Combined Tibial Plateau Levelling Osteotomy and Tibial Tuberosity Transposition: An Ex Vivo Mechanical Study

2018 ◽  
Vol 31 (02) ◽  
pp. 124-130
Author(s):  
Ryan Birks ◽  
Michael Kowaleski
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Tibial Plateau ◽  
Ex Vivo ◽  
Tensile Force ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Fixation Failure ◽  
Significant Difference ◽  
Mode Of Failure

Objectives The purpose of this study is to compare the load at failure and mode of failure between (1) tibial plateau levelling osteotomy (TPLO) and combined TPLO and tibial tuberosity transposition (TPLO-TTT) (Phase I) and (2) TPLO-TTT and tibial tuberosity transposition (TTT) (Phase II). Methods Seven pairs of cadaveric tibiae were tested in each of the Phase I (TPLO vs. TPLO-TTT) and Phase II (TPLO-TTT vs. TTT) experiments. One limb of each pair was randomly assigned to one of two groups for each experimental phase. A tensile force was applied to the patellar ligament until construct failure occurred. Results There was a significant difference in mean load at failure between TPLO (2092.8 N) and TPLO-TTT (1067.8 N), p = 0.004. All TPLO constructs failed by fracture of the tibial crest. The TPLO-TTT constructs failed by cranial displacement of the distal tibial crest. Additionally, the tibial plateau was displaced in the majority of limbs. There was a significant difference in mean load at failure between TPLO-TTT (1157.6 N) and TTT (1394.0 N), p = 0.025. The TTT constructs demonstrated a similar mode of failure as TPLO-TTT. Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative clinical scenario, these results demonstrate reduced construct strength of the combined TPLO-TTT technique compared with TPLO or TTT alone. When performing TPLO-TTT, meticulous technique and implants of adequate strength must be employed to create a robust construct and minimize postoperative tibial crest fixation failure.

Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study

2021 ◽  
Author(s):  
Esa V. Eskelinen ◽  
Ari P. Suhonen ◽  
Juha V. Virolainen ◽  
William D. Liska
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Locking Plate ◽  
Ex Vivo ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Patellar Ligament ◽  
Raccoon Dog ◽  
Tension Band Wire ◽  
Lower Load

Abstract Objectives The purpose of this study was to compare the load at failure, stiffness and mode of failure between three types of tibial tuberosity transposition fixation techniques: (a) pin and figure-8 tension band wire (Pin-TBW), (b) locking plate with pin and a tension band wire (Plate-Pin-TBW) and (c) locking plate with a pin (Plate-Pin). Methods Six pairs of raccoon dog cadaveric tibiae were tested in Phase I Pin-TBW versus Plate-Pin-TBW and seven pairs in Phase II Plate-Pin-TBW versus Plate-Pin. One limb of each pair was randomly assigned to one of two groups for each phase. A tensile force was applied to the patellar ligament until construct failure. Results Pin-TBW (342N ± 54.7N) failed at a lower load than Plate-Pin-TBW (469N ± 77.3N), p = 0.00748, with all Pin-TBW failing by fracture and the majority of Plate-Pin-TBW failing by rupture of patellar ligament. Pin-TBW group Phase I, normalized with Plate-Pin-TBW Phase I, failed at a lower load than Plate-Pin group Phase II, normalized with Plate-Pin-TBW Phase II, p = 0.00467. There was no significant difference in mean load at failure, stiffness or mode at failure between the groups in the Phase II study. Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative live dog or cat, these results demonstrate lower construct strength of the Pin-TBW construct compared with the Plate-Pin construct in the raccoon dog cadaver model.

