In vivo comparison of two hinged transarticular external skeletal fixators for multiple ligamentous injuries of the canine stifle

S. Lauer; G. Hosgood; S. Ramirez; M. Lopez

doi:10.3415/VCOT-06-11-0090

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2008; 21(01): 25-35
DOI: 10.3415/VCOT-06-11-0090

Original Research

Schattauer GmbH

In vivo comparison of two hinged transarticular external skeletal fixators for multiple ligamentous injuries of the canine stifle

Authors

S. Lauer

¹Louisiana State University – VCS, School of Veterinary Medicine, Baton Rouge, Louisiana, USA
G. Hosgood

¹Louisiana State University – VCS, School of Veterinary Medicine, Baton Rouge, Louisiana, USA
S. Ramirez

¹Louisiana State University – VCS, School of Veterinary Medicine, Baton Rouge, Louisiana, USA
M. Lopez

¹Louisiana State University – VCS, School of Veterinary Medicine, Baton Rouge, Louisiana, USA

Abstract

Summary

Controlled mobilization after the surgical repair of multiple disrupted ligaments is considered to be essential for return to normal function. This study compared the outcome after post-surgical mobilization without any protection to mobilization with two transarticular external skeletal fixator hinge prototypes after surgical repair of experimental injuries to multiple stifle ligaments in 15 hounds. The repair was left unprotected (NP: n = 5), protected with a self-centering hinge (SH: n = 5) andwith a conventional hinge (CH: n = 5) for four weeks after surgical repair. Outcome measurements included: orthopaedic examination, goniometric and thigh circumference (TC) measurements, total tibial translation (TT), radiographs, and kinetic gait analysis up to 120 days post-operatively. Asignificant effect of treatment controlling for time for medial collateral stability, TC, TT, osteophyte scores, peakvertical force (PVF) and vertical impulse (VI) was not found. There was a significant difference between time points for subjective lameness scores, TC, PVF, VI, TT and osteophyte scores within treatment. Stifle extension was significantly decreased in CH dogs compared to NP dogs on day 28. Stifle flexion was significantly decreased in CH and SH dogs on day 28 compared toNP dogs. Stifle flexion was normal in all dogs by day 42. Both hinges compromised stifle flexion initially after hinge removal, but range of motion normalized within two weeks. Hinges were not indicated for adjunct treatment after repair of multiple experimentally induced ligamentous stifle injuries.

Keywords

Stifle luxation - external skeletal fixation - transarticular hinge - joint mobilization - ligamentous injuries

