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Engdahl K, Bergström A, Höglund O, Moldal ER, Emanuelson U, Boge GS. Long-term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index. Vet Rec 2023; 193:e3172. [PMID: 37439319 DOI: 10.1002/vetr.3172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Cranial cruciate ligament disease (CCLD) is common in dogs, but studies on the long-term treatment outcome are scarce. METHODS The long-term outcome in a cohort of 71 dogs with CCLD treated with tibial plateau levelling osteotomy (TPLO, n = 18), tibial tuberosity advancement (TTA, n = 23) or lateral fabellotibial suture (LFS, n = 30) was evaluated using the canine orthopaedic index. RESULTS The risk of stiffness and lameness was increased in dogs treated with TPLO (stiffness: incidence rate ratio [IRR] 1.33, p = 0.015; lameness: IRR 1.34, p = 0.020) or TTA (stiffness: IRR 1.26, p = 0.035; lameness: IRR 1.31, p = 0.026) when compared to LFS at a median follow-up time of 4.6 years. LIMITATIONS No follow-up veterinary examination was performed. Data were collected from only two university animal hospitals, and thus, a referral bias towards more complicated cases is possible, which may limit the generalisability of the results. CONCLUSION Clinicians can use the results to inform dog owners about the expected long-term outcome in dogs with CCLD.
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Affiliation(s)
- Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Annika Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Odd Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Elena R Moldal
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Gudrun S Boge
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
- Norwegian Medicines Agency, Oslo, Norway
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Yair N, Yiapanis C, Ben-Amotz R, Milgram J. The effect of joint orientation on passive movement of the dog's stifle. Front Vet Sci 2023; 10:1207164. [PMID: 37448585 PMCID: PMC10336201 DOI: 10.3389/fvets.2023.1207164] [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: 04/17/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction The cranial cruciate ligament (CCL) is one of numerous structures which determine the path of the tibia relative to the femur when passively flexing/extending the stifle of the dog. The effect of cutting the CCL on passive motion with the hind limb in different orientations, is unknown. The aim of this study was to describe passive movement of the tibia relative to the femur in dogs, with the hind limb in three different orientations, and with CCL intact and cut. Methods Ten cadaveric hind limbs were obtained from dogs weighing between 20 kg and 25 kg and prepared for testing in a custom-built joint testing machine. Each hind limb was tested in three different orientations with data collected, using an electromagnetic tracking system, during 2 cycles of flexion/extension with the CCL intact and cut. Each cycle was initiated with the stifle in full extension (0°) and data was collected at 0°, 20°, 30°, 40°, 45°, and 55° of stifle flexion/extension. Results Flexion of the stifle resulted in caudal translation and internal rotation of the tibia relative to the femur, with cranial translation and external rotation occurring during extension along the identical path. Cutting the cranial cruciate ligament did not result in significant differences in translation or rotation when the stifle was orientated to approximated the standing position of a dog. Discussion Isometric points at the origin and insertion of the CCL can potentially be identified in CCL deficient stifles using a technique based on passive motion of an intact stifle.
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Affiliation(s)
- Nadav Yair
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Laboratory of Biomechanics, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Ron Ben-Amotz
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Laboratory of Biomechanics, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua Milgram
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Laboratory of Biomechanics, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Engdahl K, Boge GS, Ingman J, Näslund V, Ley CJ. Degree of osteophyte formation seen on radiographs provides useful prognostic information for dogs with cruciate ligament disease. Vet Rec 2023; 192:e2478. [PMID: 36504411 DOI: 10.1002/vetr.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concurrent osteoarthritis is generally present in the stifle joints of dogs with cranial cruciate ligament disease (CCLD), but it is not known if the degree of osteoarthritis-related changes affects the prognosis. Development of osteophytes is a key radiographic feature of osteoarthritis. The aim of this study was to evaluate the association between the degree of osteophyte formation seen on radiographs and CCLD-related euthanasia in dogs with CCLD. METHODS A retrospective cohort study including 226 dogs treated for CCLD at two university animal hospitals was performed. Clinical and follow-up information was retrieved, and stifle radiographs taken during the 31 days before treatment for the CCLD were graded for osteophyte formation by three veterinary radiologists. A multivariable Cox proportional hazards model was applied to assess the association between the degree of osteophyte formation and CCLD-related euthanasia. RESULTS An association between the degree of osteophyte formation and CCLD-related euthanasia was found, with increased osteophyte formation associated with an increased hazard of CCLD-related euthanasia (hazard ratio 1.06, 95% confidence interval 1.01-1.11, p = 0.01). LIMITATIONS No clinical assessment of the outcome was performed. CONCLUSION The findings suggest that evaluation of stifle radiographs for osteophyte formation could provide useful prognostic information for dogs with CCLD.
