Does a fabella-tibial suture alter the outcome for dogs with cranial cruciate ligament insufficiency undergoing arthrotomy and caudal pole medial meniscectomy?

2009 ◽  
Vol 22 (04) ◽  
pp. 283-288 ◽  
Author(s):  
E.J. Comerford ◽  
M.R. Owen ◽  
M.S. Tivers
Keyword(s):  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Control Group ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Stifle Joint ◽  
Medial Meniscectomy ◽  
Before And After ◽  
Clinical Records

Summary Objectives: The objective of this study was to evaluate the effects of fabella-tibial suture (FTS) on long-term outcome in dogs with cranial cruciate ligament (CCL) insufficiency and concurrent medial meniscal tear (MMT) that were managed by an open, caudal pole medial meniscectomy (CPMM). Methods: A retrospective review was performed of the clinical records of dogs treated for CCL insufficiency with concurrent MMT by open CPMM, with or without the non-random addition of a nylon FTS according to surgeon preference, during the period of 2001 to 2004. The Bristol Osteoarthritis in Dogs questionnaire was modified for owner assessment of outcome using a visual analogue scale based on several criteria: level of activity, disability, severity of lameness and frequency of lameness before and after surgery. Results: Completed questionnaires from 31 dog owners were received. A FTS was used after CPMM in 22 dogs (FTS group), but in nine dogs (control group) only a CPMM was performed. The median time to follow up was longer in the FTS group (25 months) than the control group (16 months) (P=0.03). There were not any significant differences between the two groups before and after surgery for the following: disability, activity, frequency of lameness, severity of lameness, ability to climb stairs and ability to sit down. Clinical Significance: The placement of a FTS following stifle joint arthrotomy and CPMM in dogs with CCL deficiency and concurrent MMT may not be a significant factor affecting the ultimate surgical outcome, although our study is limited by the non-randomised study design.

Effect of Suture Type on Stifle Joint Biomechanics After Extra-Articular Repair of Cranial Cruciate Ligament Transection in the Dog

1991 ◽  
Vol 4 (04) ◽  
pp. 144-149 ◽  
Author(s):  
M. S. Bauer ◽  
W. E. Blevins ◽  
W. R. Widmer ◽  
Jaqueline Davidson ◽  
S. W. Aiken ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Before And After ◽  
Joint Biomechanics ◽  
Cranial Cruciate Ligament Rupture

SummaryThe effect of two suture types, monofilament polybutester and braided polyester, on stifle joint biomechanics after extra-articular repair of cranial cruciate ligament rupture was evaluated by analysis of the instant centre of motion. The instant centres of motion and resulting velocity vectors were determined radiographically on both stifles of eight fresh canine cadavers before and after cranial cruciate ligament transection. After ligament transection, all 16 stifles were repaired with an extra-articular technique utilizing a double strand of suture placed between the lateral fabella and the tibial tuberosity. One stifle on each cadaver was repaired with each suture type. The instant centres of motion and resulting velocity vectors were re-evaluated post repair. All stifles had normal instant centres of motion prior to transection of the cranial cruciate ligament. Neither ligament transection nor extra-articular repair with either suture type resulted in an abnormal change in the instant centre of motion.

scholarly journals Arthroscopic Articular Cartilage Scores of the Canine Stifle Joint with Naturally Occurring Cranial Cruciate Ligament Disease

2020 ◽  
Author(s):  
Kimberly A. Agnello ◽  
Kei Hayashi ◽  
Dorothy Cimino Brown
Keyword(s):  
Articular Cartilage ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Meniscal Tear ◽  
Trochlear Groove ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Naturally Occurring ◽  
Medial Meniscal Tear ◽  
Severity Scores

