Radiographic location of the femoral footprint of the cranial cruciate ligament in dogs

Summary

Objective: To describe the radiographic location of the center of the femoral footprint of the cranial cruciate ligament (CrCL) in dogs. Material and methods: Using femora from 49 adult, orthopedically sound dogs (bodyweight ≥ 20 kg), a radiopaque marker was placed on the cranial border of the femoral footprint of the CrCL. Computed tomography and threedimensional (3D) reconstruction of each femur was performed subsequently, followed by manual segmentation of the footprint on the 3D models and calculation of its center. Finally, virtual digital radiographs in two planes were produced and the location of the calculated center of the CrCL was expressed using three different methods (4×4 box grid method and percentage position for the medio-lateral projection; o’clock position for the disto-proximal projection). Results: In the medio-lateral radiographs the center of the femoral footprint was consistently located in the second rectangle from the top of the most caudal column of the 4×4 grid. The mean percentage caudo-cranial and proximo-distal location was 20.2% (± 2.2) and 33.8% (± 3.7), respectively. In the disto-proximal radiograph, the o’clock position of the CrCL center was between 2 and 3 o’clock in 97.6% of cases. Conclusion: The radiographic location of the center of the femoral footprint can be consistently predicted in medio-lateral and disto-proximal stifle radiographs of dogs over 20 kg. Clinical significance: The reported data can be used to plan and verify the placement of the femoral tunnel opening for intra-articular anatomic CrCL repair.

Zusammenfassung

Zie: war, beim Hund die radiologische Position des Zentrums zu bestimmen, in dem das vordere Kreuzband am Femur entspringt. Material und Methoden: An 49 Femora orthopädisch gesunder Hunde (Körpermasse > 20 kg) wurde die kraniale Begrenzung des femoralen Ursprungs des vorderen Kreuzbands mit einem röntgendichten Draht markiert. Anschließend wurde ein Computertomogramm und eine dreidimensionale (3D) Rekonstruktion jedes Femurs angefertigt und anhand derer der Ursprung manuell segmentiert und das Zentrum berechnet. Basierend auf den 3D-Modellen erfolgte eine Berechnung virtueller Röntgenbilder in zwei Ebenen. An diesen wurde die Position des berechneten Zentrums mit drei unterschiedlichen Methoden bestimmt (4×4-Gitterbox-Methode und prozentuale Position für die mediolaterale Projektion; Ziffernblattmethode für die distoproximale Projektion). Ergebnisse: In der mediolateralen Projektion befand sich das Zentrum des femoralen Kreuzbandursprungs im zweiten Rechteck von proximal in der kaudalen Spalte. Die mittlere prozentuale kaudokraniale und proximodistale Position war 20,2% (± 2,2) bzw. 33,8% (± 3,7). Im distoproximalen Röntgenbild lag bei 97,6% der Femora das Zentrum des Kreuzbandursprungs zwischen 2 und 3 Uhr. Schlussfolgerung: Die radiologische Lage des Ursprungs des vorderen Kreuzbands lässt sich in mediolateralen und distoproximalen Röntgenbildern von Hunden mit einer Körpermasse > 20 kg vorhersagen. Klinische Relevanz: Die erarbeiteten Referenzwerte können zur Planung sowie intraund postoperativen Kontrolle der femoralen Bohrkanalplatzierung bei der intraartikulären anatomischen Rekonstruktion des vorderen Kreuzbands dienen.

