with fusion of the gap and disappearance of the osteotomy line. Six months postoperatively, no lameness was detected at a walk and trot. The owner was completely satisfied and reported the dog being free from lameness even after long walks. No complications related to the TPLO surgery occurred.
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Affiliation(s)
- Yauheni Zhalniarovich
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 14, 10-718 Olsztyn, Poland; (M.M.); (M.M.-K.)
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Clark N, Comerford E. An update on mobility assessment of dogs with musculoskeletal disease. J Small Anim Pract 2023; 64:599-610. [PMID: 37455329 DOI: 10.1111/jsap.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/31/2023] [Accepted: 06/10/2023] [Indexed: 07/18/2023]
Abstract
Mobility impairments associated with musculoskeletal diseases, such as osteoarthritis and degenerative joint disease, affect approximately 200,000 dogs annually and pose a notable challenge to canine health and welfare. Osteoarthritis causes the remodelling of synovial joints, alongside inflammation and impaired mechanical function which can be extremely debilitating. Secondary osteoarthritis commonly affects dogs and can be exacerbated by previous joint abnormalities, such as patellar luxation or cranial cruciate ligament rupture. Although musculoskeletal diseases can affect dogs of any age, the early subtle signs of gait abnormalities are perhaps missed by owners, thus, dogs may be in the latter stages of osteoarthritis progression when they are presented to veterinarians. Dogs showing subtle signs of gait abnormalities must be presented to veterinary practices for acute diagnosis to prevent long-term deterioration. Musculoskeletal diseases, such as osteoarthritis and degenerative joint disease, are commonly diagnosed via visible radiographic changes. However, veterinarians can use a combination of subjective and objective clinical scoring systems, such as clinical metrology instruments and gait assessment in conjunction with radiography to aid their diagnosis and longitudinal monitoring of musculoskeletal diseases. These scoring systems may be more sensitive to earlier signs of mobility impairments in dogs, ultimately, promoting increased canine health and welfare by enabling pain reduction, improvement of muscle strength and preservation of joint function. Current canine mobility scoring systems available to veterinarians will be discussed in turn throughout this review for implementation into clinical practice.
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Affiliation(s)
- N Clark
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - E Comerford
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
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Scaglione J, Carver J. Incidence of postoperative administration of opioids in dogs undergoing a tibial plateau leveling osteotomy after intra-operative liposomal bupivacaine administration with or without morphine epidural. BMC Vet Res 2023; 19:102. [PMID: 37525246 PMCID: PMC10388522 DOI: 10.1186/s12917-023-03664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To determine the influence of two intraoperative pain management protocols on the need for additional opioids in patients receiving an epidural and periarticular liposomal bupivacaine (PLB) vs. PLB alone in the 12-24 h period after undergoing a TPLO. STUDY DESIGN Retrospective study. ANIMALS One hundred seventy-four dogs with cranial cruciate ligament tears presenting for TPLO. METHODS Medical records of dogs presenting for a unilateral or bilateral cranial cruciate ligament tear who had a TPLO performed were reviewed for signalment, weight, body condition score, and peri-operative pain management protocol. Dogs were divided into two groups: those who received an epidural and PLB, and those who received only PLB. Post-operative opioid administration was recorded for each group. RESULTS Patients who received an epidural and PLB received fewer postoperative opioids. There were 36% fewer opioid injections administered to dogs who received epidurals compared to dogs who did not receive epidurals (IRR) (95% CI) = 0.64 (0.45-0.92), P = 0.02). BCS was not a significant predictor of the post-operative opioid requirement (IRR (95% CI) = 1.3 (0.75-2.4), P = 0.38). When adjusting for BCS as a possible confounder, there were 39% fewer opioid injections in dogs who received epidurals than dogs without (IRR (95% CI) = 0.61 (0.42-0.88), P = 0.009). CONCLUSIONS The incidence of postoperative opioid administration was significantly diminished in patients receiving both an epidural and PLB. CLINICAL SIGNIFICANCE Administration of an epidural in addition to infiltration of PLB significantly decreased the incidence of postoperative opioid administration in dogs undergoing a TPLO.
