Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture

2011 ◽  
Vol 24 (01) ◽  
pp. 27-31 ◽  
Author(s):  
J. Mills ◽  
V. Busoni ◽  
L. Brunel ◽  
M. Balligand ◽  
S. Etchepareborde
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Direction Parallel ◽  
Cage Size ◽  
Osteotomy Plane ◽  
The Difference ◽  
Clinically Significant ◽  
Cranial Cruciate Ligament Rupture

Summary Objectives: To calculate the difference between the desired tibial tuberosity advancement (TTA) along the tibial plateau axis and the advancement truly achieved in that direction when cage size has been determined using the method of Montavon and colleagues. To measure the effect of this difference on the final patellar tendon-tibial plateau angle (PTA) in relation to the ideal 90°. Methods: Trigonometry was used to calculate the theoretical actual advancement of the tibial tuberosity in a direction parallel to the tibial plateau that would be achieved by the placement of a cage at the level of the tibial tuberosity in the osteotomy plane of the tibial crest. The same principle was used to calculate the size of the cage that would have been required to achieve the desired advancement. The effect of the difference between the desired advancement and the actual advancement achieved on the final PTA was calculated. Results: For a given desired advancement, the greater the tibial plateau angle (TPA), the greater the difference between the desired advancement and the actual advancement achieved. The maximum discrepancy calculated was 5.8 mm for a 12 mm advancement in a case of extreme TPA (59°). When the TPA was less than 31°, the PTA was in the range of 90° to 95°. Clinical significance: A discrepancy does exist between the desired tibial tuberosity advancement and the actual advancement in a direction parallel to the TPA, when the tibial tuberosity is not translated proximally. Although this has an influence on the final PTA, further studies are warranted to evaluate whether this is clinically significant.

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.

Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog

2009 ◽  
Vol 22 (01) ◽  
pp. 16-20 ◽  
Author(s):  
D. Koch ◽  
M. Bass ◽  
M. Haessig ◽  
R. Inauen
Keyword(s):  
Body Weight ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Relative Body Weight ◽  
Breeding Selection ◽  
Healthy Dogs ◽  
Cranial Cruciate Ligament Rupture

SummaryThe influence of the tibial tuberosity conformation on cranial cruciate ligament (CrCl) rupture was evaluated and the size of the tibial tuberosity of healthy dogs (group H) was compared with dogs with CrCl rupture (group R) and dogs treated by tibial tuberosity advancement (TTA) (group T). The medio-lateral radio-graphs of 219 stifle joints were evaluated. Relative tibial tuberosity width (rTTW), proximal tibial tuberosity angle (PTTA), tibial plateau angle (TPA), tibial width (TW) and tibial plateau length (TPL) were measured on each radiograph. Body weight (BW) was measured and relative body weight (rBW) was calculated. The data from group H was compared with that of group R and group T. Group H had significantly larger rTTW, lower BW, lower rBW and smaller PTTA than group R. A comparison of groups H and T showed that dogs from group H were significantly younger, had a lower BW, a lower rBW, a greater PTTA and a smaller rTTW. In each of the comparisons, the TPA and the TW/TPL were not significantly different. The conformation of the canine tibial tuberosity has a significant influence on CrCl rupture. We hypothesized that the smaller the tibial tuberosity width, the larger the cranial tibial thrust, which results in more rapid CrCL degeneration, thus leading to rupture in a younger population of dogs. The rTTW could be a helpful measurement for breeding selection. Only dogs with a rTTW of more than 0.90 should be used for breeding.

Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review

2018 ◽  
Vol 46 (04) ◽  
pp. 223-235 ◽  
Author(s):  
Patricia Beer ◽  
Barbara Bockstahler ◽  
Eva Schnabl-Feichter
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Complication Rates ◽  
Cranial Cruciate Ligament ◽  
Evidence Level ◽  
Lower Complication ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Rupture

