Treatment of cranial cruciate ligament rupture in the feline stifle

R. De. Sousa; M. Sutcliffe; N. Rousset; M. Holmes; S.J. Langley-Hobbs

doi:10.3415/VCOT-14-05-0078

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2015; 28(06): 401-408
DOI: 10.3415/VCOT-14-05-0078

Original Research

Schattauer GmbH

Treatment of cranial cruciate ligament rupture in the feline stifle

Biomechanical comparison of a standard fabella-tibial suture and lateral sutures placed between quasi-isometric points

R. De. Sousa

¹Small Animal Teaching Hospital, Leahurst Campus, University of Liverpool, Neston, UK

,

M. Sutcliffe

²Department of Engineering, University of Cambridge, Cambridge, UK

,

N. Rousset

³Department of Veterinary Medicine, University of Cambridge, Cambridge, UK

,

M. Holmes

³Department of Veterinary Medicine, University of Cambridge, Cambridge, UK

,

S.J. Langley-Hobbs

⁴University of Bristol, Langford, Bristol, UK

› Institutsangaben

Abstract

Summary

Objective: 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.

Keywords

Cat - stifle joint - cruciate disease - lateral suture - quasi-isometric points

Volltext

Referenzen

References
1 Umphlet RC. Feline stifle disease. Vet Clin North Am Small Anim Pract 1993; 23: 897-913.
2 Harasen GLG. Feline cranial cruciate rupture. Vet Comp Orthop Traumatol 2005; 18: 254-257.
3 Alexander J, Shumway J, Lau R. Anterior cruciate ligament rupture. Feline Practice 1977; 6: 38-39.
4 Ruthrauff CM, Glerum LE, Gottfried SD. Incidence of meniscal injury in cats with cranial cruciate ligament ruptures. Can Vet J 2011; 52: 1106-1110.
5 McLaughlin RM. Surgical disease of the stifle joint. Vet Clin Small Anim 2002; 32: 963-982.
6 Voss K, Langley-Hobbs SJ, Montavon PM. Stifle joint.. In: Montavon PM, Voss K, Langley-Hobbs SJ.. editors. Feline Orthopaedic Surgery and Musculoskeletal Disease Philadelphia, PA: Saunders; 2009: 475-490.
7 D’Amico LL, Lanz OI, Aulakh KS. et al. The effects of a novel lateral extracapsular suture system on the kinematics of the cranial cruciate deficient canine stifle. Vet Comp Orthop Traumatol 2013; 26: 271-279.
8 Choate CJ, Lewis DD, Conrad BP. et al. Assessment of the craniocaudal stability of four extracapsular stabilization techniques during two cycling loading protocols: A cadaveric study. Vet Surg 2012; 42: 853-859.
9 Tonks CA, Lewis DD, Pozzi A. A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle. Vet Comp Orthop Traumatol 2011; 24: 167-177.
10 Brinker WO, Piermattei DL, Flo GL. Diagnosis and treatment of orthopaedic conditions of the hind limb.. In: Piermattei DL, Flo GL, DeCamp CE.. editors. Handbook of Small Animal Orthopaedics and Fracture Treatment Philadelphia: WB Saunders; 1990: 341-470.
11 Conzemius MG, Evens RB, Besancon MF. et al. 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.
12 De Sousa RS, Knudsen CS, Holmes MA. et al. Quasi-isometric points for the technique of lateral suture placement in the feline stifle joint. Vet Surg 2014; 43: 120-126.
13 Fischer C, Cherres M, Grevel V. et al. Effects of attachment sites and joint angle at the time of lateral suture fixation on tension in the suture for stabilization of the cranial cruciate ligament deficient stifle in dogs. Vet Surg 2010; 39: 334-342.
14 Hulse D, Hyman W, Beale B. et al. Determination of isometric points for placement of a lateral suture in treatment of the cranial cruciate ligament deficient stifle. Vet Comp Orthop Traumatol 2010; 23: 163-167.
15 Caporn TM, Roe SC. Biomechanical evaluation of the suitability of monofilament nylon fishing line and leader line for extraarticular stabilization of the cranial cruciate deficient stifle. Vet Comp Orthop Traumatol 1996; 9: 126-133.
16 Leighton RL. Preferred method of repair of cranial cruciate ligament rupture in dogs: a survey of ACVS diplomats specializing in canine orthopaedics. Vet Surg 1999; 28: 194
17 Lewis DD, Milthorp BK, Bellenger CR. Mechanical comparison of materials used for extra-capsular stabilization of the stifle in dogs. Aust Vet J 1997; 75: 890-896.
18 Wallace AM, Cutting ED, Sutcliffe MPF. et al. A biomechanical comparison of six different double loop configuration for use in the lateral fabella suture technique. Vet Comp Orthop Traumatol 2008; 21: 391-399.
19 Cook J, Luther J, Beetem J. et al. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2009; 39: 315-323.
