Comparison of a novel extracapsular suture technique with a standard fabellotibial suture technique for cranial cruciate ligament repair using a custom-made limb-press model in cats

2020 ◽  
Vol 22 (10) ◽  
pp. 1016-1024
Author(s):  
Bettina Lechner ◽  
Stephan Handschuh ◽  
Barbara Bockstahler ◽  
Alexander Tichy ◽  
Christian Peham ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Lateral Collateral Ligament ◽  
Suture Technique ◽  
Tibial Tuberosity ◽  
Joint Angles ◽  
Cranial Cruciate Ligament ◽  
Custom Made ◽  
Significant Difference

Objectives The aim of our study was to compare the standard fabellotibial suture with Mini TightRope fixation for the treatment of a cranial cruciate ligament (CCL) rupture using a feline custom-made limb press. Methods Cadaveric hindlimbs of 10 cats were inserted in the limb press at predefined joint angles and loads of 10% and 30% body weight (BW) were applied. Mediolateral radiographs were taken and three-dimensional coordinates were recorded using a microscribe digitiser, with intact and transected CCLs and after either fabellotibial suture or Mini TightRope fixation were performed. Different distances and angles from radiographs or microscribe coordinates were analysed. Results Radiographic distances from the femoral condyle to the cranial edge of the tibia (X1–X2) were higher in CCL-deficient stifles than in intact stifles at 10% and 30% BW loads. All fabellotibial sutures and Mini TightRope fixations neutralised excessive cranial tibial thrust. A significant difference in the distance between the patella and tibial tuberosity (D2) was observed between CCL-deficient limbs and Mini TightRope-fixed limbs at 10% BW load ( P <0.04). A significant difference in the distance between the tibial tuberosity and lateral collateral ligament of the femur (D3) was observed between the intact and transected CCLs on the left legs at 10% BW load ( P <0.003) and on both legs at 30% BW load ( P <0.002). Furthermore, we observed significant differences between CCL-deficient left legs and Mini TightRope-treated legs at 10% BW load ( P <0.003). With regard to fabellotibial suture-treated legs, we observed significant differences between transected limbs and fixed limbs at 30% BW load ( P <0.004). W1 (craniocaudal angle) and W2 (mediolateral angle) showed significant differences between intact and transected CCLs and between transected and fixed limbs at 30% BW load ( P <0.004). Conclusions and relevance Fixation of CCL-deficient stifles with lateral fabellotibial suture, as well as Mini TightRope tightened with a 20 N load, produces good biomechanical stability, as detected via radiographic assessment.

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.

Use of a custom-made limb-press model to assess intra- and extracapsular techniques for treating cranial cruciate ligament rupture in cats

2017 ◽  
Vol 20 (4) ◽  
pp. 271-279 ◽  
Author(s):  
Wolfgang Kneifel ◽  
Danilo Borak ◽  
Barbara Bockstahler ◽  
Eva Schnabl-Feichter
Keyword(s):  
Body Weight ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Reference Points ◽  
Joint Angles ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Custom Made ◽  
Before And After ◽  
Cranial Cruciate Ligament Rupture

Objectives This study aimed to compare the under-and-over technique, a type of intracapsular treatment, and the standard fabella–tibial suture, a method for extracapsular treatment, in achieving immediate, postoperative stifle stability after cranial cruciate ligament (CrCL) rupture by using a feline, custom-made limb-press model. Methods Cadaveric feline hindlimb specimens (n = 14) were positioned in the limb press at predefined joint angles (stifle joint: 120°; hock joint: 120°), and vertical loads of 5%, 10%, 20% and 30% body weight were applied statically. Mediolateral radiographic views were obtained of the stifles under each load before and after CrCL transection, as well as after treatment with either of the two surgical techniques, and differences in distance between two predefined radiographic points for each radiograph were analysed. Results The general linear model showed a significant effect of load ( P <0.01) and technique ( P = 0.004) and a significant interaction between load and technique ( P = 0.006) regarding craniocaudal stifle stability. Distances between predefined tibial and femoral reference points were consistently higher in transected CrCLs than in intact stifles. All standard fabella–tibial suture-treated stifles (n = 7) were stable at all loads tested. Of the seven under-and-over technique-treated stifles, one was unstable at 20% body weight load and three at 30% body weight load. Conclusions and relevance Our model, which appropriately reproduced certain aspects of domestic shorthair cat stifle mechanics, indicated that a 40 lb monofilament nylon prosthesis, tightened at 20 N, produces more favourable biomechanical stabilisation of craniocaudal cruciate-related stifle instability than a 0.5 cm wide strip of fascia lata applied intracapsularly.