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Affiliation(s)
- Jessie Scaglione
- Surgery Department, The Veterinary Medical Center of Long Island, 75 Sunrise Highway, West Islip, NY, USA.
| | - Jacqueline Carver
- Surgery Department, The Veterinary Medical Center of Long Island, 75 Sunrise Highway, West Islip, NY, USA
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Palierne S, Blondel M, Patard F, Autefage A. Impacts of tibial plateau levelling osteotomy on the tibial insertion of the medial collateral ligament of the canine stifle joint - A cadaveric study. Res Vet Sci 2023; 154:66-72. [PMID: 36493586 DOI: 10.1016/j.rvsc.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the potential consequences of tibial plateau levelling osteotomy (TPLO) for the medial collateral ligament (MCL) tibial insertion (TI) with a particular focus on the effects of the TPLO planning technique and of the size of saw blade. STUDY DESIGN Eighty-six stifle joints were collected from 43 canine cadavers and dissected free of soft tissue to expose the MCL. The MCL insertion sites were first identified with Chinese ink on intact stifle joints, and then marked with radio-opaque barium sulfate after removal of the MCL. Mediolateral radiographs were made of each marked stifle joint and used for TPLO digital planning. For each stifle, planning the TPLO was performed by centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia in group 1, and at the top of the intercondylar tubercles in group 2. Whenever possible, two saw blade sizes were tested in each group. Measurements were taken after TPLO simulation to assess how the procedure would alter the MCL TI. RESULTS In group 1, the integrity of the MCL TI was affected by the TPLO planning in 87.2% of the cases with the small saw blade and in 59.3% of the cases with the large blade, and in group 2, in 94.2% of the cases with the small and 77.9% with the large saw blade. In group 1, the osteotomy line was located above the TI, completely severing the MCL in four cases versus in 11 cases in group 2, while severing occurred in 14/15 cases with the small saw blade. CONCLUSION During TPLO, the osteotomy line transected the MCL TI in the majority of dogs. Centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia and using the largest saw size that preserves tibial tuberosity and patellar tendon insertion seems to be the best way to preserve the MCL TI as much as possible. Further research is needed to evaluate the clinical impact of MCL TI transection.
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Affiliation(s)
- Sophie Palierne
- Small animal Surgery, Department of Clinical Sciences, Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, ENVT, Toulouse, France.
| | - Margaux Blondel
- Small animal Surgery, Department of Clinical Sciences, Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, ENVT, Toulouse, France
| | - François Patard
- Small animal Surgery, Department of Clinical Sciences, Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, ENVT, Toulouse, France
| | - André Autefage
- Small animal Surgery, Department of Clinical Sciences, Ecole Nationale Vétérinaire de Toulouse, Université de Toulouse, ENVT, Toulouse, France
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Yu J, Griffon DJ, Wisser G, Mostafa AA, Dong F. Validation of a novel 3D printed positioning device and dynamic radiographic technique to quantify rotational laxity of the stifle in dogs. Front Vet Sci 2023; 10:1118755. [PMID: 36937019 PMCID: PMC10020341 DOI: 10.3389/fvets.2023.1118755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Cranial cruciate ligament deficiency (CCLD) results in internal rotational instability of the stifle (RLS). By contrast, tibial torsion (TT) is an anatomical feature of the tibia along its longitudinal axis. The objective of this study was to validate a dynamic radiographic technique to measure internal rotational laxity of the stifle and differentiate it from TT. Models included transection of the CCL for RLS and an osteotomy for TT. One limb within eight pairs of canine cadaveric hind limbs was randomly assigned to CCLD. The contralateral limb underwent TT, followed by CCLD. Neutral and stress radiographs were taken with the limb in a custom rotating 3-D printed positioning device before and after each modification. The position of the calcaneus on neutral views and the magnitude of its displacement under standardized torque were compared within limbs and between groups. Transection of the CCL increased the magnitude of displacement of the calcaneus by 1.6 mm (0.3-3.1 mm, p < 0.05) within limbs. The lateral calcaneal displacement (dS-dN) tended to be greater when CCLD limbs were compared to limbs with intact CCL. A magnitude of calcaneal displacement of 3.45 mm differentiated limbs with RLS from intact limbs with 87.5% sensitivity and 68.7% specificity. The calcaneus was displaced further laterally by about 3 mm on neutral radiographs (dN) when limbs with experimental TT were compared to those without TT (p < 0.05). A calcaneus located at least 3.25 mm from the sulcus differentiated limbs with TT from intact limbs with 87.5% sensitivity and 87.5% specificity. The technique reported here allowed detection of RLS, especially within limbs. A calcaneus located at least 3.25 mm on neutral radiographs of large dogs should prompt a presumptive diagnosis of TT.
