Biomechanical Effects of Tibial Plateau Levelling Osteotomy on Joint Instability in Normal Canine Stifles: An In Vitro Study

Abstract Objective The aim of the study was to determine the changes in biomechanical characteristics following tibial plateau levelling osteotomy (TPLO) using simulated manual tests. Study Design Twenty-one stifles from healthy Beagle dogs that had undergone TPLO or had not (control) were first tested in the intact form, and then the cranial cruciate ligament (CrCL) was transected in each to provide four test situations: control-intact, control-CrCL-transected, TPLO-intact and TPLO-CrCL-transected. The stifles were then analysed using a robotic joint biomechanical testing system. The craniocaudal drawer, axial rotation and proximal compression tests were applied. Results The craniocaudal displacement during the drawer test was not significantly different between the control-intact and TPLO-intact. However, the displacement was significantly greater in the TPLO-CrCL-transected than in the control-intact. In the axial rotation test, the internal–external (IE) rotation was significantly greater in the TPLO-intact than in the control-intact. Similarly, the IE rotation was significantly greater in the TPLO-CrCL-transected than in the control-CrCL-transected. In the proximal compression test, craniocaudal displacement was not significantly different among the control-intact, TPLO-intact and TPLO-CrCL-transected. Conclusion These findings suggest that TPLO influences the tension of the collateral ligaments and might generate laxity of the tibiofemoral joint. Instability after the osteotomy might be associated with the progression of osteoarthritis.

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Lateral Extra-articular Tenodesis Alters Lateral Compartment Contact Mechanics under Simulated Pivoting Maneuvers: An In Vitro Study

The American Journal of Sports Medicine ◽

10.1177/03635465211028255 ◽

2021 ◽

pp. 036354652110282

Author(s):

Niv Marom ◽

Hamidreza Jahandar ◽

Thomas J. Fraychineaud ◽

Zaid A. Zayyad ◽

Hervé Ouanezar ◽

...

Keyword(s):

Contact Mechanics ◽

Contact Force ◽

Contact Stress ◽

Tibial Plateau ◽

Cruciate Ligament ◽

In Vitro Study ◽

Lateral Compartment ◽

Lateral Tibial Plateau ◽

Intact Knee

Background: There is concern that utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) may disturb lateral compartment contact mechanics and contribute to joint degeneration. Hypothesis: ACLR augmented with LET will alter lateral compartment contact mechanics in response to simulated pivoting maneuvers. Study Design: Controlled laboratory study. Methods: Loads simulating a pivot shift were applied to 7 cadaveric knees (4 male; mean age, 39 ± 12 years; range, 28-54 years) using a robotic manipulator. Each knee was tested with the ACL intact, sectioned, reconstructed (via patellar tendon autograft), and, finally, after augmenting ACLR with LET (using a modified Lemaire technique) in the presence of a sectioned anterolateral ligament and Kaplan fibers. Lateral compartment contact mechanics were measured using a contact stress transducer. Outcome measures were anteroposterior location of the center of contact stress (CCS), contact force from anterior to posterior, and peak and mean contact stress. Results: On average, augmenting ACLR with LET shifted the lateral compartment CCS anteriorly compared with the intact knee and compared with ACLR in isolation by a maximum of 5.4 ± 2.3 mm ( P < .001) and 6.0 ± 2.6 mm ( P < .001), respectively. ACLR augmented with LET also increased contact force anteriorly on the lateral tibial plateau compared with the intact knee and compared with isolated ACLR by a maximum of 12 ± 6 N ( P = .001) and 17 ± 10 N ( P = .002), respectively. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress by 0.7 ± 0.5 MPa ( P = .005) and by 0.17 ± 0.12 ( P = .006), respectively, at 15° of flexion. Conclusion: Under simulated pivoting loads, adding LET to ACLR anteriorized the CCS on the lateral tibial plateau, thereby increasing contact force anteriorly. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress at 15° of flexion. Clinical Relevance: The clinical and biological effect of increased anterior loading of the lateral compartment after LET merits further investigation. The ability of LET to anteriorize contact stress on the lateral compartment may be useful in knees with passive anterior subluxation of the lateral tibia.

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An In Vitro Study to Determine the Effectiveness of a Patellar Ligament/Fascia Lata Graft and New Tibial Suture Anchor Points for Extracapsular Stabilization of the Cranial Cruciate Ligament-Deficient Stifle in the Dog

Veterinary Surgery ◽

10.1111/j.1532-950x.2004.04075.x ◽

2004 ◽

Vol 33 (5) ◽

pp. 531-541 ◽

Cited By ~ 15

Author(s):

Tisha A. M. Harper ◽

Robert A. Martin ◽

Daniel L. Ward ◽

J. Wallace Grant

Keyword(s):

Suture Anchor ◽

Cruciate Ligament ◽

In Vitro Study ◽

Fascia Lata ◽

Vitro Study ◽

Patellar Ligament ◽

Cranial Cruciate Ligament ◽

Fascia Lata Graft ◽

Anchor Points

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The effect of tibial tuberosity advancement and meniscal release on kinematics of the cranial cruciate ligament-deficient stifle during early, middle, and late stance