Comparison of Intra- and Postoperative Complications between Bilateral Simultaneous and Staged Tibial Plateau Levelling Osteotomy with Arthroscopy in 176 Cases

2020 ◽  
Author(s):  
Raz Peress ◽  
Sebastian Mejia ◽  
Marcos Unis ◽  
Giovanni Sotgiu ◽  
Simone Dore ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Complication Rate ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Statistical Error ◽  
Major Complication ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Significant Difference ◽  
Client Factors

Abstract Objective The aim of this study was to compare the resulting short-term complications after simultaneous (SIM) or staged (ST) tibial plateau levelling osteotomy (TPLO) in patients that presented with bilaterally torn cranial cruciate ligaments. Study Design This was a retrospective study. Materials and Methods Medical records of dogs diagnosed with bilateral cranial cruciate ligament disease that underwent bilateral SIM or ST TPLO surgery with arthroscopy (2005–2015) were reviewed to evaluate the intra- and postoperative complications. Data were analysed and major and minor complications were compared between the two groups. Results A total of 176 client-owned dogs (352 stifles) that had TPLO performed bilaterally with SIM or ST procedures were included for analysis. The overall complication rate was 47.5% for the SIM group and 19.5% for the ST group. The incidence of major complications was 10.1 and 3.8% in the SIM and ST groups respectively. Minor complications were 38.4 and 15.6% in the SIM and ST groups respectively. Tibial tuberosity fractures requiring revision were noted in 2% of the SIM group and none of the ST group. Clinical Significance Although no significant difference was noted in major complication rate or tibial tuberosity fractures in our cohort of patients, a Type II statistical error was found. The complication rate in the SIM group is numerically greater by a factor of 2–3× or more for nearly all categories. Surgeons should consider the risks and benefits of SIM versus ST procedures as well as relevant individual patient and client factors before electing either alternative.

Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs

2012 ◽  
Vol 25 (05) ◽  
pp. 402-409 ◽  
Author(s):  
M. S. Hirshenson ◽  
M. S. Thompson ◽  
H. M. Knapp-Hoch ◽  
A. R. Jay-Silva ◽  
M. McConkey ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Single Session ◽  
Short Term ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Significant Difference ◽  
Cranial Cruciate Ligament Rupture

SummaryObjective: To compare the resulting complications, short-term results, and client satisfaction for treatment of cranial cruciate ligament rupture using either unilateral or bilateral single-session tibial tuberosity advancement (TTA) in dogs.Methods: Medical records of 68 dogs (101 stifles) undergoing unilateral or bilateral single-session TTA were evaluated. Data gathered included signalment, history, physical examination findings, anaesthesia and surgical time, type of cranial cruciate ligament rupture and meniscal injury, implants, and intra-operative and postoperative complications. A mixed effect logistic regression analysis was performed to determine if complications were grouped by surgical procedure. Linear regression was performed to determine the influence of the variables on the occurrence of complications. Values of p <0.05 were considered significant.Results: No major intra-operative complications occurred. Twenty stifles (20%) developed a complication after surgery (11 minor, 9 major). There was no significant difference in occurrence of complications between dogs undergoing unilateral (n = 8) or bilateral single-session (n = 12) TTA (p = 0.69). The only risk factor found to be associated with complication occurrence was age.Clinical significance: This is the first report evaluating the use of bilateral simultaneous TTA. There was no significant difference in complication rates between unilateral and bilateral single-session TTA. Additional evaluation is needed to fully determine the extent of complications and long-term outcome of bilateral single-session TTA.

