Repair of chronic rupture of the insertion of the gastrocnemius tendon in the dog using a polyethylene terephthalate implant

M. A. Morton; D. G. Thomson; R. M. Rayward; M. Jiménez-Peláez; R. G. Whitelock

doi:10.3415/VCOT-14-08-0133

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2015; 28(04): 282-287
DOI: 10.3415/VCOT-14-08-0133

Clinical Communication

Schattauer GmbH

Repair of chronic rupture of the insertion of the gastrocnemius tendon in the dog using a polyethylene terephthalate implant

Early clinical experience and outcome

M. A. Morton

¹Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK

,

D. G. Thomson

¹Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK

,

R. M. Rayward

¹Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK

²Current address: Coast Veterinary Referrals Ltd, Eastbourne, East Sussex, UK

,

M. Jiménez-Peláez

¹Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK

,

R. G. Whitelock

¹Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK

› Author Affiliations

Abstract

Summary

Objectives: Chronic degeneration of the gastrocnemius tendon results in scar tissue formation at the insertion of the tendon, and detachment from the calcaneus. In severe cases, excision of this tissue makes repositioning of the tendon to the calcaneus extremely difficult. A polyethylene terephtha-late implant, used to aide repair by bridging gaps and allowing tissue ingrowth, was evaluated.

Methods: In this retrospective study, clinical records were evaluated to assess long-term outcomes and complications. The surgical technique is also described. The implant was sutured proximally into the gastrocnemius at the myotendinous junction, and secured into the calcaneus using an interference screw.

Results: The implant was used in 10 patients; of which seven returned to full function. Major complications, due to infection, were identified in two of the 10 patients. Minor complications occurred in five of the 10 patients. These were associated with external coaptation in three of the patients in the immediate postoperative period. One minor infection was reported. These all resolved without further complication. Long-term outcome was available in eight patients, with six of these eight dogs returning to normal exercise.

Clinical significance: This implant may be suitable for use in canine patients with severe gastrocnemius tendon degeneration. Ongoing evaluation is warranted.