Full Text

References

Literature
1 Bruce WJ. Multiple ligamentous injuries of the canine stifle joint: astudy of 12 cases. J Small Anim Pract 1998; 39: 333-340.
2 Aron D. Traumatic dislocation of the stifle joint. J Am Anim Hosp Assoc. 1988 24. 333.
3 Hulse D, Shires P. Multiple ligamentous injury of the stifle joint in the dog. J Am Anim Hosp Assoc. 1986 22. 105.
4 Welches C, Scavelli T. Transarticular pinning to repair luxation of the stifle joint in dogs and cats: A retrospective study of 10 cases. J Am Anim Hosp Assoc. 1990 26. 207.
5 Connery NA, Rackard S. The surgical treatment of traumatic stifle disruption in a cat. Vet Comp Orthop Traumatol 2000; 13: 208-211.
6 Jaeger GH, Wosar MA, Marcellin-Little DJ. et al. Use of hinged transarticular external fixation for adjunctive joint stabilization in dogs and cats: 14 cases (1999-2003). J Am Vet Med Assoc 2005; 227: 586-591.
7 Behrens F, Kraft EL, Oegema Jr. TR. Biochemical changes in articular cartilage after joint immobilization by casting or external fixation J Orthop Res 1989; 7: 335-343.
8 Akeson WH. Effect or immobilization on joints. Clin Orthop 1987; 219: 28-37.
9 Akeson WH. et al. The connective tissue response to immobility: biochemical changes in periarticu- lar connective tissue of the immobilized rabbit knee. Clin Orthop 1973; 93: 356-362.
10 Buckwalter JA. Effects of earlymotion on healing of musculoskeletal tissues. Hand Clin 1996; 12: 13-24.
11 Frank C, Akeson WH, Woo SL. et al. Physiology and therapeutic value of passive joint motion. Clin Orthop 1984; 185: 113-125.
12 O'Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am 1998; 80: 1795-1812.
13 Salter RB. History of rest and motion and the scientific basis for early continuous passive motion. HandClin 1996; 12: 1-11.
14 Snood S. A study of the effects of immobilization on rabbit articular cartilage. J Anat. 1971 108. 497.
15 Houshian S, Gynning B, Schroder HA. Chronic flexion contracture of proximal interphalangeal joint treated with the compass hinge external fixator. A consecutive series of 27 cases. J Hand Surg [Br] 2002; 27: 356-358.
16 Kerkhoffs GM, Rowe BH, Assendelft WJ. et al. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev. 2002 3. CD003762.
17 Tipton CM, James SL, Mergner W. et al. Influence of exercise on the strength of the medial collateral knee ligaments of dogs. Amer J Physiol 1970; 218: 894-901.
18 Woo SL, Inoue M, McGurk Burleson E. et al. Treatment of the medial collateral ligament injury. II: Structure and function of canine knees in response to different treatment regimens. Amer J Sports Med 1987; 15: 22-29.
19 Delay BS, Smolinski RJ, Wind WM. et al. Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg. 2001; 14: 85-91.
20 Noyes FR, Barber-Westlin SD. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 1997; 25: 769-777.
21 Laing EJ. Collateral ligament injury and stifle luxation. Vet Clin North Am Small Anim Pract 1993; 23: 845-853.
22 Stannard JP, Sheils TM, McGwin G. et al. Use of a hinged external knee fixator after surgery for knee dislocation. Arthroscopy 2003; 19: 626-631.
23 Fitzpatrick DC, Sommers MB, Kam BCC. et al. Knee stability after articulated external fixation. Am. J. Sports Med 2005; 33: 1735-1741.
24 Hollister AM, Jatana S, Singh AK. et al. The axes of rotation of the knee. Clin Orthop 1993; 290: 259-268.
25 Churchill DV, Incavo SJ, Johnson CC. et al. The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop 1998; 356: 111-118.
26 Sommers MB, Fitzpatrick DC, Kahn KM. et al. Hinged external fixation of the knee. Intrinsic factors influencing passive joint motion. J Orthop Trauma 2004; 18: 163-169.
27 Madey SM, Bottlang M, Steyers CM. et al. Hinged external fixation ofthe elbow: Optimal axis alignment to minimize motion resistance. J Orthop Trauma 2000; 14: 41-47.
28 Bruce W, Frame K, Burbidge HM. et al. A comparison of the effects of joint immobilization, twice daily passive motion, and voluntary motion on articular cartilage healing in sheep. Vet Comp Orthop Traumatol 2002; 15: 23-29.
29 Arnoczky SP, Tarvin GB, Vasseur P. Surgery of the stifle – the menisci and collateral ligaments (part III). Comp Cont Ed 1980; 11: 394-399.
30 Flo GL. Modification of the lateral retinacularim-brication technique for stabilizing cruciate ligament injuries. JAAHA 1975; 11: 570-577.
31 Harari J. Caudal cruciate ligament injury. Vet Clin North Am Small Anim Pract. 1993 23. (4) 826.
32 Jaegger G, Marcellin-Little DJ, Levine D. Reliability of goniometry in Labrador Retrievers. Am J VetRes 2002; 63: 979-986.
33 Millis D. et al. Variable affecting thigh circumference measurements in dogs. In: Proceedings ofthe first international symposium on rehabilitation and physical therapy in veterinary medicine. 1999
34 Lopez MJ, Hagquist W, Jeffrey SL. et al. Instrumented measurement of in vivo anterior-posterior translation in the canine knee to assess anterior cruciate integrity. J Orthop Res 2004; 22: 949-954.
35 Vasseur PB, Berery C. Progression of stifle osteoarthritis following reconstruction of the cranial cruciate ligament in 21 dogs. J Am Anim Hosp Assoc 1992; 28: 129-136.
36 Vasseur PB, Arnoczky SP. Collateral ligaments of the canine stifle joint: Anatomic and functional analysis. Am JVet Res 1981; 42: 1133-1137.
37 Cook JL, Renfro DC, Tomlinson JL. et al. Measurements of angles of abduction for diagnosis of shoulder instability in dogs using gonio- metry and digital image analysis. Vet Surg 2005; 34: 463-468.
38 Sapega AA, Moyer RA, Schneck C. et al. Testing of isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations. J Bone Joint Surg Am 1990; 72: 259-267.
39 Gustafson S, White R. Anatometric fascia late translocation. Proc 33rd Annual Conference Veterinary Orthopedic Society 2006 p. 250.
40 Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am VetAssoc 2002; 220: 1325-1330.
41 Wroble RR, Grood ES, Cummings JS. Changes in knee kinematics after application of an articulated external fixator in normal and posterior cruciate ligament- deficient knees. Arthroscopy 1997; 13: 73-77.
42 Schatzker J, Horne JG, Summer-Smith M. The effect of movement on the holding power of screws in bone. Clin Orthop 1975; 111: 257-261.
43 Mitton GR, Ireland WP, Runyun CL. Evaluation of the instantaneous centers of rotation of the stifle before and after repair of torn cruciate ligaments by use of the over-the-top technique in dogs. Am J VetRes 1991; 52: 1731-1737.
44 Arnoczky SP, Torzilli PA, Marshall JL. Biomech- anical evaluation of anterior cruciate ligament repair in the dog. an analysis of the instant center of motion. J Am Anim Hosp Assoc 1977; 13: 553-558.
45 Korvick DL, Pijanowski GJ, Schaeffer DJ. Three- dimensional kinematics of the intact and cranial cruciate deficient stifle of dogs. J Biomech 1994; 27: 77-87.