Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease

K. Voss; D. M. Damur; T. Guerrero; M. Haessig; P. M. Montavon

doi:10.1055/s-0037-1617368

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2008; 21(03): 243-249
DOI: 10.1055/s-0037-1617368

Clinical Communication

Schattauer GmbH

Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease

K. Voss

¹Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland

,

D. M. Damur

²Tierklinik Masans, Chur, Switzerland

,

T. Guerrero

¹Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland

,

M. Haessig

³Department for Farm Animals, Vetsuisse Faculty University of Zurich, Zurich, Switzerland

,

P. M. Montavon

¹Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland

› Author Affiliations

Abstract

Summary

Objective: To assess functional outcome in dogs with cranial cruciate ligament (CrCL) disease after tibial tuberosity advancement (TTA) using force plate gait analysis, and to evaluate parameters potentially influencing outcome. Study design: Prospective clinical study. Animals: Consecutive clinical patients (n=37) with CrCL-deficient stifles (n=40). Methods: The stifle joints were examined arthroscopically prior to TTA. Meniscal release was not performed if the medial meniscus was intact. Open medial arthrotomy and partial meniscectomy were performed in the presence of meniscal tears. Vertical ground reaction forces were measured preoperatively and at follow-up examinations four to 16 months postoperatively (mean: 5.9 months). The ground reaction forces of a group of 65 healthy dogs were used for the comparison. The potential effects of clinical parameters on functional outcome were evaluated statistically. Results: Complete CrCL rupture was identified in 28 joints, and partial CrCL rupture in 12 joints. The medial meniscus was damaged in 21 stifles. Vertical ground reaction forces were significantly higher at follow-up (P<0.01), but remained significantly lower than those of control dogs (P<0.01). Complications were identified in 25% of joints, and the dogs with complications had significantly lower peak vertical forces at follow-up than the dogs without complications (P=0.04). Other clinical parameters did not influence outcome. Conclusions: Tibial tuberosity advancement significantly improved limb function in dogs with CrCL disease, but did not result in complete return to function. Complications adversely affected functional outcome. Clinical significance: A return to a function of approximately 90% of normal can be expected in dogs with CrCL disease undergoing TTA.

Keywords

Stifle - tibial tuberosity advancement - cranial cruciate ligament - force plate gait analysis - function

Full Text

References

References
1 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle.. 1st World Orthopaedic Veterinary Congress, Munich, Germany 2002; 152.
2 Nisell R. Mechanics of the knee. A study of joint and muscle load with clinical applications.. Acta Orthop Scand. 1985; (Suppl) 216: 1-42.
3 Dennler R, Kipfer N, Tepic S. et al. Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease. Am J Vet Res 2006; 67: 1849-1854.
4 Lafaver S, Miller NA, Stubbs WP. et al. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: Surgical technique, early results, and complications in 101 dogs.. Vet Surg 2007; 36: 573-586.
5 Apelt D, Kowaleski MP, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study.. Vet Surg 2007; 36: 170-177.
6 Miller JM, Shires PK, Lanz OI. et al. Effect of 9 mm tibial tuberosity advancement on cranial tibial translation in the canine cranial cruciate ligament-deficient stifle.. J Vet Surg 2007; 36: 335-340.
7 Hoffmann DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 canine stifles.. Vet Comp Orthop Traumatol 2006; 19: 219-227.
8 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001).. J Am Vet Med Assoc 2003; 222: 184-193.
9 Priddy II, NH Tomlinson JL, Dodam JR. et al. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001).. J Am Vet Med Assoc 2003; 222: 1726-1732.
10 Thieman KM, Tomlinson JL, Fox DB. et al. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy.. Vet Surg 2006; 35: 705-710.
11 Stauffer KD, Tuttle TA, Wehrenberg AP. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003).. J Am Anim Hosp Assoc 2006; 42: 44-50.
12 Ballagas AJ, Montgomery RD, Henderson RA. et al. Pre- and postoperative force plate analysis of dogs with experimentally transsected cranial cruciate ligaments treated using tibial plateau leveling osteotomy.. Vet Surg 2004; 33: 187-190.
13 Conzemius MG, Evans 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.
14 Ayral X, Altman R. Arthroscopic evaluation of knee articular cartilage.. In: Osteoarthritis, Brandt KD, Doherty M Lohmander LS (eds). Oxford: Oxford University Press; 1998: 494-505.
15 Herzog W, Nigg BM, Read LJ. et al. Asymmetries in ground reaction force patterns in normal human gait.. Med Sci Sports Exerc 1989; 21: 110-114.
16 Voss K, Imhof J, Kaestner S. et al. Force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness.. Vet Comp Orthop Traumatol 2007; 20: 299-304.
17 Dupuis J, Harari J, Papageorges M. et al. Evaluation of fibular head transposition for repair of experimental cranial cruciate ligament injury in dogs.. Vet Surg 1994; 23: 1-12.
18 Jevens DJ, DeCamp CE, Hauptman J. et al. Use of force-plate analysis of gait to compare two surgical techniques for treatment of cranial cruciate ligament rupture in dogs.. Am J Vet Res 1996; 57: 389-393.
19 Budsberg SC. et al. Force plate analyses before and after stabilization of canine stifles for cruciate surgery.. Am J Vet Res 1988; 49: 1522-1524.
20 Havig ME, Dyce J, Kowaleski MP. et al. Relationship of tibial plateau slope to limb function in dogs treated with a lateral suture technique for stabilization of cranial cruciate ligament deficient stifles.. Vet Surg 2007; 36: 245-251.
21 Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs.. J Am Vet Medic Assoc 2002; 220: 1325-1330.
22 Maquet P. Considérations biomécaniques sur l’arthrose du genou. Un traitement biomécanique de l’arthrose fémoro-patellaire. L’avancement du tendon rotulien.. Rev Rhum Mal Ostéoartic 1963; 30: 779.
23 Radin EL, Pan HQ. Long-term follow-up study on the Maquet procedure with special reference to the causes of failure.. Clin Orthop Relat Res 1993; 290: 253-258.
24 Schmid F. The Maquet procedure in the treatment of patellofemoral osteoarthritis.. Clin Orthop Relat Res 1993; 294: 254-258.
25 Pozzi A, Kowaleski MP, Apelt D. et al. Effect of meniscal release on tibial translation after tibial plateau leveling osteotomy.. Vet Surg 2006; 35: 486-494.
26 Pozzi A, Litsky AS, Field J. et al. Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau leveling osteotomy in dogs.. Vet Comp Orthop Traumatol 2008; 21: 8-14.
27 Rumph PF, Kincaid SA, Visco DM. et al. Redistribution of vertical ground reaction force in dogs with experimentally induced chronic hindlimb lameness.. Vet Surg 1995; 24: 384-389.
28 O’Connor BL, Visco DM, Heck DA. et al. Gait alterations in dogs after transsection of the anterior cruciate ligament.. Arthritis Rheum 1989; 32: 1142-1147.