A Cadaveric Evaluation of Pin and Tension Band Configuration Strength for Tibial Tuberosity Osteotomy Fixation

2019 ◽  
Vol 33 (01) ◽  
pp. 009-014 ◽  
Author(s):  
Amy N. Zide ◽  
Stephen C. Jones ◽  
Alan S. Litsky ◽  
Nina R. Kieves
Keyword(s):  
Tensile Force ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Patellar Ligament ◽  
Tension Band Wire ◽  
Significant Strength ◽  
Significant Difference ◽  
Mode Of Failure ◽  
Vertically Aligned ◽  
And Control

Abstract Objective The purpose of this study was to compare the load at failure and mode of failure of four constructs used to stabilize a tibial tuberosity osteotomy, including two vertically aligned pins (V), two horizontally aligned pins (H), two vertically aligned pins with a tension band wire (V-TB) and two horizontally aligned pins with a tension band wire (H-TB). Study Design Eighteen pairs of cadaveric tibiae were randomized to receive a TB or no TB. One limb was randomized to be in the H or V group. The contralateral limb was then assigned to the opposite configuration. One pair of limbs was used as a control. A tensile force was applied to the patellar ligament until construct failure. Results There was no significant difference between the mean load at failure of the H (595 N) and V (556 N) groups or between H-TB (1032 N) and V-TB groups (1034 N) (p = 0.487 and p = 0.238, respectively). The TB constructs were significantly stronger than the pin only constructs (p < 0.001). The mode of failure was similar for the pin only constructs, regardless of pin orientation. The TB constructs and control tibias failed at similar loads, most commonly by patellar ligament rupture. Conclusion The use of vertically aligned pins versus horizontally aligned pins does not affect construct strength. These results support the placement of pins in a vertically or horizontally aligned fashion. When performing a tibial tuberosity osteotomy, the addition of a TB adds significant strength to the construct.

scholarly journals Radiographic changes of the patellar ligament in dogs after tibial tuberosity advancement

2013 ◽  
Vol 82 (2) ◽  
pp. 215-218
Author(s):  
Ladislav Stehlík ◽  
Pavel Proks ◽  
Petra Fedorová ◽  
Alois Nečas
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Radiographic Examination ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Significant Difference ◽  
Cranial Cruciate Ligament Rupture

Patellar desmopathy in dogs after tibial plateau levelling osteotomy has been described in many studies. Tibial tuberosity advancement is a biomechanically different technique. It is assumed that the patellar ligament is loaded with little force similarly as after tibial plateau levelling osteotomy. Various aspects related to secondary patellar desmopathy are not completely understood. This study deals with computed radiography measurement of patellar ligament thickness after tibial tuberosity advancement in dogs with cranial cruciate ligament rupture. The thickness of the patellar ligament in exactly predetermined locations was measured from mediolateral radiographs of stifle joints. A total of 18 dogs (20 knee joints) with cranial cruciate ligament (ligamentum cruciatum craniale) rupture underwent three radiographic examinations of the knee (preoperative examination and control examination 7 and 15 weeks after the surgery). Significant difference was found between the thickness of the patellar ligament in the first and second examinations. Some of the demographic factors possibly related to patellar ligament thickness (age, sex, body weight, type of cranial cruciate ligament rupture, arthrotomy, cage size, meniscal injury, time between surgery and radiographic examination) were analyzed. However, statistical analyses did not show any effect of these factors on the thickness of the patellar ligament, except for the time between surgery and radiographic examination. These findings can extend the surgeons’ knowledge of biomechanical aspects of tibial tuberosity advancement.

scholarly journals Analysis of the ex-vivo transformation of semen, saliva and urine as they dry out using ATR-FTIR spectroscopy and chemometric approach

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tanurup Das ◽  
Abhimanyu Harshey ◽  
Ankit Srivastava ◽  
Kriti Nigam ◽  
Vijay Kumar Yadav ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Body Fluids ◽  
Biochemical Changes ◽  
Partial Least Square ◽  
The Body ◽  
Slow Phase ◽  
Time Since Deposition ◽  
Dry Out