20 DeAnglis M, Lau RE. A lateral retinacular imbrication technique for surgical correction of anterior cruciate ligament rupture in the dog. J Am Vet Med Assoc 1970; 157: 79-84.
21 Guenego L, Zahra A, Madelenat A. et al. Cranial cruciate ligament rupture in large and giant dogs. A retrospective evaluation of a modified lateral extracapsular stabilization. Vet Comp Orthop Traumatol 2007; 20: 43-50.
22 Kunkel KA, Basinger RR, Suber JT. et al. Evaluation of a transcondylar toggle system for stabilization of the cranial cruciate deficient stifle in small dogs and cats. Vet Surg 2009; 38: 975-982.
23 Flo GL. Modification of the lateral retinacular imbrication technique for the surgical correction of anterior cruciate ligament injuries. J Am Anim Hosp Assoc 1975; 157: 570-577.
24 Moores AP, Beck AL, Jespers KJ. et al. Mechanical evaluation of two loop tensioning methods for crimp clamp extracapsular stabilization of the cranial cruciate ligament-deficient canine stifle. Vet Surg 2006; 35: 476-479.
25 Roe SC, Kue J, Gemma J. Isometry of potential suture attachment sites for the cranial cruciate ligament deficient canine stifle. Vet Comp Orthop Traumatol 2008; 21: 215-220.
26 Choate CJ, Pozzi A, Lewis DD. et al. Mechanical testing of lateral circumfabellar suture, Tightrope CCL, and SwiveLock Bone Anchor for extracapsular stabilization of the cranial cruciate ligament deficient stifle in dogs. Veterinary Orthopaedic Society 38th Annual Conference Abstracts. Vet Comp Orthop Traumatol 2011; 24: A9 (Nr. 35)
27 Hulse DA, Butler DL, Kay MD. et al. Biomechanics of cranial cruciate ligament reconstruction in the dog. In vitro laxity testing. Vet Surg 1983; 12: 109-112.
28 Patterson RH, Smith GK, Gregor TP. et al. Biomechanical stability of four cranial cruciate ligament repair techniques in the dog. Vet Surg 1991; 20: 85-90.
29 Harper TAM, Martin RA, Ward DL. et al. An in vitro study to determine the effectiveness of a patellar ligament/fascia lata graft and new tibia suture anchor points for extracapsular stabilization of the cranial cruciate ligament-deficient stifle in the dog. Vet Surg 2004; 33: 531-541.
30 Snow LA, White R, Gustafson S. et al. Ex vivo comparison of three surgical techniques to stabilize canine cranial cruciate ligament deficient stifle. Vet Surg 2010; 39: 195-207.
31 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle Joint.. In: Tobias KM, Johnston SA.. editors. Veterinary Surgery Small Animal. Vol 2 St. Louis, Missouri:: Elsevier Saunders; 2011: 906-998.
32 Maitland ME, Leonard T, Frank CB. et al. Longitudinal measurement of tibial motion relative to the femur during passive displacements in the cat before and after anterior cruciate ligament transection. J Orthop Res 1998; 16: 448-454.
33 Piermattei DL, Flo GL, DeCamp CE. The stifle joint. In: Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopeadics and Fracture Repair. Missouri: Saunders; 2006: 562-632.
34 Dunn AL, Buffa EA, Marchevsky AM. et al. Inter- and intra-operator variability associated with extracapsular suture tensioning: an ex vivo study. Vet Comp Orthop Traumatol 2012; 14 25: 472-477.
35 Romans CW, Conzemius MG, Horstman CL. Use of pressure platform gait analysis in cats with and without bilateral onychectomy. Am J Vet Res 2004; 65: 1276-1278.
36 Hulse D, Saunders B, Beale B. et al. Extra-articular stabilization of the cranial cruciate deficient stifle with anchor systems. Tierärztl Prax Ausg K Kleintiere Heimtiere 2011; 39: 363-367.
37 Lewis DD, Miltthorp BK, Bellenger CR. Mechanical comparison of materials used for extracapsular stabilization of the stifle in dogs. Aust Vet J 1997; 75: 890-896.
38 Sicard GK, Hayashi K, Manley PA. Evaluation of 5 types of fishing material, 2 sterilization methods, and a crimp-clamp system for extracapsular stabilization of the canine stifle joint. Vet Surg 2002; 31: 78-84.
39 Katz S, Izhar M, Mirelman D. Bacterial adherence to surgical sutures. Ann Surg 1981; 194: 35-41.
40 Fisher MB, Jung HJ, McMahonn PJ. et al. Evaluation of bone tunnel placement for suture augmentation of an injuried anterior cruciate ligament: Effects on joint stability in a goat model. J Orthop Res 2010; 28: 1373-1379.
41 Aulakh KS, Harper TA, Lanz OI. et al. 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: an in vitro study. Vet Comp Orthop Traumatol 2013; 26: 208-217.