A Prospective Study Comparing Two Fascial Reconstruction Techniques to Stabilise the Cranial Cruciate Deficient Stifle in the Dog

G. L. Coetzee; A. M. Lubbe

doi:10.1055/s-0038-1632434

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 1995; 08(02): 82-90
DOI: 10.1055/s-0038-1632434

Clinical Research

Schattauer GmbH

A Prospective Study Comparing Two Fascial Reconstruction Techniques to Stabilise the Cranial Cruciate Deficient Stifle in the Dog

Authors

G. L. Coetzee

¹From the Department of Surgery, University of Pretoria, South Africa
A. M. Lubbe

¹From the Department of Surgery, University of Pretoria, South Africa

Abstract

Summary

The standard intra-articular “underand-over” (U & O) cranial cruciate ligament substitute technique, using autogenous fascia lata, was compared with a combined intra- and extracapsular U & O fascial reconstruction procedure. Medium, large and giant dog breeds (body weights ≥ 15 kg), presented with unilateral rupture of the cranial cruciate ligament, were included in the study. Functional usage of the operated limb was evaluated according to a clinical grading system within the first six weeks and again at 12 and 26 weeks after the operation.

Dogs treated with the standard intraarticular U & O procedure were partly weight-bearing on the operated limb within three to five weeks postoperatively. Return to full use of the limb with no or only mild, occasional lameness was recorded in 20 of 24 dogs (83.3%) after 26 weeks. Those treated with the combined intra- and extracapsular U & O procedure, returned to partial weight-bearing within four to seven weeks after the operation. These dogs exhibited slightly more cranial drawer motion (± 1.0 - 2.0 mm) at the six- and 12-week follow-up examinations, when compared to the first group, but stifle stability improved between 12 and 26 weeks. The results obtained from 45 of 55 dogs (81.9%) treated with the combined intra- and extracapsular U & O technique were comparable with the standard intra-articular U & O procedure with return to full use of the limb after 26 weeks. Radiological evidence of peri-articular osteophyte formation showed no remarkable difference between the two techniques after 26 weeks. Results obtained from the standard intra-articular U & O technique indicated that it was an effective method for use in large dogs with body weights greater than 30 kg. This is in agreement with findings in other studies. The combined intra- and extracapsular U &O fascial reconstruction was a reliable alternative for use in the medium to large dog breeds with body weights ranging between 15 and 26 kg.

The standard intra-articular “under-and-over” (U & O) replacement technique was effective for use in dogs with body weights (BW) >30 kg. Dogs treated with the combined intra- and extracapsular U & O method had slightly more cranial drawer motion at the six-week and 12-week examinations, but stifle stability improved between 12 and 26 weeks, especially in medium-sized to larger dogs with BW ranging between 15 and 26 kg.

