Modelling the Effects of Cranial Cruciate Ligament Transection, Medial Meniscal Release and Triple Tibial Osteotomy on Stability of the Canine Stifle Joint

Abstract

Objective The aim of this study was to evaluate the ex vivo effects of sequential cranial cruciate ligament transection (CCLx), medial meniscal release (MMR) and triple tibial osteotomy (TTO) on canine stifle stability compared with the intact state, across a wide range of joint angles.

Study Design Nine right hind limb preparations were instrumented to provide constant quadriceps and gastrocnemius loads in a 3:1 ratio, and extended from full flexion during fluoroscopic recording. Recordings were repeated after each of CCLx, MMR and TTO. Fluoroscopic landmarks were used to calculate tibial subluxation and patellar ligament angle.

Results Medial meniscal release resulted in additional cranial tibial subluxation compared with CCLx. Triple tibial osteotomy restored stifle stability up to a joint angle of 125 degrees. The presence of the crossover angle could be inferred from the patellar ligament angle and subluxation curves.

Conclusion Our results suggest that in the cranial cruciate ligament-deficient stifle, the crossover angle at which loading shifts between the caudal and cranial cruciate ligaments is dependent on both loading and integrity of the medial meniscus. Triple tibial osteotomy improves stifle stability over a wide range of joint angles under a quadricep to gastrocnemius loading ratio of 3:1 by converting cranial tibial thrust to caudal tibial thrust, due to TTO increasing the amount of joint extension required to reach the crossover angle.

Keywords

stifle joint - cranial cruciate ligament - triple tibial osteotomy - stifle model - meniscal release - stability

Authors' Contributions

James E. Miles and Lene E. Buelund contributed to conception of study and study design. All authors contributed to data acquisition. James E. Miles, Tanja V. Jensen and Signe S. Kristiansen performed data analysis and interpretation. All authors contributed to drafting, revision and approval of the final manuscript.

^* Joint first authors.

• References

• 1 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38 (11) 1807-1814
• 2 de Rooster H, de Bruin T, van Bree H. Morphologic and functional features of the canine cruciate ligaments. Vet Surg 2006; 35 (08) 769-780
• 3 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp OrthopTraumatol 1994; 7: 56-69
• 4 Warzee CC, Déjardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286
• 5 Reif U, Hulse DA, Hauptman JG. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31 (02) 147-154
• 6 Pozzi A, Kowaleski MP, Apelt D, Meadows C, Andrews CM, Johnson KA. Effect of medial meniscal release on tibial translation after tibial plateau leveling osteotomy. Vet Surg 2006; 35 (05) 486-494
• 7 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 (02) 170-177
• 8 Kipfer NM, Tepic S, Damur DM, Guerrero T, Hässig M, Montavon PM. Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles. An in vitro study. Vet Comp Orthop Traumatol 2008; 21 (05) 385-390
• 9 Hoffmann DE, Kowaleski MP, Johnson KA, Evans RB, Boudrieau RJ. Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement. Vet Surg 2011; 40 (03) 311-320
• 10 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion. Vet Surg 2010; 39 (03) 363-370
• 11 Johnson K, Lanz O, Elder S, McLaughlin R, Werre S, Harper T. The effect of stifle angle on cranial tibial translation following tibial plateau leveling osteotomy: an in vitro experimental analysis. Can Vet J 2011; 52 (09) 961-966
• 12 Butler JR, Syrcle JA, McLaughlin RM, Elder SH. The effect of tibial tuberosity advancement and meniscal release on kinematics of the cranial cruciate ligament-deficient stifle during early, middle, and late stance. Vet Comp Orthop Traumatol 2011; 24 (05) 342-349
• 13 Kanno N, Hara Y, Fukano S. , et al. Tibial displacement with stifle joint flexion and cranial cruciate ligament transection in the dog. An ex vivo study using a robotic simulator. Vet Comp Orthop Traumatol 2014; 27 (04) 277-284
• 14 Hottinger HA, DeCamp CE, Olivier NB, Hauptman JG, Soutas-Little RW. Noninvasive kinematic analysis of the walk in healthy large-breed dogs. Am J Vet Res 1996; 57 (03) 381-388
• 15 Colborne GR. Are sound dogs mechanically symmetric at trot? No, actually. Vet Comp Orthop Traumatol 2008; 21 (03) 294-301
• 16 Slocum B, Slocum TD. Meniscal release. In: Bojrab M. , ed. Current Techniques in Veterinary Surgery. Baltimore: Williams and Wilkins; 1998: 1197-1199
• 17 Bruce WJ, Rose A, Tuke J, Robins GM. Evaluation of the triple tibial osteotomy. A new technique for the management of the canine cruciate-deficient stifle. Vet Comp Orthop Traumatol 2007; 20 (03) 159-168
• 18 Dennler R, Kipfer NM, Tepic S, Hassig M, Montavon PM. 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 (11) 1849-1854
• 19 Blumensaat C. Die Lageabweichungen und Verrenkungen der Kniescheibe (Malpositioning and Dislocations of the Patella). Ergeb Chir Orthop 1938; 31: 149-223
• 20 Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat 1979; 6: 65-70
• 21 Portney LG, Watkins MP. Statistical measures of reliability. In: Portney LG, Watkins MP. , eds. Foundations of Clinical Research: Applications to Practice. 3rd ed. Philadelphia: F.A. Davis Company; 2015: 585-618
• 22 Tepic S, Damur DM, Montavon P. Biomechanics of the stifle joint. In: Proceedings of the 1st World Orthopaedic Veterinary Congress; September 5–8; Munich, Germany; 2002:189–190
• 23 Nisell R, Németh G, Ohlsén H. Joint forces in extension of the knee. Analysis of a mechanical model. Acta Orthop Scand 1986; 57 (01) 41-46
• 24 Kim SE, Lewis DD, Pozzi A. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing. Vet Surg 2012; 41 (04) 465-470
• 25 Renwick AI, McKee WM, Emmerson TD, House AK. Preliminary experiences of the triple tibial osteotomy procedure: tibial morphology and complications. J Small Anim Pract 2009; 50 (05) 212-221
• 26 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 (01) 86-91
• 27 Schwede M, Rey J, Böttcher P. In vivo fluoroscopic kinematography of cranio-caudal stifle stability after tibial tuberosity advancement (TTA): a retrospective case series of 10 stifles. Open Vet J 2018; 8 (03) 295-304
• 28 Rey J, Fischer MS, Böttcher P. Sagittal joint instability in the cranial cruciate ligament insufficient canine stifle. Caudal slippage of the femur and not cranial tibial subluxation. Tierarztl Prax Ausg K Klientiere Heimtiere 2014; 42 (03) 151-156
• 29 Shahar R, Banks-Sills L. A quasi-static three-dimensional, mathematical, three-body segment model of the canine knee. J Biomech 2004; 37 (12) 1849-1859
• 30 Jensen RH, Davy DT. An investigation of muscle lines of action about the hip: a centroid line approach vs the straight line approach. J Biomech 1975; 8 (02) 103-110