Abstract Objective This study aimed to evaluate frequency, location and severity of cartilage pathology in dogs with naturally occurring cranial cruciate ligament (CCL) disease. Study Design Stifle arthroscopic video recordings (n = 120) were reviewed. A modified Outerbridge classification system (MOCS) (0–4) was used to score cartilage at 10 locations in the femorotibial (medial and lateral femoral condyles and tibial plateaus) and patellofemoral compartments (proximal, middle and distal locations of the patella and femoral trochlear groove) of the stifle joint. Synovial pathology was scored and the presence of a medial meniscal tear was recorded. A Kruskal–Wallis test was used to evaluate association of location and synovitis with cartilage score; and presence of meniscal tear with cartilage and synovitis scores. Bonferroni correction was utilized and p < 0.05 was considered significant. Results Cartilage pathology and synovitis were identified in all joints. Overall cartilage severity scores were low (median MOCS 1). The median MOCS of the proximal trochlear groove (2) was significantly higher than all other locations evaluated. Higher synovitis scores were significantly associated with higher cartilage severity scores and a medial meniscal tear had no association with cartilage severity scores or synovitis. Conclusion Arthroscopic articular cartilage lesions are common in dogs with CCL disease at the time of surgical intervention, although the severity of cartilage damage is mild. The proximal trochlear groove of the femur had the most severe cartilage score in the stifle joint.

scholarly journals Does meniscal release confer similar clinical benefits to meniscal tear treatment when compared to meniscectomy?

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Ben Garland
Keyword(s):  
Cruciate Ligament ◽  
Research Question ◽  
Meniscal Tear ◽  
Clinical Expertise ◽  
Meniscal Tears ◽  
Bottom Line ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Time Of Surgery ◽  
Naturally Occurring

PICO question In adult dogs with naturally occurring medial meniscal tears concurrent to cranial cruciate ligament disease does meniscal release confer the same benefits in lameness resolution as meniscectomy?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed A single prospective cross-sectional study was reviewed, that fulfilled the criteria Strength of evidence None Outcomes reported Meniscal release, meniscectomy (partial, hemi- or complete), or the two combined performed for concurrent medial meniscal pathology at time of surgery for naturally occurring cranial cruciate ligament (CCL) rupture resulted in an acceptable long-term outcome. Difference in outcome between the techniques was not reported Conclusion There is no evidence that meniscal release provides an equal or superior treatment option for medial meniscal injury treated at the time of surgery for CCL rupture when compared to meniscectomy. The study critically reviewed performed meniscal release via radial transection through the meniscotibial ligament, and therefore does not represent mid-body abaxial radial release. Neither is this summary appropriate for considering prophylactic meniscal release of the normal meniscus. In addition, the surgical treatments for cranial cruciate ligament rupture were either ‘Tightrope’ or tibial plateau levelling osteotomy (TPLO) procedures. Further studies are required to compare clinical outcome between meniscal release or meniscectomy for treatment of concurrent meniscal tears   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

Effect of Tibial Plateau Levelling Osteotomy on Cranial Tibial Subluxation in the Feline Cranial Cruciate Deficient Stifle Joint: An Ex Vivo Experimental Study

2018 ◽  
Vol 31 (04) ◽  
pp. 273-278
Author(s):  
A. Bilmont ◽  
M. Retournard ◽  
E. Asimus ◽  
S. Palierne ◽  
A. Autefage
Keyword(s):  
Tibial Plateau ◽  
Rotation Angle ◽  
Ex Vivo ◽  
Cruciate Ligament ◽  
Tibial Rotation ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Before And After ◽  
Osteotomy Technique ◽  
Gastrocnemius Muscles

Objectives This study evaluated the effects of tibial plateau levelling osteotomy on cranial tibial subluxation and tibial rotation angle in a model of feline cranial cruciate ligament deficient stifle joint. Methods Quadriceps and gastrocnemius muscles were simulated with cables, turnbuckles and a spring in an ex vivo limb model. Cranial tibial subluxation and tibial rotation angle were measured radiographically before and after cranial cruciate ligament section, and after tibial plateau levelling osteotomy, at postoperative tibial plateau angles of +5°, 0° and –5°. Results Cranial tibial subluxation and tibial rotation angle were not significantly altered after tibial plateau levelling osteotomy with a tibial plateau angle of +5°. Additional rotation of the tibial plateau to a tibial plateau angle of 0° and –5° had no significant effect on cranial tibial subluxation and tibial rotation angle, although 2 out of 10 specimens were stabilized by a postoperative tibial plateau angle of –5°. No stabilization of the cranial cruciate ligament deficient stifle was observed in this model of the feline stifle, after tibial plateau levelling osteotomy. Clinical Significance Given that stabilization of the cranial cruciate ligament deficient stifle was not obtained in this model, simple transposition of the tibial plateau levelling osteotomy technique from the dog to the cat may not be appropriate.

