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Cheon J, Kang J, Kim N, Heo S. Comparing the Accuracy of Patient-Specific Guide and Universal Guide for Distal Femoral Osteotomy in Dogs. Vet Comp Orthop Traumatol 2024. [PMID: 39227028 DOI: 10.1055/s-0044-1790219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
OBJECTIVE To introduce a novel universal guide design for distal femoral osteotomy (DFO) to treat femoral deformities and other hindlimb orthopaedic diseases, and to compare its accuracy to the patient-specific guide in vitro and ex vivo on X-ray and computed tomography (CT). METHODS Thirteen anatomic specimens of canine femurs and 13 3D-printed femoral bone models were subjected to DFO using a patient-specific and a universal guide. The anatomical lateral distal femoral angle and anteversion angle were measured on radiographic and CT images before and after surgical procedure and used to compare the accuracy of the surgical guides in treating uniplanar or biplanar deformities. Bone models were used to compare the accuracy with ex vivo models. RESULTS The mean correction errors were -1.18° to 0.72° on X-ray and -1.91° to 0.53° on CT scan. The analysis showed no statistically significant difference in the mean error between the groups based on type of guide used, nor in the mean error between groups based on whether anteversion correction was performed based on both the CT and X-ray imaging data. CONCLUSION Both the patient-specific and universal guides can produce accurate results in DFO surgery, and the universal guide shows potential as a useful surgical tool.
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Affiliation(s)
- Jaeeon Cheon
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Jinsu Kang
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic Korea
| | - Namsoo Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Suyoung Heo
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
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Nagahiro Y, Murakami S, Shimada M, Kanno N, Harada Y, Hara Y. Evaluation of the quadriceps muscle length to femoral length ratio in small breed dogs with medial patellar luxation. Vet Surg 2023; 52:587-598. [PMID: 36881987 DOI: 10.1111/vsu.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 01/07/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To determine the quadriceps muscle length (QML) to femoral length (FL) ratio (QML/FL) and its associated factors in small breed dogs with medial patellar luxation (MPL) and to compare the differences in the QML/FL between MPL grades. STUDY DESIGN Retrospective study. SAMPLE POPULATION Small breed dogs (<10 kg) with MPL: 78 dogs (134 limbs). METHODS Medical records and computed tomography (CT) images from 2008-2020 were reviewed. Furthermore, age, bodyweight, sex, laterality, MPL grade, femoral inclination angle (FIA), femoral torsion angle (FTA), anatomical lateral distal femoral angle (aLDFA), and patellar ligament length to patellar length ratio were included in the regression analysis to determine the factors associated with QML/FL. Each measurement parameter was compared among the four MPL grade groups. RESULTS The final model demonstrated that the QML/FL increased with increasing age (p = .004) and decreased with increasing FTA and aLDFA (p = .015 and p < .001, respectively). The MPL grade IV group had a lower QML/FL than the grade I, II, and III groups (p = .002, p < .001, and p < .001, respectively). CONCLUSION Among small breed dogs, those with MPL grade IV had a shortened QML associated with femoral deformities. CLINICAL SIGNIFICANCE Noninvasive evaluation of the QML/FL improves our understanding of the length mismatch between the quadriceps muscle and the femur.