Keywords

Cranial cruciate ligament - fascial reconstruction - stifle - dog

Full Text

References

REFERENCES
1 Denny HR, Barr AR. An evaluation of two “over-the-top” techniques for anterior cruciate ligament replacement in the dog. J Small Anim Pract 1984; 25: 759-69.
2 Dickenson CR, Nunamaker DM. Repair of ruptured anterior cruciate ligament in the dog: experience with 101 cases using a modified fascia strip technique. J Am Vet Med Assoc 1977; 170: 827-30.
3 Hulse DA, Michaelson F, Johnson C, Abdelbaki YZ. A technique for reconstruction of the anterior cruciate ligament in the dog: preliminary report. Vet Surg 1980; 9: 135-40.
4 O’Donoghue DH, Frank GR, Jeter GL, Johnson W, Zeiders JW, Kenyon R. Repair and reconstruction of the anterior cruciate ligament in dogs. J Bone Joint Surg 1971; 53 A 710-18.
5 Arnoczky SP, Marshall JL. The cruciate ligament of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-14.
6 Bennett D, Tennant B, Lewis DG, Banghan J, May C, Carter S. A reappraisal of anterior cruciate ligament disease in the dog. J Small Anim Pract 1988; 29: 275-97.
7 Vasseur PB, Pool RR, Arnoczky SP, Lau RE. Correlative biomechanical and histologic study of the cranial cruciate ligament in dogs. Am J Vet Res 1985; 46 (09) 1842-54.
8 Heffron LE, Campbell JR. Osteophyte formation in the canine stifle joint following treatment for rupture of the cranial cruciate ligament. J Small Anim Pract 1979; 20: 603-11.
9 Arnoczky SP, Tarvin GB, Marshall JL, Saltzman B. The over-the-top procedure: a technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-90.
10 Denny HR, Barr ARS. A further evaluation of the “over-the-top” technique for anterior cruciate ligament replacement in the dog. J Small Anim Pract 1987; 28: 681-6.
11 Shires PK, Hulse DA, Liu W. The underand- over fascial replacement technique for anterior cruciate ligament rupture in dogs: a retrospective study. J Am Anim Hosp Assoc 1984; 20: 69-77.
12 Butler DL, Hulse DA, Kay MD, Grood ES, Shires PK, D’Ambrosia R, Shoji H. Biomechanics of cranial cruciate ligament reconstruction in the dog II. Mechanical properties. Vet Surg 1983; 12: 113-18.
13 Johnson SG, Hulse DA, Hogan HA, Nelson JK, Boothe HW. System behaviour of commonly used cranial cruciate ligament reconstruction autografts. Vet Surg 1989; 18: 459-65.
14 Flo GL. Modification of the lateral retinacular imbrication technique for stabilizing cruciate ligament injuries. J Am Anim Hosp Assoc 1975; 2: 570-76.
15 Gambardella PC, Wallace LJ, Cassidy F. Lateral suture technique for management of anterior cruciate ligament rupture in dogs: a retrospective study. J Am Anim Hosp Assoc 1981; 17: 33-8.
16 Smith GK, Torg JS. Fibular head transposition for repair of the cruciate deficient stifle in the dog. J Am Vet Med Assoc 1985; 187: 375-83.
17 Aiken SW, Bauer MS, Toombs JP. Extraarticular fascial strip repair of the cranial cruciate deficient stifle: technique and results in seven dogs. V.C.O.T 1992; 5: 145-50.
18 Arnoczky SP. 1988 The cruciate ligaments: The enigma of the canine stifle. J Small Anim Pract 1988; 29: 71-90.
19 Arnoczky SP, Torzilli PA, Marshall JL. Biomechanical evaluation of anterior cruciate ligament repair in the dog: an analysis of the instant centre of motion. J Am Anim Hosp Assoc 1977; 13: 553-61.
20 Shires PK. 1993 Intracapsular repairs for cranial cruciate ligament ruptures. Vet Clin North Am: Small Anim Pract 1993; 23 (04) 761-76.
21 Elkins AD, Pechman R, Kearney MT, Herron M. A retrospective study evaluating the degree of degenerative joint disease in the stifle of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533-40.
22 Coetzee GL. An in vitro comparison of two replacement techniques utilizing fascia lata after cranial cruciate ligament transection in the dog. V.C.O.T 1993; 6: 85-92.
23 Pichler ME, Bacon JP, Evans JA. The fascia lata as a replacement for the cranial cruciate ligament: two new surgical techniques. J Am Anim Hosp Assoc 1982; 18: 779-84.
24 Noyes FR, Butler DL, Paulos LE, Grood ES. Intra-articular cruciate reconstruction I: Perspectives on graft strength, vascularization, and immediate motion after replacement. Clin Orthop 1983; 172: 71-7.
25 Statistical Analysis System Institute Inc. SAS/STAT version 5 User’s Guide. Release 6.03 Edition SAS Institute Inc., Cary, North Carolina, 1988.
26 Patterson RH, Smith GK, Gregor TP, Newton CD. Biomechanical stability of four cranial cruciate ligament repair techniques in the dog. Vet Surg 1991; 20: 85-90.
27 Olmstead ML. The use of orthopedic wire as a lateral suture for stifle stabilization. Vet Clin North Am: Small Anim Pract 1993; 23 (04) 735-53.
28 Johnson RJ, Beynnon BD, Nichols CE, Renstrom AFH. Current concepts review. The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg 1992; 74 A 140-51.
29 Butler DL. Anterior cruciate ligament: its normal response and replacement. J Orthop Res 1989; 7: 910-21.
30 Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg 1980; 62 A 259-70.
31 Noyes FR, De Lucas JL, Torvic PJ. 1974 Biomechanics of anterior cruciate ligament failure: An analysis of strain-rate sensitivity and mechanism of failure in primates. J Bone Joint Surg 1974; 56 A 236-53.