Selective iNOS-inhibition does not influence apoptosis in ruptured canine cranial cruciate ligaments

2009 ◽  
Vol 22 (03) ◽  
pp. 198-203 ◽  
Author(s):  
D. Hofer ◽  
S. Forterre ◽  
A. Schweighauser ◽  
M. Krayer ◽  
M. Doherr ◽  
...  
Keyword(s):  
Cell Death ◽  
Articular Cartilage ◽  
Apoptotic Cell ◽  
Cruciate Ligament ◽  
Control Group ◽  
No Production ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Nos Inhibitor ◽  
Inos Inhibition

SummaryAbnormal patterns of cell death, including increased apoptosis, can influence homeostasis of ligaments and could be involved in the pathogenesis of cranial cruciate ligament (CCL) rupture. Increased nitric oxide (NO) production has been implicated as a stimulus to increased apoptosis in articular cartilage. This study investigated apoptotic cell death in ruptured canine CCL (CCL group, n = 15), in ruptured CCL of dogs treated with oral L-N6-(1-iminoethyl)-lysine (L-NIL), a selective NO-synthetase(NOS)-inhibitor, (L-NIL group, n = 15) and compared the results with normal canine CCL (control group, n = 10).Orally administered L-NIL at a dosage of 25 mg/m2 of body surface area was effective in inhibiting NO production in the articular cartilage of dogs in the L-NIL group, but it did not significantly influence the increased quantity of apoptotic cells found in ruptured CCL specimens. The results of this study suggest that apoptosis of ligamentocytes in the canine CCL is not primarily influenced by increased NO production within the stifle joint.

Bacterial Culture of the Canine Stifle Joint following Surgical Repair of Ruptured Cranial Cruciate Ligament

1999 ◽  
Vol 12 (01) ◽  
pp. 01-05 ◽  
Author(s):  
M. G. Conzemius ◽  
G. K. Smith ◽  
P. M. McManus ◽  
D. Maloney ◽  
C. M. Hill
Keyword(s):  
Synovial Fluid ◽  
Physical Examination ◽  
Bacterial Contamination ◽  
Clinical Success ◽  
Cruciate Ligament ◽  
Low Grade ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Stifle Joint ◽  
Satisfactory Outcome

SummaryThe purpose of this project was to determine if chronic, low grade bacterial contamination is associated with an unsatisfactory outcome of cranial cruciate ligament (CCL ) repair. Additionally, signalment and physical examination findings were compared between dogs doing well and dogs doing poorly. A sample of synovial fluid was obtained from the stifle joints of dogs with either a satisfactory or an unsatisfactory long term outcome following extra-capsular CCL repair. Aerobic and anaerobic bacterial cultures were obtained and antibiotic sensitivities determined. Significant differences were not found between the two groups with regards to the frequency of positive cultures, signalment, or synovial fluid analyses. The dogs with an unsatisfactory outcome did have significantly more pain, less range of motion, and less cranial drawer signs than dogs with a satisfactory outcome. Chronic, low grade bacterial contamination is not associated with an unsatisfactory clinical outcome and, in general, appears to be an uncommon sequela to CCL repair. Physical examination findings suggest that elimination of cranial drawer is not a major determinant of clinical success of the procedure.Synovial fluid cultures and physical exam findings were compared in dogs doing well and dogs doing poorly following cranial cruciate ligament repair.

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.