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Affiliation(s)
- Jin Yu
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Dominique J. Griffon
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, United States
- *Correspondence: Dominique J. Griffon
| | - Gary Wisser
- Center for Excellence in Teaching and Learning, Western University of Health Sciences, Pomona, CA, United States
| | - Ayman A. Mostafa
- Department of Small Animal Surgery and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, United States
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Tinga S, Hughes N, Jones SC, Park B, Palm L, Desaraju SS, Banks SA, MacArthur SL, Lewis DD. Stifle kinematics in 4 dogs with cranial cruciate ligament insufficiency treated by CORA-based leveling osteotomy. Front Vet Sci 2022; 9:1052327. [DOI: 10.3389/fvets.2022.1052327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
ObjectiveThe purpose of this study was to quantify three-dimensional (3D) stifle kinematics during walking in dogs with complete cranial cruciate ligament insufficiency (CCL-I) treated with a CORA-based leveling osteotomy (CBLO).Study designFour client-owned dogs with unilateral complete CCL-I were prospectively enrolled. Custom digital 3D models of the femora and tibiae were created from pre-and postoperative computed tomographic scans for each dog. Lateral view fluoroscopic images were collected during treadmill walking preoperatively and 6 months after CBLO. Results were generated using a 3D-to-2D image registration process. Pre-and postoperative stifle kinematics (craniocaudal translation, extension angle) were compared to that of the unaffected contralateral (control) stifle. Force plate gait analysis was performed, and symmetry indices (SI) were calculated for peak vertical force (PVF) and vertical impulse (VI).ResultsAfter CBLO, craniocaudal femorotibial motion was reduced by a median (range) of 43.0 (17.0–52.6) % over the complete gait cycle. Median (range) PVF SI was 0.49 (0.26–0.56) preoperatively and 0.92 (0.86–1.00) postoperatively, and VI SI was 0.44 (0.20–0.48) preoperatively and 0.92 (0.82–0.99) postoperatively.ConclusionCBLO mitigated but did not fully resolve abnormal craniocaudal translation; lameness was substantially improved at 6 months.
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Wemmers AC, Charalambous M, Harms O, Volk HA. Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement-A systematic review with a meta-analytic approach. Front Vet Sci 2022; 9:1004637. [PMID: 36532339 PMCID: PMC9748159 DOI: 10.3389/fvets.2022.1004637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 12/17/2023] Open
Abstract
Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.
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Affiliation(s)
- Annika Christina Wemmers
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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Johnson TA, Conzemius MG. Outcome of cranial cruciate ligament replacement with an enhanced polyethylene terephthalate implant in the dog: A pilot clinical trial. Vet Surg 2022; 51:1215-1222. [PMID: 36165283 PMCID: PMC9827950 DOI: 10.1111/vsu.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/12/2022] [Accepted: 08/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the 6-month outcome and survival of enhanced polyethylene terephthalate (PET) implants as a replacement for the cranial cruciate ligament (CCL) in dogs with spontaneous CCL disease (CCLD). STUDY DESIGN Pilot, prospective case series. ANIMALS Ten client-owned large breed dogs with unilateral spontaneous CCLD. METHODS Dogs were evaluated before and 6 months after intra-articular placement of a PET implant with the Liverpool Osteoarthritis in Dogs questionnaire and force platform gait analysis. Arthroscopy was performed 6 months after surgery to visually assess implant integrity. RESULTS Scores on owner questionnaires and limb asymmetry improved in all dogs that reached the 6-month time point, by 51.7% (p = .008) and 86% (p = .002), respectively. The PET implant appeared intact and functioning in two stifles, partially intact and functioning in four stifles and completely torn in three stifles. One dog had an implant infection and was removed from the study. Evidence of deterioration and tearing occurred in the midbody of the implant. CONCLUSION Although function improved over the course of this study, only 2/10 implants appeared intact 6 months after placement. CLINICAL SIGNIFICANCE Implant survivability prohibits further clinical investigation using this implant.