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-10-08-0122 ◽

2011 ◽

Vol 24 (05) ◽

pp. 342-349 ◽

Cited By ~ 10

Author(s):

J. A. Syrcle ◽

R. M. McLaughlin ◽

S. H. Elder ◽

J. R. Butler

Keyword(s):

Cruciate Ligament ◽

Axial Rotation ◽

Biomechanical Study ◽

Tibial Tuberosity ◽

Rotational Stability ◽

Tibial Rotation ◽

Cranial Cruciate Ligament ◽

Rotational Displacement ◽

Treatment Conditions

SummaryObjectives: To evaluate the effect of tibial tuberosity advancement (TTA) and meniscal release on cranial-caudal and axial rotational displacement during early, middle and late stance phases in the canine cranial cruciate ligament- (CCL) deficient stifle.Study design: In vitro biomechanical study.Methods: Eighteen pelvic limbs were evaluated for the effects of TTA on cranial-caudal displacement and axial rotation under a load equivalent to 30% bodyweight, and under the following treatment conditions: normal (intact CCL), CCL deficient, TTA-treated (CCL deficient + TTA), and meniscal release (TTA treated + meniscal release). The limbs were evaluated in the early, middle, and late stance phases using electromagnetic tracking sensors to determine cranial tibial displacement and tibial rotation relative to the femur.Results: Transection of the CCL resulted in significant cranial tibial displacement during early, middle, and late stance (p < 0.0001) and significant internal rotation during early (p = 0.049) and middle stance (p = 0.0006). Performance of TTA successfully eliminated cranial tibial displacement in early, middle, and late stance (p <0.0001) however, the TTA was unsuccessful in normalizing axial rotation in middle stance (p = 0.030). Meniscal release had no effect on cranial-caudal or rotational displacement when performed in conjunction with the TTA.Clinical significance: Tibial tuberosity advancement effectively eliminates cranial tibial displacement during early, middle and late stance however, TTA failed to provide rotational stability in mid-stance.

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Effect of tibial insertion site for lateral suture stabilization on the kinematics of the cranial cruciate ligament deficient-stifle during early, middle and late stance

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-12-04-0051 ◽

2013 ◽

Vol 26 (03) ◽

pp. 208-217 ◽

Cited By ~ 6

Author(s):

T. A. Harper ◽

O. I. Lanz ◽

L. L. D'Amico ◽

J. R. Butler ◽

R. M. McLaughlin ◽

...

Keyword(s):

Tracking System ◽

Cruciate Ligament ◽

Insertion Site ◽

Three Dimensional ◽

Axial Rotation ◽

Biomechanical Study ◽

Lateral Direction ◽

Cranial Cruciate Ligament ◽

Lateral Suture

SummaryObjective: To evaluate the effect of two tibial attachment sites for lateral suture stabilization (LSS) on the three-dimensional femorotibial translational and rotational movements of the cranial cruciate ligament-deficient canine stifle during the early, middle and late stance phases.Study design: In vitro biomechanical study: 32 hindlimbs from 16 canine cadavers.Methods: Limbs were mounted in a testing jig and an electromagnetic tracking system was used to determine the three-dimensional femorotibial translational and rotational movements under 33% of body weight load during early, middle and late stance in the following sequence: cranial cruciate ligament-intact, cranial cruciate ligament-deficient and LSS with the distal anchor through the tibial tuberosity (LSSTT) or through the cranial eminence of the extensor groove (LSSEG). The proximal anchor point was the lateral femorofabellar ligament.Results: Post-LSS stifle three-dimensional femorotibial translational and rotational movements were more comparable to normal than post-transection movements for both techniques. Both LSS techniques restored femorotibial movements in cranial cruciate ligament-deficient stifles to varying amounts but neither technique successfully restored normal three-dimensional femorotibial movements. The LSSEG improved femorotibial movements of the cranial cruciate ligament-deficient stifle in the medial-lateral direction and axial rotation but performed poorly in restoring femorotibial movements in the cranial-caudal direction as compared to the LSSTT.Clinical significance: Both the LSSTT and LSSEG techniques failed to completely restore normal three-dimensional femorotibial translational and rotational movements in cranial cruciate ligament-deficient stifles in vitro.

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Lateral and medial tibial plateau angles in normal dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-13-04-0043 ◽

2014 ◽

Vol 27 (02) ◽

pp. 135-140 ◽

Cited By ~ 12

Author(s):

M. K. Ocal ◽

S. S. Sabanci

Keyword(s):