Comparison of Outcomes Associated with Tibial Plateau Levelling Osteotomy and a Modified Technique for Tibial Tuberosity Advancement for the Treatment of Cranial Cruciate Ligament Disease in Dogs: A Randomized Clinical Study

2019 ◽  
Vol 32 (04) ◽  
pp. 314-323
Author(s):  
Véronique Livet ◽  
Arnaud Baldinger ◽  
Éric Viguier ◽  
Mathieu Taroni ◽  
Mathieu Harel ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Postoperative Recovery ◽  
Tibial Tuberosity ◽  
Modified Technique ◽  
Cranial Cruciate Ligament ◽  
Symmetry Index ◽  
Randomized Clinical Study ◽  
Significant Difference ◽  
Duration Of Surgery

Objectives This study aimed to compare outcomes between the tibial plateau levelling osteotomy (TPLO) procedure and a modified tibial tuberosity advancement (TTA Rapid) in dogs with cranial cruciate ligament rupture. Materials and Methods Twenty-six dogs were prospectively randomized into two groups: a TPLO group (n = 13) and a TTA Rapid group (n = 13). A lameness score evaluation, gait analysis and radiographical examination were performed before surgery, the 3 days after surgery, and then at 1, 3 and 6 months postoperatively. Finally, owners were asked to subjectively rate their level of satisfaction. Results The duration of surgery was significantly shorter for the TTA Rapid procedure (p < 0.0001). There was no significant difference in the occurrence of complications between groups. Lameness scores were significantly higher during the first 3 days after surgery for the TPLO group (p = 0.01 at day 1, p = 0.01 at day 2 and p = 0.003 at day 3). One month after surgery, the symmetry index between healthy and affected limbs for the relative stance time during the gait cycle (symmetry index/%) was significantly higher for the TTA Rapid group (p < 0.01). No gait parameters were significantly different between the two groups 6 months after surgery. All of the owners of dogs in the TPLO group were completely satisfied, whereas only 11/13 owners of dogs in the TTA rapid group were completely satisfied. Clinical Significance Tibial plateau levelling osteotomy and TTA Rapid were associated with high long-term success rates in dogs. The immediate postoperative recovery seemed faster with TTA Rapid, but thereafter there was no difference.

Tibial tuberosity advancement in two cats with cranial cruciate ligament deficiency

2010 ◽  
Vol 23 (03) ◽  
pp. 196-202 ◽  
Author(s):  
K. Perry ◽  
N. Fitzpatrick
Keyword(s):  
Cruciate Ligament ◽  
Weight Bearing ◽  
Suture Technique ◽  
Tibial Tuberosity ◽  
The Other ◽  
Technical Application ◽  
Cranial Cruciate Ligament ◽  
Partial Tear ◽  
History Of

SummaryTwo Domestic Shorthaired cats were diagnosed with longstanding lameness attributed to cranial cruciate ligament deficiency without any history of trauma. One cat had a previous operation in which the lateral nylon suture technique was used, and the other cat was affected by a partial tear of the cranial cruciate ligament. Tibial tuberosity advancement was carried out in both patients, which resulted in long-term resolution of lameness for both. The results of these cases concur with previous studies performed on canine patients in terms of viability of technical application and satisfactory return to weight bearing postoperatively. Further investigation of tibial tuberosity advancement in feline patients is justified.

Treatment of cranial cruciate ligament rupture in the feline stifle

2015 ◽  
Vol 28 (06) ◽  
pp. 401-408 ◽  
Author(s):  
R. De. Sousa ◽  
M. Sutcliffe ◽  
N. Rousset ◽  
M. Holmes ◽  
S.J. Langley-Hobbs
Keyword(s):  
Cruciate Ligament ◽  
Suture Technique ◽  
Radiographic Examination ◽  
Axial Loads ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Significant Difference ◽  
Bone Anchors ◽  
Distal Direction ◽  
Lateral Suture

SummaryObjective: To determine whether a lateral suture placed with bone anchors between quasi-isometric points in a cat is superior to a standard fabella-tibial suture for the stabilization of cranial cruciate ligament (CrCL) rupture compared to an intact stifle joint.Study design: Biomechanical cadaveric study.Methods: Six stifle joints with intact cruciate ligaments from three skeletally mature cats were placed in a loading mounting set and tested with axial loads of 20N and 60N at three different joint angles (75°,130° and 160°). The procedure was repeated with a transected CrCL; a stabilized stifle joint after a combination of three lateral suture techniques (fabella-tibial suture technique [SFT]; femoro-tibial suture technique 1 [FTS-1] and femoro-tibial suture technique 2 [FTS-2]). Radiographic examination of the relative position of the tibia to the fixed femur was compared.Results: Stabilization of the stifle joint with lateral sutures had comparable stability to the intact specimens in the cranio-caudal direction (p = 0.2) but not in the proximo- distal direction for the SFT (p = 0.04) and FTS-2 technique (p = 0.03). There was no significant difference between the three stabilization techniques (p >0.05).Clinical significance: Lateral sutures placed with bone anchors at quasi-isometric points performed better than SFT and FTS-2 in stabilizing the feline stifle after CrCL rupture in the proximo-distal plane. Biomechanical stability in the cranio-caudal plane after placement of a lateral suture across the feline stifle was similar to the intact CrCL.