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Affiliation(s)
- Tiffany A. Johnson
- Department of Veterinary Clinical SciencesUniversity of Minnesota, College of Veterinary MedicineSaint PaulMinnesotaUSA
| | - Michael G. Conzemius
- Department of Veterinary Clinical SciencesUniversity of Minnesota, College of Veterinary MedicineSaint PaulMinnesotaUSA
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Corr S. Update on the management of canine cruciate disease. IN PRACTICE 2022. [DOI: 10.1002/inpr.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mazdarani P, Pedram MS, Miles JE. Effect of center of angulation of rotation-based leveling osteotomy on ex vivo stifle joint stability following cranial cruciate ligament transection and medial meniscal release with and without a hamstring load. Vet Surg 2022; 51:940-951. [PMID: 35289413 PMCID: PMC9546295 DOI: 10.1111/vsu.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/17/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the effect of center of rotation of angulation (CORA)‐based leveling osteotomy (CBLO) and hamstring load on stifle stability following cranial cruciate ligament transection (CCLx) and medial meniscal release (MMR). Study design Ex vivo experimental study. Sample population Cadaver hind limb preparations (n = 7). Methods After instrumentation, constant quadriceps and gastrocnemius loads with an optional hamstring load in a 3:1:0.6 ratio were applied, and stifles were extended from fully flexed using an electrical motor during fluoroscopic recording. The recording process was repeated after each of CCLx, MMR and CBLO and the extracted landmark coordinates were used for calculation of cranial tibial translation (CTT) and patellar ligament angle (PTA). Results Mean initial tibial plateau angle was 28.1°: post‐CBLO the mean was 9.7°. Cranial tibial translation developed from 50° and 75° with CCLx and MMR respectively (p < .04, < .02) without hamstring loading. Hamstring loading mitigated CTT due to CCLx and delayed CTT until 120° for MMR (P < .02) in this model. CBLO prevented CTT, except at 140° without hamstring loading (P = .01). Similar results were seen for PTA, but CBLO curves were parallel to and lower than intact values at all tested angles (P < .04), consistent with induced effective joint flexion. Conclusion CBLO to a target tibial plateau angle of 10° largely eliminated CTT induced by CCLx and MMR. Hamstring loads of 20% quadriceps load improved stifle stability in this model. Impact Stifle stability following CBLO appears to be multifactorial and depends on meniscal integrity, joint angle, and hamstring strength.
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Affiliation(s)
- Parisa Mazdarani
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Mir Sepehr Pedram
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - James E Miles
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
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15
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Tibial Plateau Leveling Following Tibial Tuberosity Advancement: A Case Series. Vet Sci 2022; 9:vetsci9010016. [PMID: 35051100 PMCID: PMC8779685 DOI: 10.3390/vetsci9010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/24/2021] [Accepted: 12/31/2021] [Indexed: 11/18/2022] Open
Abstract
Persistent stifle instability is a recognized complication following tibial tuberosity advancement techniques (TTAT). The aim of this study is to report the feasibility and outcome of tibial plateau leveling techniques (TPLT) to treat dogs with persistent lameness, suspected to be secondary to persistent stifle instability, following (TTAT). Medical records of dogs presented for persistent lameness after TTAT were reviewed. Preoperative data included orthopedic examination, lameness score and radiographs. Inclusion criteria included performance of a surgery to address persistent lameness and suspected instability. Short-term follow up data included orthopedic examination and radiographs of the stifle. Long-term follow up was based on postoperative Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Seven dogs were included in the study. Mean subjective preoperative lameness score was 3 ± 1.53. Mean preoperative patellar ligament angle relative to the tibial plateau (PLATP) was 94° and mean tibial plateau angle (TPA) was 28°. Six dogs had tibial plateau leveling osteotomy and one had modified cranial closing wedge ostectomy. Mean postoperative PLATP was 79° and mean TPA was 5°. Mean subjective lameness score at follow up was 0.57 ± 0.49. Minor complications were present in 2 dogs and major complication in 1 dog. Mean LOAD questionnaire score was 6.6/52. TPLT can be performed after TTAT and may improve clinical function and stability in these cases in which persistent instability is suspected.