Tibial Plateau ◽

Cruciate Ligament ◽

Axial Rotation ◽

T Test ◽

Medial Tibial Plateau ◽

Lateral Tibial Plateau ◽

Cranial Cruciate Ligament ◽

Significant Difference ◽

The Mean ◽

The Difference

SummaryTo measure lateral and medial tibial plateau angle values in isolated canine tibiae and to compare lateral and medial tibial plateau angle values between dogs based on sex and breed.Tibiae of 90 dogs from 24 different breeds were used. Photographs were taken of the medial and lateral aspects of the tibiae for measurement of the medial and lateral tibial plateau angles. Additionally, the medial tibial plateau angle was measured from radiographs of the tibiae. Two-way analysis of variance was used to test the effects of side, sex and breed on the medial and lateral tibial plateau angles as measured from photographs as well as the medial tibial plateal angles as measured from radiographs. The photographic and radiographic medial tibial plateau angles were compared by paired t-test, whereas the medial and lateral photographic tibial plateau angles were compared by t-test.When all dogs were included in the analysis, the difference between the mean medial tibial plateau angle (24.0 ± 3.19°) and the mean lateral tibial plateau angle (25.5 ± 3.84°) as measured from photographs was significant (p <0.05). The difference in the photographic medial tibial plateau angle between male and female dogs was significant (p <0.05), whereas the difference in the photographic lateral tibial plateau angle between sexes was not significant. There was a significant difference between the medial and lateral tibial plateau angles as measured from photographs in male dogs (p <0.05) but not in female dogs. Breed comparisons also showed significant differences for the photographic lateral tibial plateau angle (p <0.05).The axial rotation of the femoral condyles on the tibial plateau is probably affected by the discrepancy between the medial and lateral tibial plateau angles, and this difference in certain breeds might influence the prevalence of cranial cruciate ligament disease.

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Sagittal joint instability in the cranial cruciate ligament insufficient canine stifle

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.1055/s-0038-1623760 ◽

2014 ◽

Vol 42 (03) ◽

pp. 151-156 ◽

Cited By ~ 16

Author(s):

J. Rey ◽

M. S. Fischer ◽

P. Böttcher

Keyword(s):

Tibial Plateau ◽

Cruciate Ligament ◽

Wedge Osteotomy ◽

Motion Pattern ◽

Cranial Cruciate Ligament ◽

Sound Control ◽

In Vitro Simulation ◽

Canine Stifle

Summary Objective: This in vivo study qualitatively describes the sagittal motion pattern of the cranial cruciate ligament (CrCL) insufficient canine stifle in operated and unoperated joints with cranio-caudal laxity on palpation. Material and methods: Sagittal stifle kinematics were recorded in vivo in dogs (> 15 kg BW) with unilateral (n = 7) or bilateral (n = 6) complete CrCL rupture and positive cranial drawer test as well as two sound control dogs using uniplanar fluoroscopic kinematography with the dogs walking on a treadmill. Stifle stability and sagittal motion pattern of the femur and the tibia were determined by visual inspection of the fluoroscopic video sequences. Results: Control dogs showed no cranio-caudal instability, identical to the contralateral stifles of the dogs with unilateral rupture. All unoperated stifles with CrCL rupture (n = 6) showed caudal slippage of the femur at the beginning of the stance phase. Of the 13 operated stifles (TightRope: n = 1, tibial tuberosity advancement, TTA: n = 6, tibial plateau leveling osteotomy, TPLO: n = 5, cranial closing wedge osteotomy, CCWO: n = 1) nine were unstable, showing the same motion pattern as the unoperated stifles. Conclusion: In the CrCL insufficient stifle with in vivo cranio-caudal instability caudal slippage of the distal femur at tow touch is the predominant motion pattern. Clinical significance: The discrepancy between in vivo motion pattern and in vitro simulation of CrCL insufficiency in which cranial tibial subluxation is the predominant sagittal motion pattern warrants further studies.

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An in vitro Comparison of Two Replacement Techniques Utilizing Fascia Lata after Cranial Cruciate Ligament Transection in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633025 ◽

1993 ◽

Vol 06 (02) ◽

pp. 85-92 ◽

Cited By ~ 3

Author(s):

G. L. Coetzee

Keyword(s):

Femoral Condyle ◽

Cruciate Ligament ◽

Maximum Load ◽

Fascia Lata ◽

Patellar Ligament ◽

Cross Sectional ◽

Cranial Cruciate Ligament ◽

Replacement Technique ◽

Over The Top

SummaryThe immediate postoperative biomechanical properties of an “underand-over” cranial cruciate ligament (CCL) replacement technique consisting of fascia lata and the lateral onethird of the patellar ligament, were compared with that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The right CCL in twelve adult dogs was dissected out and replaced with an autograft. The contralateral, intact CCL served as the control. In group A, the graft was secured to the lateral femoral condyle with a spiked washer and screw. In group B the intracapsular graft was secured to the lateral femoro-fabellar ligament, and the remainder to the patellar tendon. Both CCL replacement techniques exhibited a 2.0 ± 0.5 mm anterior drawer immediately after the operation. After skeletonization of the stifles, the length and cross-sectional area of the intact CCL and CCL substitutes were determined. Each bone-ligament unit was tested in linear tension to failure at a fixed distraction rate of 15 mm/s with the stifle in 120° flexion. Data was processed to obtain the corresponding material parameters (modulus, stress and strain in the linear loading region, and energy absorption to maximum load).The immediate postoperative structural and material properties of the “under-and-over” cranial cruciate ligament replacement technique with autogenous fascia lata, were compared to that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The combined UOT T technique was slightly stronger (6%), but allowed 2.8 ± 0.9 mm more cranial tibial displacement at maximum linear force.

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