Summary Objective: The optimal surgical technique for treatment of cranial cruciate ligament rupture in canine has been scientifically discussed for decades. Despite the continuous debate, proximal tibial osteotomies such as tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) are increasingly common. The objective of this review was to systematically evaluate the literature reporting outcome and complications associated with TPLO and TTA. Materials and methods: A systematic search of literature databases identified articles published from August 2004 to February 2016 describing evaluations of short- or longterm outcomes as well as complications following TPLO or TTA. Results: Ninety-one studies were included in this review and assigned to one out of four evidence levels. Of those, 89 studies provided the lowest evidence level and only two were assigned to the third-best evidence level. A comparison of subjective gait analyses could not detect differences in the decrease of lameness between TPLO and TTA, while objective gait analysis supports the superiority of TPLO. Fewer patients treated with TPLO were diagnosed with postoperative joint instability and TPLO had a lower percent increase of osteoarthritis (OA) after surgery. Owner satisfaction was high for both techniques. For TPLO and TTA the average total, minor, major and catastrophic complication rates were 15.9 % and 20.8 %, 7.9 % and 11.6 %, 5.2 % and 13.2 % as well as 0.8 % and 5.6 %, respectively. Conclusion and clinical significance: The assessed literature supports the hypothesis that TPLO is associated with lower complication rates, an improved clinical-functional outcome and less increase of OA compared to TTA. The results are indicative for a long-term restoration of normal limb function after TPLO. However, the strength of available evidence and the comparability of each study’s results were poor and more comparative studies are needed to draw strong conclusions towards the superiority of the TPLO over the TTA.

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.

Conformation of the proximal tibia and cranial cruciate ligament disease in small breed dogs

2017 ◽  
Vol 30 (03) ◽  
pp. 178-183 ◽  
Author(s):  
Michal Kyllar ◽  
Duncan Midgley ◽  
Martin Owen ◽  
Jan Janovec
Keyword(s):  
Body Weight ◽  
Clinical Significance ◽  
Tibial Plateau ◽  
Proximal Tibia ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Relative Body Weight ◽  
Cranial Cruciate Ligament Disease ◽  
Small Breed

SummaryObjectives: To investigate the conformation of the proximal tibia in small breed dogs with and without cranial cruciate ligament disease (CCLD) and to identify morphologic abnormalities that may predispose to development of CCLD.Methods: Mediolateral radiographs of the entire tibia of dogs <15 kg with surgically confirmed CCLD were retrospectively evaluated. Proximal tibial width (PTW), tibial plateau length (TPL), tibial plateau angle as described by Slocum and Slocum (sTPA), proximal tibial tuberosity angle (PTTA), tibial plateau angle as described by Inauen and colleagues (nTPA), and diaphyseal tibial width (DTW) were measured. The same variables were obtained from mediolateral radiographs of the entire tibia of dogs <15 kg without CCLD. In addition, a quotient nTPA/ PTW, relative tibial tuberosity width (rTTW), and relative body weight (rBW) were calculated for each dog. Independent two-sample t-test (p = 0.05) was used to compare mean ± SD of all measured variables between the two groups.Results: Gender, age, and weight mean ± SD were not significantly different between the two groups of dogs (p <0.05). Dogs with CCLD had significantly greater sTPA (p = 0.015) and rBW (p = 0.016).Clinical significance: In dogs of small breeds, a combination of an excessively steep tibial plateau and an increased relative body weight may predispose to early CCLD development. The slope of the tibial plateau was found to be caused by an abnormal caudal angulation of the proximal tibia, a phenomenon previously associated with CCLD development in small breed dogs in individual cases.

Measurement of the tibial plateau angle in cats with and without cranial cruciate ligament rupture

2009 ◽  
Vol 22 (02) ◽  
pp. 83-86 ◽  
Author(s):  
S. Reese ◽  
K. Lorinson ◽  
D. Lorinson ◽  
E. Schnabl
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Inter Observer Variability ◽  
Measurement Results ◽  
Cranial Cruciate Ligament Rupture

SummaryThe objective of the present study was to determine the tibial plateau angle (TPA) in cats without stifle pathology and to compare it with cats suffering from an isolated cranial cruciate ligament rupture. Mediolateral radiographs of the stifle were taken and the tibial plateau angle was measured based on the method previously described by Slocum and Devine (1983) for dogs. Three observers with different levels of experience evaluated the radiographs of all of the cats in this study. The mean tibial plateau angle measured by all three observers in the cats with a rupture of the cranial cruciate ligament (CCL) was 3.1° greater than in cats without stifle pathology. Neither gender, age, body weight nor degenerative joint disease had an influence on measurement results. The authors found an inter-observer variability of ± 5.3°. Hence it can be concluded that cats with cranial cruciate ligament rupture have a greater TPA, and this at least lends some credence to the possibility of higher TPA being a predis-posing factor for cruciate injury in this species.

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