AbstractThe ex-vivo biochemical changes of different body fluids also referred as aging of fluids are potential marker for the estimation of Time since deposition. Infrared spectroscopy has great potential to reveal the biochemical changes in these fluids as previously reported by several researchers. The present study is focused to analyze the spectral changes in the ATR-FTIR spectra of three body fluids, commonly encountered in violent crimes i.e., semen, saliva, and urine as they dry out. The whole analytical timeline is divided into relatively slow phase I due to the major contribution of water and faster Phase II due to significant evaporation of water. Two spectral regions i.e., 3200–3400 cm−1 and 1600–1000 cm−1 are the major contributors to the spectra of these fluids. Several peaks in the spectral region between 1600 and 1000 cm−1 showed highly significant regression equation with a higher coefficient of determination values in Phase II in contrary to the slow passing Phase I. Principal component and Partial Least Square Regression analysis are the two chemometric tool used to estimate the time since deposition of the aforesaid fluids as they dry out. Additionally, this study potentially estimates the time since deposition of an offense from the aging of the body fluids at the early stages after its occurrence as well as works as the precursor for further studies on an extended timeframe.

scholarly journals Tibial Plateau Leveling Following Tibial Tuberosity Advancement: A Case Series

2022 ◽  
Vol 9 (1) ◽  
pp. 16
Author(s):  
Daniele Serrani ◽  
Pierre Paul Picavet ◽  
Juan Marti ◽  
Bernard Bouvy ◽  
Marc Balligand ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Case Series ◽  
Major Complication ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Short Term ◽  
Long Term Follow Up ◽  
Persistent Instability

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.

scholarly journals Ipsi- and Contralateral Moxibustion Generate Similar Analgesic Effect on Inflammatory Pain

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Chuan-Yi Zuo ◽  
Peng Lv ◽  
Cheng-Shun Zhang ◽  
Ru-Xue Lei ◽  
Wei Zhou ◽  
...  
Keyword(s):  
Pain Relief ◽  
Phase I ◽  
Phase Ii ◽  
Inflammatory Pain ◽  
Analgesic Effect ◽  
Withdrawal Latency ◽  
Significant Difference ◽  
Freund’S Adjuvant ◽  
Freund's Adjuvant ◽  
Biting Time

The aim of this study was to investigate whether contralateral moxibustion would generate a similar analgesic effect with ipsilateral moxibustion. Contra- and ipsilateral moxibustion were separately applied to Zusanli (ST36) acupoints of inflammatory pain mice. The analgesic effect was evaluated, respectively, by licking/biting time (LBT) of formalin-induced inflammatory pain and thermal withdrawal latency (TWL) of complete Freund’s adjuvant- (CFA-) induced inflammatory pain. For formalin-induced pain, compared with formalin group, the total LBT of ipsi- and contralateral moxibustion reduced in both phase I and phase II, but there was no significant difference between ipsi- and contralateral moxibustion. For CFA-induced inflammatory pain, compared with CFA group, TWL of ipsi- and contra-Moxi groups increased immediately after moxibustion intervention; however there was no obvious difference between ipsi- and contralateral moxibustion at any timepoint. It indicated that contralateral moxibustion had a similar analgesic effect with ipsilateral moxibustion in both formalin- and CFA-induced pain. These results suggest that both ipsi- and contralateral moxibustion could be applied for pain relief.

scholarly journals Radiographic assessment of the proximal tibial angles in dogs and cats with and without cranial cruciate ligament rupture

2018 ◽  
Vol 38 (6) ◽  
pp. 1190-1195 ◽  
Author(s):  
Ana Flávia D.P. Arruda ◽  
Leonardo A.L. Muzzi ◽  
Antonio C.C. Lacreta Junior ◽  
Ruthnéa A.L. Muzzi ◽  
Gabriela R. Sampaio ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Patellar Ligament ◽  
Common Tangent ◽  
Cranial Cruciate Ligament ◽  
Mean Values ◽  
Stifle Joint ◽  
Significant Difference ◽  
Tangent Method ◽  
Healthy Dogs