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Affiliation(s)
- Yukari Nagahiro
- Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Sawako Murakami
- Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Masakazu Shimada
- Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Nobuo Kanno
- Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yasuji Harada
- Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yasushi Hara
- Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo, Japan
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Perry KL, Déjardin LM. Canine medial patellar luxation. J Small Anim Pract 2021; 62:315-335. [PMID: 33600015 DOI: 10.1111/jsap.13311] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 12/09/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- K L Perry
- Section Head of Small Animal Surgery, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824-1314, USA
| | - L M Déjardin
- Head of Small Animal Orthopaedics, ACVS Founding Fellow MIS Orthopaedics SA, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824-1314, USA
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Lee J, Sim H, Jeong J, Kim SY, Yang S, Jeong S, Lee H. Biomechanical analysis of canine medial patellar luxation with femoral varus deformity using a computer model. BMC Vet Res 2020; 16:471. [PMID: 33272258 PMCID: PMC7713038 DOI: 10.1186/s12917-020-02644-5] [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: 04/25/2020] [Accepted: 10/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background Femoral varus deformities complicating the realignment of the quadriceps muscles are frequently associated with medial patellar luxation (MPL) in dogs. Therefore, distal femoral osteotomy (DFO) is recommended in dogs affected with severe MPL and a distal femoral varus deformity. The presence of an anatomic lateral distal femoral angle (aLDFA) of ≥ 102° has been anecdotally recommended as an indication for performing corrective DFO in large-breed dogs. However, the effect of a femoral varus deformity on MPL has not been scientifically evaluated. We aimed to evaluate the influence of a femoral varus deformity on MPL using a finite element method based computer model. Three-dimensionally reconstructed computed tomographic images of a normal femur from a Beagle dog were deformed using meshing software to create distal varus deformities. A total of thirteen aLDFAs, including 95°, 98° and 100°–110°, were simulated. The patellar positions and reaction force between the patella and trochlear grooves were calculated for all finite element models under constant rectus femoris muscle activation. Results The patella was displaced medially from the trochlear groove at an aLDFA of ≥103°. With an aLDFA of 103° to 110°, the reaction force was equal to zero and then decreased to negative values during the simulation, while other models with aLDFAs of 95°, 98°, and 100°-102° had positive reaction force values. The patella began to luxate at 24.90 seconds (sec) with an aLDFA of 103°, 19.80 sec with an aLDFA of 104°, 21.40 sec with an aLDFA of 105°, 20.10 sec with an aLDFA of 106°, 18.60 sec with an aLDFA of 107°, 15.30 sec with an aLDFA of 108°, 16.60 sec with an aLDFA of 109°, and 11.90 sec with an aLDFA of 110°. Conclusion Severe distal femoral varus with an aLDFA of ≥103° caused MPL when other anatomical factors were controlled. Thissimplified computer model provides complementary information to anecdotal cutoffs for DFO, hence it should be applied to clinical patients with caution.
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Affiliation(s)
- Jiyun Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 34134, Daejeon, Republic of Korea
| | - Heedong Sim
- Department of Mechatronics Engineering, College of Engineering, Chungnam National University, 34134, Daejeon, Republic of Korea
| | - Jaemin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 34134, Daejeon, Republic of Korea
| | - Sun-Young Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, 47906, West Lafayette, IN, USA
| | - Seokjo Yang
- Department of Mechatronics Engineering, College of Engineering, Chungnam National University, 34134, Daejeon, Republic of Korea
| | - SeongMok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 34134, Daejeon, Republic of Korea
| | - HaeBeom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 34134, Daejeon, Republic of Korea.
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Neal KM, Frederick SW, Corse MR, Cross AR. Evaluation of a Fixed-Angle Wedge Osteotomy Guide. Vet Comp Orthop Traumatol 2020; 34:32-36. [PMID: 32971543 DOI: 10.1055/s-0040-1716396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate a fixed-angle cutting guide designed to aid in the performance of coplanar wedge osteotomies using a proximal tibial cranial closing wedge ostectomy model. STUDY DESIGN A 30-degree cranial closing wedge ostectomy was created using canine tibia models with either a standard template (method T) or a wedge osteotomy guide (method G) by two surgeons. One surgeon was experienced with both procedures, and one surgeon had no previous experience with the wedge guide. The ostectomy wedges were evaluated for wedge angle, using a digital protractor, and coplanarity by using digital photographs and screen-measuring software. RESULTS The mean (standard deviation) wedge angles of the T and G groups were 28.16 (1.33) and 28.4 degrees (1.46) respectively. The mean (standard deviation) divergence angles of the T and G groups were 3.21 (1.86) and 2.22 degrees (1.69) respectively. The measured reference angles of the template and cut guides were 31.27 and 29.60 degrees respectively. Individual and cross-surgeon analysis of outcomes found no significant differences when comparing wedge angle or coplanarity with either method regardless of surgeon experience. However, mean wedge angle of group G was significantly closer to the measured reference angles than group T (p < 0.01). CONCLUSION Use of a fixed-angle surgical wedge guide was successful in consistently producing accurate closing wedge ostectomies regardless of surgeon experience. These results show that use of the guide is a valid method for performing wedge ostectomies.