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Affiliation(s)
- Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Gudrun Seeberg Boge
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences-School of Veterinary Science, Oslo, Norway
- Norwegian Medicines Agency, Oslo, Norway
| | - Jessica Ingman
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Veronica Näslund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Charles J Ley
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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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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The Effect of Cranial Cruciate Ligament Rupture on Range of Motion in Dogs. Vet Sci 2021; 8:vetsci8070119. [PMID: 34202476 PMCID: PMC8310248 DOI: 10.3390/vetsci8070119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
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.
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Serra Aguado CI, Ramos-Plá JJ, Soler C, Segarra S, Moratalla V, Redondo JI. Effects of Oral Hyaluronic Acid Administration in Dogs Following Tibial Tuberosity Advancement Surgery for Cranial Cruciate Ligament Injury. Animals (Basel) 2021; 11:1264. [PMID: 33925642 PMCID: PMC8146498 DOI: 10.3390/ani11051264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
Hyaluronic acid (HA) intraarticular injection is used in the management of osteoarthritis in veterinary medicine. However, HA oral administration is less common given the scarce currently available scientific evidence. This study was aimed at evaluating the effects of oral HA administration on synovial fluid concentrations of several selected biomarkers in dogs with cranial cruciate ligament (CCL) injury operated on using the tibial tuberosity advancement (TTA) technique. Fifty-five dogs were included in this prospective, randomized, double-blind, clinical study; they were randomly assigned to receive either a placebo (group A; n = 25) or HA (group B; n = 30) orally for 10 weeks. Synovial fluid samples were obtained before surgery, and at 10 weeks postoperatively to measure concentrations of HA, haptoglobin, nitric oxide, and paraoxonase-1. After 10 weeks, group HA showed a significant increase in HA concentration (p = 0.0016) and a significant decrease in PON-1 concentration (p = 0.011) compared to baseline. In conclusion, post-op oral HA administration in canine patients with CCL injury leads to improvements in osteoarthritis biomarkers, namely higher synovial fluid HA concentrations and reduced synovial fluid paraoxonase-1 concentrations. These findings support the bioavailability of orally-administered HA and its usefulness in improving biomarkers of osteoarthritis.