Keywords

Stifle - cranial cruciate ligament - intraarticular repair

Schlüsselwörter

Kniegelenk - vorderes Kreuzband - intraartikuläre Rekonstruktion

• References

• 1 Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L, Friederich N, Grood E, Hertel P, Jakob R. et al. Proceedings of the ESSKA Scientific Workshop on Reconstruction of the Anterior and Posterior Cruciate Ligaments. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 1994; 02: 124-132.
• 2 Arnoczky S. The “over the top” procedure: a technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-290.
• 3 Bach Jr BR, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Fiveto nine-year follow-up evaluation. Am J Sports Med 1998; 26: 20-29.
• 4 Behrend H, Stutz G, Kessler MA, Rukavina A, Giesinger K, Kuster MS. Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2006; 14: 1159-1165.
• 5 Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 1997; 10: 14-21.
• 6 Böttcher P, Brühschwein A, Winkels P, Werner H, Ludewig E, Grevel V, Oechtering G. Value of low-field magnetic resonance imaging in diagnosing meniscal tears in the canine stifle: a prospective study evaluating sensitivity and specificity in naturally occurring cranial cruciate ligament deficiency with arthroscopy as the gold standard. Vet Surg 2010; 39: 296-305.
• 7 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 329-334.
• 8 Conzemius MG, Evans RB, Besancon MF, Gordon WJ, Horstman CL, Hoefle WD, Nieves MA, Wagner SD. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226: 232-236.
• 9 Damur D, Tepic S, Montavon P. Proximal tibial osteotomy for the repair of cranial cruciate-deficient stifle joints in dogs. Vet Comp Orthop Traumatol 2003; 16: 211-216.
• 10 Dudley RM, Kowaleski MP, Drost WT, Dyce J. Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Vet Radiol Ultrasound 2006; 47: 546-552.
• 11 Fleming B, Beynnon BD, Johnson RJ, McLeod WD, Pope MH. Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament. Am J Sports Med 1993; 21: 82-88.
• 12 Getelman MH, Friedman MJ. Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg 1999; 07: 189-198.
• 13 Giron F, Cuomo P, Aglietti P, Bull AM, Amis AA. Femoral attachment of the anterior cruciate ligament. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2006; 14: 250-256.
• 14 Gordon-Evans WJ, Griffon DJ, Bubb C, Knap KM, Sullivan M, Evans RB. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243: 675-680.
• 15 Hefzy MSGE, Noyes FR. Factors affecting the region of most isometric femoral attachments Part II The posterior cruciate ligament. Am J Sports Med 1989; 17: 208-216.
• 16 Isberg J, Faxen E, Laxdal G, Eriksson BI, Karrholm J, Karlsson J. Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2011; 19: 1634-1642.
• 17 Johnson J, Austin C, Breuer G. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 07: 56-69.
• 18 Kalff S, Meachem S, Preston C. Incidence of medial meniscal tears after arthroscopic assisted tibial plateau leveling osteotomy. Vet Surg 2011; 40: 952-956.
• 19 Kim HS, Seon JK, Jo AR. Current trends in anterior cruciate ligament reconstruction. Knee Surg Relat Res 2013; 25: 165-173.
• 20 Kim SE, Lewis DD, Pozzi A. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing. Vet Surg 2012; 41: 465-470.
• 21 Lowe RL. Post-Operative Instructions: ACL Reconstruction. http://drwalt- lowe.com/media/files/None/David-Viaclovsky.pdf
• 22 Manley P. Intra-articular stabilization. In: Advances in the Canine Cranial Cruciate Ligament. Muir P. ed. Ames, Iowa, USA: Wiley-Blackwell; 2010: 189-193.
• 23 Nelson SA, Krotscheck U, Rawlinson J, Todhunter RJ, Zhang Z, Mohammed H. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42: 38-50.
• 24 Niklaus F, Muller F. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 2000; 08: 207-213.
• 25 Paatsama S. Ligament injuries of the canine stifle joint: A clinical and experimental study. Master’s thesis, Helsinki, 1952
• 26 Palmisano M, Andrish JT, Olmstead ML, Kambic H, Shah A. A comparative study of the length pattern of the anterior cruciate ligament reconstructions in the dog and man. Vet Comp Orthop Traumatol 2000; 13: 73-77.
• 27 Pena E, Calvo B, Martinez MA, Palanca D, Doblare M. Influence of the tunnel angle in ACL reconstructions on the biomechanics of the knee joint. Clin Biomech (Bristol, Avon) 2006; 21: 508-516.
• 28 Penner DA, Daniel DM, Wood P, Mishra D. An in vitro study of anterior cruciate ligament graft placement and isometry. Am J Sports Med 1988; 16: 238-243.
• 29 Ralphs SC, Whitney WO. Arthroscopic evaluation of menisci in dogs with cranial cruciate ligament injuries: 100 cases (1999–2000). J Am Vet Med Assoc 2002; 221: 1601-1604.
• 30 Reichert EE, Kunkel KA, Suber JT, Basinger RR, Gerard PD. Radiographic localization and isometry of the origin and insertion of the canine cranial cruciate ligament. Vet Surg 2013; 42: 860-866.
• 31 Schafer SL, Flo GL. Current Techniques in Veterinary Surgery. 4th edn.. Baltimore, USA: Williams and Wilkens; 1998
• 32 Simmons R, Howell SM, Hull ML. Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surgy Am 2003; 85-A: 1018-1029.
• 33 Skinner OT, Kim SE, Lewis DD, Pozzi A. In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. Vet J 2013; 196: 86-91.
• 34 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
• 35 Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M. Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. The Cochrane database of systematic reviews 2012; 11: CD008413.
• 36 Tivers MS, Mahoney PN, Baines EA, Corr SA. Diagnostic accuracy of positive contrast computed tomography arthrography for the detection of injuries to the medial meniscus in dogs with naturally occurring cranial cruciate ligament insufficiency. J Small Anim Pract 2009; 50: 324-332.
• 37 Tompkins M, Milewski MD, Brockmeier SF, Gaskin CM, Hart JM, Miller MD. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med 2012; 40: 1313-1321.
• 38 Topliss C, Webb J. An audit of tunnel position in anterior cruciate ligament reconstruction. The Knee 2001; 08: 59-63.
• 39 Vasseur PB, Stevenson S, Gregory CR, Rodrigo JJ, Pauli S, Heitter D, Sharkey N. Anterior cruciate ligament allograft transplantation in dogs. Clin Orthop Rel Res 1991; 269: 295-304.
• 40 Winkels P, Werner H, Grevel V, Oechtering G, Böttcher P. Development and in situ application of an adjustable aiming device to guide extrato intraarticular tibial tunnel drilling for the insertion of the cranial cruciate ligament in dogs. Vet Surg 2010; 39: 324-333.
• 41 Wolf R, Lemak L. Revision anterior cruciate ligament reconstruction surgery. J South Orthop Assoc 2002; 11: 25-32.
• 42 Yiannakopoulos C, Fules P, Korres D. Revision anterior cruciate ligament surgery using the over-the-top femoral route. Arthroscopy 2005; 21: 243-247.