ABSTRACT: The influence of the proximal tibial angles in the cranial cruciate ligament (CCL) rupture in dogs is still controversial, and little is known regarding this topic in cats. The aim of this study was to evaluate and compare the angles of the proximal portion of the tibia in dogs and cats with and without CCL rupture. Retrospective and prospective radiographs of the stifle joints were obtained and divided into four groups. Group 1 was composed of 70 stifle joint images of dogs without orthopedic disorders (healthy dogs), group 2 had 70 stifle joint images of dogs with CCL rupture, group 3 had 50 stifle joint images of cats without orthopedic disorders (healthy cats) and group 4 had 25 stifle joint images of cats with CCL rupture. Radiographs were taken with the stifle joint in the mediolateral projection, positioned at the angle of hind limb support. Between the two groups of dogs evaluated, the dogs with CCL rupture had statistically greater tibial plateau angle (TPA) compared with healthy dogs. No difference was shown in relation to the TPA between healthy cats and cats with CCL rupture. In relation to the patellar ligament angle by tibial plateau method the values for the healthy dogs were significantly higher than those for the CCL ruptured dogs. Similarly, healthy cats had significantly higher mean values than cats with CCL rupture. In the patellar ligament angle by common tangent method there was no significantly difference between the two groups of dogs. Between the two groups of cats, animals with CCL rupture had statistically higher mean values than healthy cats. In general, the groups of dogs showed higher mean values than the groups of cats. For the patellar ligament insertion angle (PLIA) healthy dogs showed a significantly higher mean than dogs with CCL rupture. There was no significant difference between the groups of cats. In conclusion, the TPA and the PLIA possibly influence the etiology of CCL rupture in dogs but not in cats. The low patellar ligament angle measured by common tangent method may favorably influence the reduced incidence of CCL rupture in cats.

Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: An ex vivo canine study

2014 ◽  
Vol 27 (04) ◽  
pp. 271-276 ◽  
Author(s):  
N. Bertollo ◽  
W. Walsh ◽  
K. Voss ◽  
M. Newman
Keyword(s):  
Computed Tomography ◽  
Cyclic Loading ◽  
Tibial Plateau ◽  
Ex Vivo ◽  
Peak Load ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Load To Failure ◽  
Canine Study

SummaryObjectives: To evaluate the degree of lateralization achievable and strength of tibial tuberosity transposition and advancement (TTTA) relative to pin and tension band wiring (PTBW) for lateral tibial tuberosity transposition.Methods: Six pairs of cadaveric tibiae were used. Tibial tuberosity position was determined with computed tomography (CT); bones were then randomly assigned into TTTA and PTBW groups. The PTBW group had a tibial tuberosity osteotomy and fixation with pin and tension band wiring. The TTTA group had a tibial tuberosity advancement performed with lateralization of the tibial tuberosity by 50% of cage depth, using spacers on the cranial cage screw. Postoperative CT images showed lateralization and craniocaudal deviation. Single axial distractive loading was applied to the patella at 90° to the tibial plateau, and peak load, energy, and stiffness were calculated.Results: There were significant differences in lateralization (PTBW: 67.92 ± 5.1 %; TTTA: 88.51 ± 5.5 %) (p = 0.0173) and craniocaudal deviation (PTBW: –8.30 ± 1.4 %; TTTA: 6.83 ± 0.6) (p = 0.0001). There were no significant differences in peak load to failure (N) (PTBW: 1448 ± 121; TTTA: 1597 ± 43) (p = 0.4541), energy to failure (N/mm) (PTBW: 15013 ± 2719; TTTA: 17314 ± 887) (p = 0.646), or stiffness (N/mm)(PTBW: 102.8 ± 4.7; TTTA: 92.9 ± 4.8) (p = 0.2716).Clinical significance: The TTTA was more effective at lateralization of the tibial tuberosity, and of comparable strength to PTBW. Greater support of the osteotomized fragment with TTTA may resist cyclic loading, and requires evaluation.