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Affiliation(s)
- Claudio Iván Serra Aguado
- Hospital Veterinario UCV, Departamento de Medicina y Cirugía, Facultad de Veterinaria y Ciencias Experimentales, Universidad Católica de Valencia San Vicente Mártir, 46018 Valencia, Spain;
| | - Juan José Ramos-Plá
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain;
| | - Carme Soler
- Hospital Veterinario UCV, Departamento de Medicina y Cirugía, Facultad de Veterinaria y Ciencias Experimentales, Universidad Católica de Valencia San Vicente Mártir, 46018 Valencia, Spain;
| | - Sergi Segarra
- R&D Bioiberica S.A.U., 08950 Esplugues de Llobregat, Spain;
| | | | - José Ignacio Redondo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain;
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Pinna S, Lanzi F, Grassato L. Bologna Healing Stifle Injury Index: A Comparison of Three Surgical Techniques for the Treatment of Cranial Cruciate Ligament Rupture in Dogs. Front Vet Sci 2020; 7:567473. [PMID: 33195546 PMCID: PMC7655652 DOI: 10.3389/fvets.2020.567473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/21/2020] [Indexed: 12/04/2022] Open
Abstract
The aim of this retrospective study was to test the efficacy of the Bologna Healing Stifle Injury Index (BHSII) in assessing the medium-term outcomes of dogs treated for cranial cruciate ligament rupture. This tool can be used for comparison across surgical interventions. The study population included 53 dogs with unilateral cranial cruciate ligament rupture treated using either Paatsama, Tight-Rope or tibial tuberosity advancement techniques, and 20 orthopedically sound dogs for comparative purposes. The BHSII was utilized for all the treated dogs at the time of surgery, and 1, 3, and 6 months postoperatively, while it was utilized twice in the control group. Although all the techniques achieved a successful outcome at the end of the evaluation, the application of the BHSII permitted differentiating results at each time point and stimulating discussion regarding the rapidity and degree of the healing process for each technique. It also pointed out some incongruities between the owner's and the clinician's assessment of the process. These achievements demonstrated that the BHSII should be considered by the research and clinical communities as an effective and easy tool which can be used as a repeatable and standardized method of comparison of the progress at different time points toward a final good outcome in dogs treated for cranial cruciate ligament rupture.
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Affiliation(s)
- Stefania Pinna
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Lanzi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Lisa Grassato
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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Crovace AM, Staffieri F, Monopoli D, Artiles A, Fracassi L, Crovace A, Lacitignola L. Role of Tibial Tuberosity Fracture/Fissure through the Maquet Hole in Stifle Osteoarthritis after Porous Tibial Tuberosity Advancement in Dogs at Mid-Term Follow-Up. Vet Sci 2019; 7:vetsci7010001. [PMID: 31877885 PMCID: PMC7157639 DOI: 10.3390/vetsci7010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022] Open
Abstract
Tibial tuberosity advancement (TTA) is used to treat cranial cruciate ligament rupture of the stifle joint in dogs. Tibial tuberosity fracture/fissure is a complication of TTA that may have a favorable prognosis. The aim of this study was to detect how tibial tuberosity fracture/fissure through the Maquet hole worsens the progression of osteoarthritis (OA) in the stifle joint of dogs treated with porous TTA. Seventeen cases were included in the study, divided into two groups. The first group (n = 10) included subjects that had tibial tuberosity fracture/fissure through the Maquet, and the second group included subjects that had no complications (n = 7). Both groups showed significant progression compared to OA at 3 months after surgery. We observed that at T0, the control group showed a higher level of OA. For this reason, we normalized the OA scores, evaluating the percentage difference from T0 and T1. We verified that there were no statistically significant differences between the two groups. The results confirm that OA progression in subjects undergoing TTA was not significantly influenced by fracture/fissure of the tibial tuberosity through the Maquet hole. Therefore, fracture fissure through the Maquet hole should be considered as a common minor complication during TTA.
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Affiliation(s)
| | - Francesco Staffieri
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, s.p. per Casamassima Km 3. Valenzano, 70010 Bari, Italy; (F.S.); (A.C.)
| | - Donato Monopoli
- Instituto Tecnológico de Canarias, Santa Cruz de la Palma, 38009 Las Palmas, Spain;
| | - Alejandro Artiles
- Dottorato di ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (A.A.); (L.F.)
| | - Laura Fracassi
- Dottorato di ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (A.A.); (L.F.)
| | - Antonio Crovace
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, s.p. per Casamassima Km 3. Valenzano, 70010 Bari, Italy; (F.S.); (A.C.)
| | - Luca Lacitignola
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, s.p. per Casamassima Km 3. Valenzano, 70010 Bari, Italy; (F.S.); (A.C.)
- Correspondence:
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