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Affiliation(s)
- Katherine M Neal
- BluePearl Veterinary Partners, Sandy Springs, Georgia, United States
| | | | - Matthew R Corse
- Northlake Veterinary Surgery, Clarkston, Georgia, United States
| | - Alan R Cross
- BluePearl Veterinary Partners, Sandy Springs, Georgia, United States
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Peterson JL, Torres BT, Hutcheson KD, Fox DB. Radiographic determination of normal canine femoral alignment in the sagittal plane: A cadaveric pilot study. Vet Surg 2020; 49:1230-1238. [PMID: 32484579 DOI: 10.1111/vsu.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/04/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish a reliable methodology for radiographic determination of alignment of the normal canine femur in the sagittal plane. STUDY DESIGN Cadaveric pilot study. SAMPLE POPULATION Twenty-nine cadaveric canine femurs. METHODS Femoral specimens were collected from the University of Missouri veterinary anatomy laboratory, and standardized sagittal plane radiographs were obtained. The anatomic and mechanical axes, joint orientation, lines and joint orientation angles were determined in the sagittal plane by using the center of rotation of angulation methodology. Landmarks were clearly described to allow repeatability and reliability of measurements. Three observers with various degrees of experience measured two centers of rotation of normal angulation, the anatomic caudoproximal femoral angle, and the mechanical caudodistal femoral angle for all femurs on three separate days. Interobserver and intraobserver reliability were measured by using two-way mixed intraclass correlation coefficients (ICC) with associated 95% CI. RESULTS Twenty-nine medium to large breed canine femora were measured. A high degree of correlation was present both among and between observers for all measurements performed, as defined by an ICC >0.8 for each. CONCLUSION The described methodology was reliable and repeatable for measurement of angulation of grossly normal canine femora in the sagittal plane when performed by observers with varying degrees of clinical experience, as evidenced by a high degree of correlation for all values measured. CLINICAL SIGNIFICANCE This methodology may be used for standardized evaluation of alignment of canine femora in the sagittal plane.
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Affiliation(s)
| | - Bryan T Torres
- Veterinary Health Center, University of Missouri, Columbia, Missouri
| | - Kyle D Hutcheson
- Veterinary Health Center, University of Missouri, Columbia, Missouri
| | - Derek B Fox
- Veterinary Health Center, University of Missouri, Columbia, Missouri
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Eby A, Bleedorn J. A computed tomographic graphical approach to guide correction of femoral torsion. Vet Surg 2020; 49:1015-1023. [PMID: 32386242 DOI: 10.1111/vsu.13438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/24/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report geometric methods to assess femoral transverse bone morphology and develop a virtual method to guide the surgical correction of femoral torsional deformities. STUDY DESIGN Observational study. SAMPLE POPULATION Sixteen client-owned dogs comprising 14 normal femurs and 14 femurs with angulation-rotation bone deformities. METHODS Femoral torsion angle was measured with computed tomographic (CT) three-dimensional (3D) multiplanar reconstruction. Distal femoral transverse morphology was estimated with geometric methods and compared to direct measurements to span a target 20° angle on 3D reconstructions. A virtual correction of 20° was performed, and 3D-printed bone models were created. Femoral torsion of corrected bone models was compared to precorrection. RESULTS Geometric estimates with an arc and chord of the metaphyseal area and chord of a best fit circle did not differ from direct measurement of femoral cortical length along the cranial cortex. Femoral torsion differed between normal femurs (25.8° ± 6°) and those with deformity (36.9° ± 8.4°, P < .001). Torsion that was measured on corrected 3D bone models did not differ from the expected torsion (preoperative +20°). CONCLUSION Geometric methods provided an accurate estimate of distal femoral transverse bone morphology. Rotation of the distal femur based on geometric methods resulted in an accurate correction of torsion. CLINICAL SIGNIFICANCE Femoral bone diameter can be measured on a CT cross-section, and rotation distance can be calculated to achieve a desired correction of torsion. This approach provides a simple and accurate method to guide the correction of femoral torsion.