Keywords

Gastrocnemius - Achilles - interference screw - synthetic - dog

Full Text

References

References
1 Meutstege FJ. The classification of canine Achilles tendon lesions. Vet Comp Orthop Traumatol 1993; 6: 53-55.
2 Corr SA, Draffan D, Kulendra E. et al. Retrospective study of Achilles mechanism disruption in 45 dogs. Vet Rec 2010; 11: 407-411.
3 Moores AP, Comerford EJ, Tarlton JF. et al. Biomechanical and clinical evaluation of a modified 3-loop pulley suture pattern for reattachment of canine tendons to bone. Vet Surg 2004; 33: 391-397.
4 Perry BS, Harper TA, Mitchell MA. et al. Barbed versus smooth poly-propylene three-loop pulley for repair of canine gastrocnemius tendon. Vet Comp Orthop Traumatol 2014; 18 (27) 436-440.
5 Gelberman RH, Boyer MI, Brodt MD. et al. The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. J Bone Joint Surg 1999; 81: 975-982.
6 Gall TT, Santoni BG, Egger EL. et al. In vitro biomechanical comparison of polypropylene mesh, modified three-loop pulley suture pattern, and a combination for repair of distal canine Achilles tendon injuries. Vet Surg 2009; 38: 845-851.
7 Baltzer WI, Rist P. Achilles tendon repair in dogs using the semitendinosus muscle: surgical technique and short-term outcome in five dogs. Vet Surg 2009; 38: 770-779.
8 Gilbert TW, Stewart-Akers AM, Simmons-Byrd A. et al. Degradation and remodelling of small intestinal submucosa in canine Achilles tendon repair. J Bone Joint Surg Am 2007; 89: 621-630.
9 Swiderski J, Fitch RB, Staatz A. et al. Sonographic assisted diagnosis and treatment of bilateral gastrocnemius tendon rupture in a Labrador retriever repaired with fascia lata and polypropylene mesh. Vet Comp Orthop Traumatol 2005; 18: 258-263.
10 Shani J, Shahar R. Repair of chronic complete traumatic rupture of the common calcaneal tendon in a dog, using a fascia lata graft. Vet Comp Orthop Traumatol 2000; 13: 104-108.
11 Sivacolundhu RK, Marchevsky AM, Read RA. et al. Achilles mechanism reconstruction in four dogs. Vet Comp Orthop Traumatol 2001; 14: 25-31.
12 Fossum TW, Hedlund CS, Hulse DA. Management of muscle and tendon injury or disease. In: Small Animal Surgery. 2nd ed. St. Louis, MO: Mosby; 2002: 1158-1167.
13 Guerin S, Burbidge H, Firth E. et al. Achilles tenorrhaphy in five dogs: A modified surgical technique and evaluation of a cranial half cast. Vet Comp Orthop Traumatol 1998; 11: 205-210.
14 Reinke JD, Mughannam AJ, Owens JM. Avulsion of the gastrocnemius tendon in 11 dogs. J Am Anim Hosp Assoc 1993; 29: 410-418.
15 Worth AJ, Danielsson F, Bray JP. et al. Ability to work and owner satisfaction following surgical repair of common calcaneal tendon injuries in working dogs in New Zealand. New Zeal Vet J 2004; 52: 109-116.
16 Morshead D, Leeds EB. Kirschner-Ehmer apparatus immobilization following Achilles tendon repair in six dogs. Vet Surg 1984; 13: 11-14.
17 deHaan JJ, Goring RL, Renberg C. et al. Modified transarticular external skeletal fixation for support of Achilles tenorrhaphy in four dogs. Vet Comp Orthop Traumatol 1995; 8: 32-35.
18 Norton J, Decamp C, Yu J. et al. Use of a single-ring transarticular fixator construct for immobilisation of the talocrural joint following commoncalcaneal tenorrhaphy. Vet Comp Orthop Traumatol 2009; 22: 430-435.
19 Nielsen C, Pluhar GE. Outcome following surgical repair of Achilles tendon rupture and comparison between postoperative tibiotarsal immobilization methods in dogs 28 cases (1997-2004). Vet Comp Orthop Traumatol 2006; 19: 246-249.
20 Lister SA, Renberg WC, Roush JK. Efficacy of immobilization of the tarsal joint to alleviate strain on the common calcaneal tendon in dogs. Am J Vet Res 2009; 70: 134-140.
21 Morton MA, Whitelock RG, Innes JF. Mechanical testing of a synthetic canine gastrocnemius tendon implant. Vet Surg 2015 April 3; [Epub ahead of Print].
22 Ibrahim SA. Surgical treatment of chronic Achilles tendon rupture. J Foot Ankle Surg 2009; 48: 340-346.
23 Trieb K, Blahovec H, Brand G. et al. In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res 2004; 36: 148-151.
24 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39: 905-908.
25 Impellizeri JA, Tetrick MA, Muir PJ. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. J Am Vet Med Assoc 2000; 216: 1089-1091.
26 Meeson RL. Davidson, Arthurs GI. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. A retrospective study of sixty dogs and cats. Vet Comp Orthop Traumatol 2011; 24: 126-131.
27 Alexander JW, Kaplan JZ, Altemeier WA. Role of suture materials in the development of wound infection. Ann Surg 1967; 165: 192-199.
28 Klinge U, Junge K. Spellerberg. et al. Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 2002; 63: 765-771.
29 Hayes GM, Ramirez J, Langley Hobbs SJ. Use of the cumulative summation technique to quantitatively assess a surgical learning curve: canine total hip replacement. Vet Surg 2011; 40: 1-5.
30 Proot JLJ, Corr SA. Clinical audit for the tibial tuberosity advancement procedure: establishing the learning curve and monitoring ongoing performance for the tibial tuberosity advancement procedure using the cumulative summation technique. Vet Comp Orthop Traumatol 2013; 26: 280-284.