Phase I Dose-Escalation Trial of Checkpoint Kinase 1 Inhibitor MK-8776 As Monotherapy and in Combination With Gemcitabine in Patients With Advanced Solid Tumors

2015 ◽  
Vol 33 (9) ◽  
pp. 1060-1066 ◽  
Author(s):  
Adil I. Daud ◽  
Michelle T. Ashworth ◽  
Jonathan Strosberg ◽  
Jonathan W. Goldman ◽  
David Mendelson ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Dose Intensity ◽  
Median Number ◽  
Qtc Prolongation ◽  
Checkpoint Kinase ◽  
Checkpoint Kinase 1 ◽  
Recommended Phase Ii Dose

Purpose We determined the safety, pharmacokinetics, pharmacodynamics, and recommended phase II dose of MK-8776 (SCH 900776), a potent, selective checkpoint kinase 1 (Chk1) inhibitor, as monotherapy and in combination with gemcitabine in a first-in-human phase I clinical trial in patients with advanced solid tumor malignancies. Patients and Methods Forty-three patients were treated by intravenous infusion with MK-8776 at seven dose levels ranging from 10 to 150 mg/m2 as monotherapy and then in combination with gemcitabine 800 mg/m2 (part A, n = 26) or gemcitabine 1,000 mg/m2 (part B, n = 17). Forty percent of patients had three or more prior treatment regimens, and one third of patients had previously received gemcitabine. Results As monotherapy, MK-8776 was well tolerated, with QTc prolongation (19%), nausea (16%), fatigue (14%), and constipation (14%) as the most frequent adverse effects. Combination therapy demonstrated a higher frequency of adverse effects, predominantly fatigue (63%), nausea (44%), decreased appetite (37%), thrombocytopenia (32%), and neutropenia (24%), as well as dose-related, transient QTc prolongation (17%). The median number of doses of MK-8776 administered was five doses, with relative dose-intensity of 0.96. Bioactivity was assessed by γ-H2AX ex vivo assay. Of 30 patients evaluable for response, two showed partial response, and 13 exhibited stable disease. Conclusion MK-8776 was well tolerated as monotherapy and in combination with gemcitabine. Early evidence of clinical efficacy was observed. The recommended phase II dose is MK-8776 200 mg plus gemcitabine 1,000 mg/m2 on days 1 and 8 of a 21-day cycle.

Streptokinase and Urokinase in the Treatment of Pulmonary Thromboemboli

1976 ◽  
Vol 35 (01) ◽  
pp. 057-069 ◽  
Author(s):  
William R Bell
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Phase I ◽  
Phase Ii ◽  
Clinical History ◽  
Pulmonary Angiography ◽  
Lung Perfusion ◽  
Bleeding Complications ◽  
Significant Difference ◽  
Cardiopulmonary Hemodynamics

SummaryIn Phase I of this study of 160 patients with pulmonary embolism, it was demonstrated that 12 hours of urokinase accelerated the resolution of pulmonary thromboemboli compared to heparin alone. Phase II compared 12 hours of urokinase, 24 hours of urokinase and 24 hours of streptokinase in 167 patients. All patients had a clinical history and angiographic diagnosis of pulmonary embolism. Patients were randomly allocated to treatment. All physicians making patient observations were unaware of drug assignment.Resolution of the thromboembolism 24–30 hours after therapy had been instituted was determined by pulmonary angiography, lung perfusion scans and cardiopulmonary hemodynamics. Twenty-four hours of urokinase did not demonstrate greater clot resolution than 12 hours of urokinase. Twenty-four hours of urokinase resulted in greater improvement than streptokinase in lung perfusion scans, but not in angiograms. In patients with massive embolism, this difference was statistically significant. Hemodynamic differences varied.Bleeding complications and morbidity due to allergic reactions with streptokinase and urokinase were minimal. There was no statistically significant difference in mortality in the three treatment groups.From the Phase I and Phase II data it is reasonable to conclude that all three regimens of thrombolytic therapy are more effective than heparin alone in accelerating resolution of pulmonary emboli. Thrombolytic therapy offers the clinician an alternative to pulmonary embolectomy.

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