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16
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Del Carpio LI, Petit Y, Diotalevi L, Laroche E, Levasseur A, Lussier B. Three-dimensional kinematic evaluation of lateral suture stabilization in an in vitro canine cranial cruciate deficient stifle model. PLoS One 2021; 16:e0261187. [PMID: 34928969 PMCID: PMC8687534 DOI: 10.1371/journal.pone.0261187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
The impact of surgical correction of cranial cruciate ligament rupture (CCLR) on 3D kinematics has not been thoroughly evaluated in dogs. The success of current techniques remains limited, as illustrated by suboptimal weightbearing and progression of osteoarthritis. The inability to restore the stifle's 3D kinematics might be a key element in understanding these suboptimal outcomes. The objective of this study was to evaluate the impact of lateral suture stabilization (LSS) on the 3D kinematics of the canine stifle joint. We hypothesized that LSS would not restore 3D kinematics in our model. Ten cadaveric pelvic limbs collected from large dogs (25-40 kg) were tested using a previously validated apparatus that simulates gait. Three experimental conditions were compared: (a) intact stifle; (b) unstable stifle following cranial cruciate ligament transection (CCLt) and (c) CCLt stabilized by LSS. Three-dimensional kinematics were collected through 5 loading cycles simulating the stance phase of gait and curves were analyzed using a Wilcoxon signed-rank test. LSS restored baseline kinematics for the entire stance phase for cranial and lateromedial translation, flexion, and abduction. It restored distraction over 90% of the stance phase. Internal rotation was limited, but not restored. This in vitro study had limitations, as it used a simplified model of stifle motion and weight-bearing. The results of this study report that LSS can restore physiologic 3D kinematics largely comparable to those of healthy stifles. Suboptimal outcome in patients following CCLR stabilization by LSS may therefore result from causes other than immediate postoperative abnormal 3D kinematics.
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Affiliation(s)
- Laura-Isabela Del Carpio
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Yvan Petit
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada
- CIUSSS-NÎM Research Center, Sacré-Cœur Hospital of Montreal, Montreal, Quebec, Canada
| | - Lucien Diotalevi
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada
- CIUSSS-NÎM Research Center, Sacré-Cœur Hospital of Montreal, Montreal, Quebec, Canada
| | - Elisabeth Laroche
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada
- CIUSSS-NÎM Research Center, Sacré-Cœur Hospital of Montreal, Montreal, Quebec, Canada
| | - Annie Levasseur
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada
- CIUSSS-NÎM Research Center, Sacré-Cœur Hospital of Montreal, Montreal, Quebec, Canada
| | - Bertrand Lussier
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
- GREPAQ (Research Group in Animal Pharmacology of Quebec), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
- Osteoarthritis Research Unit, Hospital Research Centre (CRCHUM), Université de Montréal, Montreal, Quebec, Canada
- * E-mail:
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17
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Schmutterer JM, Augat P, Greinwald M, Meyer-Lindenberg A. Evaluation of Meniscal Load and Load Distribution in the Canine Stifle after Tibial Plateau Levelling Osteotomy with Postoperative Tibia Plateau Angles of 6 and 1 Degrees. Vet Comp Orthop Traumatol 2021; 35:73-80. [PMID: 34666413 DOI: 10.1055/s-0041-1736186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the kinetic and kinematic changes in the stifle after a tibial plateau levelling osteotomy (TPLO) with a postoperative tibia plateau angle (TPA) of either 6 or 1 degrees. STUDY DESIGN Biomechanical ex vivo study using seven unpaired canine cadaver hindlimbs from adult Retrievers.Hinge plates were applied and a sham TPLO surgery was performed. Motion sensors were fixed to the tibia and the femur for kinematic data acquisition. Pressure mapping sensors were placed between femur and both menisci. Thirty per cent bodyweight was applied to the limbs with the stifle in 135 degrees of extension. Each knee was tested with intact cranial cruciate ligament (CCL), deficient CCL, 6 degrees TPLO and 1degree TPLO. RESULTS Transection of the CCL altered kinematics and kinetics. However, comparing the intact with both TPLO set-ups, no changes in kinematics were detected. After 1 degree TPLO, a significant reduction in the force acting on both menisci was detected (p = 0.006). CONCLUSIONS Tibial plateau levelling osteotomy restores stifle kinematics and meniscal kinetics after transection of the CCL ex vivo. The contact force on both menisci is reduced significantly after TPLO with a TPA of 1 degree. Increased stifle flexion might lead to caudal tibial motion.