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Affiliation(s)
- Adam Eby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Jason Bleedorn
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Shamir SK, Wolynski JG, Duncan CG, Puttlitz C, Duerr FM. Ex vivo evaluation of a novel surgical guide on the accuracy of closing wedge osteotomies. Vet Surg 2019; 48:1429-1436. [PMID: 31120595 DOI: 10.1111/vsu.13237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/06/2019] [Accepted: 04/28/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of a novel surgical guide on the accuracy and technical difficulty of closing wedge osteotomies (CWO). STUDY DESIGN Ex vivo experimental study. SAMPLE POPULATION Canine tibia models (n = 40). METHODS A 20° cranial CWO (CCWO) was created without (standard procedure; STCCWO) or with the aid of a novel wedge osteotomy guide (WOCCWO). Procedures were performed by diplomate (n = 4) and resident (n = 6) surgeons, with each performing 2 STCCWO followed by 2 WOCCWO. To prevent bias, surgeons were unaware of the study purpose until after completing the STCCWO. The wedges were evaluated by comparing the deviation from the 20° target angle, divergence of the 2 osteotomies (osteotomy divergence angle [ODA]), and measurements of the wedge height at the caudomedial cortex (CMC) and caudolateral cortex (CLC). Technique difficulty was explored through a surgeon questionnaire. RESULTS The WOCCWO resulted in smaller mean ODA (WOCCWO = 0.86°, SD ± 0.38°, P < .001), and smaller mean difference between CMC and CLC (WOCCWO = 0.29 mm, SD ± 0.19, P < .001) than for the STCCWO (4.22°, SD ± 2.16° and 1.39 mm, SD ± 0.65 respectively). Deviation from the target 20° wedge angle was greater after STCCWO (1.46°, SD ± 1.27°) than after WOCCWO (0.53°, SD ± 0.33°, P = .004). No difference was reported regarding the difficulty of the procedures, but resident surgeons stated that they were more likely to use the guide in a clinical setting compared with diplomates. CONCLUSION The wedge osteotomy guide improved the accuracy of CCWO compared with standard technique. CLINICAL SIGNIFICANCE The clinical significance of the differences detected in this study is unclear and warrants in vivo investigation.
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Affiliation(s)
- Shelly K Shamir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jakob G Wolynski
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Colleen G Duncan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Christian Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Felix M Duerr
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Hall EL, Baines S, Bilmont A, Oxley B. Accuracy of patient-specific three-dimensional-printed osteotomy and reduction guides for distal femoral osteotomy in dogs with medial patella luxation. Vet Surg 2018; 48:584-591. [PMID: 30446995 DOI: 10.1111/vsu.13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/16/2018] [Accepted: 10/06/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare precorrectional and postcorrectional femoral alignment following distal femoral osteotomy using patient-specific 3-dimensional (3D)-printed osteotomy and reduction guides in vivo and ex vivo. STUDY DESIGN Prospective study. SAMPLE POPULATION Ten client-owned dogs and matching 3D-printed plastic bone models. METHODS Distal femoral osteotomy was performed via a standard approach using osteotomy and reduction guides developed with computer-aided design software prior to 3D-printing. Femoral osteotomy and reduction was also performed on 3D-printed models of each femur with identical reprinted guides. Femoral varus angle (FVA) and femoral torsion angle (FTA) were measured on postoperative computed tomographic images by 3 observers. RESULTS In vivo, the mean difference between target and achieved postoperative was 2.29° (±2.29°, P = .0076) for the FVA, and 1.67° (±2.08°, P = .300) for the FTA. Ex vivo, the mean difference between target and achieved postoperative was 0.29° (±1.50°, P = .813) for the FVA, and -2.33° (±3.21°, P = .336) for the FTA. Intraobserver intraclass correlation coefficients (ICC; 0.736-0.998) and interobserver ICC (0.829 to 0.996) were consistent with an excellent agreement. CONCLUSION Use of 3D-printed osteotomy and reduction guides allowed accurate correction of FTA in vivo and both FVA and FTA ex vivo. CLINICAL SIGNIFICANCE Use of 3D-printed osteotomy and reduction guides may improve the accuracy of correction of femoral alignment but warrant further evaluation of surgical time, perioperative complications, and patient outcomes compared with conventional techniques.
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Affiliation(s)
- Emma L Hall
- Willows Veterinary Centre and Referral Service, England, United Kingdom
| | - Stephen Baines
- Willows Veterinary Centre and Referral Service, England, United Kingdom
| | - Alexis Bilmont
- Willows Veterinary Centre and Referral Service, England, United Kingdom
| | - Bill Oxley
- Willows Veterinary Centre and Referral Service, England, United Kingdom
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