The effects of a novel lateral extracapsular suture system on the kinematics of the cranial cruciate deficient canine stifle

2013 ◽  
Vol 26 (04) ◽  
pp. 271-279 ◽  
Author(s):  
O. I. Lanz ◽  
K. S. Aulakh ◽  
J. R. Butler ◽  
R. M. McLaughlin ◽  
T. A. Harper ◽  
...  
Keyword(s):  
Body Weight ◽  
Internal Rotation ◽  
Relative Position ◽  
Cruciate Ligament ◽  
Biomechanical Study ◽  
Electromagnetic Tracking ◽  
Joint Angles ◽  
Cranial Cruciate Ligament ◽  
Significant Difference

SummaryObjective To evaluate the relative position of the femur and tibia in cranial cruciate ligament- intact stifles, cranial cruciate ligamentdeficient stifles, and cruciate-deficient stifles following lateral extracapsular suture system (LESS) stabilization under load at specific joint angles.Study design In vitro biomechanical study.Methods Twenty pelvic limbs from 11 dogs were used to evaluate the relative position of the femur and tibia between three stifle conditions (cranial cruciate ligament-intact, cranial cruciate ligament-deficient, and LESSstabilized) at a load of 30% of body weight and stifle angles of 125°, 135°, and 145° using electromagnetic tracking sensors.Results Cranial cruciate ligament-deficient stifles had significantly greater (p <0.0001) cranial displacement and internal rotation of the tibia relative to the femur than cranial cruciate ligament-intact or LESS stifles at all stifle angles. Cranial displacement of the tibia relative to the femur for cranial cruciate ligament-intact and LESS stifles were not significantly different from one another at a stifle angle of 125°, but were significantly different at stifle angles of 135° (p = 0.0182) and 145° (p = 0.0012). There was no significant difference in internal rotation of the tibia relative to the femur between the cranial cruciate ligament-intact and LESS stifles at any of the stifle angles.Clinical significance The LESS procedure effectively decreased cranial tibial displacement and eliminated internal rotation of the tibia relative to the femur in the cranial cruciate ligament-deficient stifles at stifle angles of 125°, 135°, and 145° in vitro.

Comparison of Outcome and Complications in Dogs Weighing Less Than 12 kg Undergoing Miniature Tibial Tuberosity Transposition and Advancement versus Extracapsular Stabilization with Tibial Tuberosity Transposition for Cranial Cruciate Ligament Disease with Concomitant Medial Patellar Luxation

2020 ◽  
Author(s):  
Morgan Hackett ◽  
Lindsay St Germaine ◽  
Margaret-Ann Carno ◽  
Daniel Hoffmann
Keyword(s):  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Short Term ◽  
Retrospective Case ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Significant Difference ◽  
Case Comparison ◽  
Secondary Objective ◽  
Cranial Cruciate Ligament Disease

Abstract Objective The aim of this study was to describe a technique for performing miniature tibial tuberosity transposition and advancement (mTTTA). The secondary objective of this study was to compare the short-term outcome and complications in small breed dogs weighing less than 12 kg undergoing surgical correction of cranial cruciate ligament disease with concurrent medial patellar luxation via either extracapsular stabilization with tibial tuberosity transposition (ECS + TTT) or mTTTA. Study Design This is a retrospective case comparison study. Results There was no significant difference in overall outcome between the ECS + TTT group and the mTTTA group when comparing 8-week postoperative radiographic healing scores as well as 2- and 8-week postoperative lameness scores. Conclusion This study concluded that the mTTTA procedure was feasible and the overall outcome and complications for the dogs that underwent ECS + TTT and those that underwent mTTTA were comparable.

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

1993 ◽  
Vol 06 (02) ◽  
pp. 85-92 ◽  
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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