Long-term outcome of surgery for dogs with cranial cruciate ligament deficiency

2000 ◽  
Vol 147 (12) ◽  
pp. 325-328 ◽  
Author(s):  
J. F. Innes ◽  
D. Bacon ◽  
C. Lynch ◽  
A. Pollard
Keyword(s):  
Cruciate Ligament ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Outcome Of Surgery

Triple tibial osteotomy for treatment of the canine cranial cruciate ligament-deficient stifle joint

2009 ◽  
Vol 22 (06) ◽  
pp. 473-478 ◽  
Author(s):  
T. P. Hill ◽  
M. Glyde ◽  
A. D. Moles
Keyword(s):  
Postoperative Complications ◽  
Cruciate Ligament ◽  
Wedge Angle ◽  
Tibial Osteotomy ◽  
Meniscal Injury ◽  
Patient Age ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Patient Âgé ◽  
Clinical Records

Summary Objective: To report the surgical findings and early post-operative complications of triple tibial osteotomy (TTO) for the treatment of cranial cruciate ligament disruption in dogs. Methods: Clinical records of 84 dogs (97 stifles) that had TTO procedures were reviewed. Surgical findings and postoperative complications were assessed. A complication was defined as any undesirable outcome resulting from TTO that required further diagnostic investigation or surgical treatment. Results: Mean tibial wedge angle was 13.6 degrees (range 10–20). Incomplete tibial crest osteotomy was achieved in 79% of TTO procedures. Implants were placed in the tibial crest in 67% of stifles. Early postoperative complications occurred in 23% of joints, and included avulsion of the tibial crest (9.1%), fracture at the distal cortical attachment of the tibial crest (6.2%), fibula fracture (4.1%), patellar tendonitis (3.1%), late meniscal injury (3.1%), implant complications (3.1%) and patellar fracture (2.1%). Increased patient age (p = 0.023), increased wedge angle (p = 0.009) and intra-operative fracturing of the cranial tibial cortex (p = 0.017) were significantly associated with postoperative tibial crest avulsion. Implants did not prevent tibial crest avulsion. Increased patient age (p = 0.012) was significantly associated with tibial crest fracture. Clinical relevance: Tibial crest avulsion and fracture are the most common postoperative complications for TTO. Late meniscal injury is uncommon after TTO.

Cranial cruciate ligament disease in cats: an epidemiological retrospective study of 50 cats (2011–2016)

2019 ◽  
Vol 22 (4) ◽  
pp. 277-284
Author(s):  
Gudrun S Boge ◽  
Karolina Engdahl ◽  
Elena R Moldal ◽  
Annika Bergström
Keyword(s):  
Chronic Pain ◽  
Cruciate Ligament ◽  
Life Questionnaire ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Cranial Cruciate Ligament Disease

Objectives The aim of this study was to describe the characteristics and long-term outcome of surgically and conservatively treated cats with cranial cruciate ligament disease (CCLD). Methods A retrospective cohort study of cats with CCLD, diagnosed at two university animal hospitals between January 2011 and December 2016, was performed. Signalment, history, treatment and follow-up information were retrieved. Cat owners were contacted for additional long-term follow-up information. The cases were divided into two groups: one conservatively managed and one surgically treated with the lateral fabellotibial suture technique. A quality of life questionnaire, the Feline Musculoskeletal Pain Index (FMPI), was distributed to the owners of cats alive at follow-up for assessment of chronic pain as a long-term outcome. Univariable statistical methods were used to evaluate the data. Results Fifty cats were identified and were followed for a median of 41 months after diagnosis of CCLD. Seven cats (14%) developed bilateral CCLD. Twenty-eight cats (56%) were treated conservatively and 22 (44%) surgically. All surgically treated cats in which arthrotomy was performed (19/22) had total cranial cruciate ligament rupture and 9/19 (47%) had meniscal injuries. Postoperative surgical complications were recorded in 6/22 cats (27%). Owners of 24/29 (83%) cats still alive at follow-up completed the FMPI questionnaire. The conservatively treated cats had a lower FMPI score, indicating less chronic pain, than those cats treated surgically ( P = 0.017). Conclusions and relevance Conservatively treated cats with CCLD experienced less chronic pain at long-term follow-up than surgically treated cats. Bilateral disease is not uncommon in cats with CCLD.

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