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Affiliation(s)
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Greinwald
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
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18
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Geier CM, Frederick SW, Cross AR. Evaluation of the risk of patella fracture as the result of decreasing tibial plateau angle following tibial plateau leveling osteotomy. Vet Surg 2021; 50:984-989. [PMID: 33914340 DOI: 10.1111/vsu.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/29/2021] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the effect of postoperative tibial plateau angle (TPA) following tibial plateau leveling osteotomy (TPLO) on the risk of patella fracture during the convalescent period. STUDY DESIGN Retrospective study. SAMPLE POPULATION Fracture group: 20 stifles; reference group: 65 stifles. METHODS Medical records were reviewed for stifles with patellar fractures after a TPLO procedure (fracture group) and stifles with >180 days radiographic examination with no complications following TPLO (reference group). Stifle radiographs were masked to group and final TPA (fTPA) was measured, at the time of fracture diagnosis (fracture group) and at last follow-up (reference group), using PACS software. TPAs in the fracture and reference groups were compared using the Wilcoxon rank-sum test. Statistical significance was set at .05. RESULTS Patellar fractures were diagnosed at a median of 69 days (range 31-189) after surgery. The median duration of follow-up time for the reference group was 471 days (range 180-1868). Median fTPA for the fracture group was 1.4° (range [-10.3]-7.1). Median fTPA for the reference group was 4.1° (range [-3.9]-14.1). The odds of patellar fractures increased by 21.7% (95% CI: 8.6%-35.6%) for every 1° decrease in fTPA. CONCLUSION The risk of patella fractures increased as TPAs after TPLOs decreased. CLINICAL SIGNIFICANCE Care should be taken to avoid excessive rotation during TPLO to decrease the likelihood of postoperative patellar fractures.
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Affiliation(s)
- Cindy M Geier
- Department of Small Animal Surgery, BluePearl Specialty + Emergency Pet Hospital, Sandy Springs, Georgia, USA
| | - Steven W Frederick
- Department of Small Animal Surgery, BluePearl Specialty + Emergency Pet Hospital, Sandy Springs, Georgia, USA
| | - Alan R Cross
- Department of Small Animal Surgery, BluePearl Specialty + Emergency Pet Hospital, Sandy Springs, Georgia, USA
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19
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Lin CC, Wang SN, Lu M, Chao TY, Lu TW, Wu CH. Description of soft tissue artifacts and related consequences on hindlimb kinematics during canine gait. PeerJ 2020; 8:e9379. [PMID: 32617192 PMCID: PMC7323716 DOI: 10.7717/peerj.9379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Soft tissue artifacts (STAs) are a source of error in marker-based gait analysis in dogs. While some studies have revealed the existence of STAs in the canine hindlimb, STAs and their influence on kinematic gait analysis remain unclear. Methods Thirteen healthy Taiwan dogs affixed with twenty skin markers on the thigh and crus were recruited. Soft tissue artifacts and their influence on the determination of segment poses and stifle angles were assessed by simultaneously measuring marker trajectories and kinematics of the underlying bones via a model-based fluoroscopic analysis method. Results Markers on the thigh showed higher STAs than those on the crus, with root-mean-square amplitudes up to 15.5 mm. None of the tested marker clusters were able to accurately reproduce the skeletal poses, in which the maximum root-mean-square deviations ranged from 3.4° to 8.1°. The use of markers resulted in overestimated stifle flexion during 40–60% of the gait cycle and underestimated stifle flexion during 80–90% of the gait cycle. Conclusions Considerable magnitudes and effects of STAs on the marker-based 3D gait analysis of dogs were demonstrated. The results indicate that the development of error-compensation techniques based on knowledge regarding STAs is warranted for more accurate gait analysis.
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Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shi-Nuan Wang
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Ming Lu
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Tzu-Yi Chao
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Veterinary Hospital, Taipei, Taiwan
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