Cranial cruciate ligament repair in dogs with and without meniscal lesions treated by different minimally invasive methods

Summary

The goal of this study was to evaluate different minimally invasive surgical options as therapy for cranial cruciate ligament rupture and resulting meniscal injuries. In this study, 81 stifle joints of dogs with complete or partial rupture of the cranial cruciate ligament were treated with minimally invasive surgery at the Small Animal Clinic of the University of Veterinary Medicine in Hannover. The patients were divided into three groups depending on intraoperative diagnosis and the surgical technique applied. The dogs in group I (n = 26) had an isolated rupture of the cranial cruciate ligament (CCLR), while those in groups II (n = 26) and III (n = 29) also had an injury of the medial meniscus. Re-section of the damaged meniscal part was performed by arthroscopically guided partial meniscectomy (AGPM) on the dogs in group II, while minimally invasive medial arthrotomy (MIMA) was used on the dogs of group III. All of the stifles were stabilized with a modified lateral imbrication technique using a braided, synthetic, absorbable suture material (Panacryl^®). Six months after surgery 76.5% of all patients were examined clinically and 74.1% radiographically for evaluation of the success of the different treatment techniques. At this examination, there were no signs of lameness in 42.1% of group I (CCLR), 65.0% of group II (AGPM) and 87.0% of group III (MIMA). Upon palpation, 75.8% of these stifle joints were found to be stable. Radiographic evaluations did not show any indication of progression of gonarthrosis in 73.3% of all stifle joints examined here.

Keywords

Arthroscopy - minimally invasive arthrotomy - stifle - meniscectomy

• References

• 1 Vasseur PBStifle joint. In: Slatter D (ed): Textbook of Small Animal Surgery. 3^rded Philadelphia: W.B. Saunders; 2003: 2090-2133.
• 2 Lampman TJ, Lund EM, Lipowitz AJ. Cranial cruciate disease: current status of diagnosis, surgery, and risk for disease. Vet Comp Orthop Traumatol 2003; 16: 122-130.
• 3 De Angelis M, Lau RE. A lateral retinacular imbrication technique for the surgical correction of anterior cruciate ligament rupture in the dog. J Am Vet Med Assoc 1970; 157: 79-84.
• 4 Flo GL. Modification of the lateral retinacular imbrication technique for stabilizing cruciate ligament injuries. J Am Anim Hosp Assoc 1975; 11: 570-577.
• 5 Gambardella PC, Wallace LJ, Cassify F. Lateral suture technique for managment of anterior cruciate ligament rupture in dogs: A retrospective study. J Am Anim Hosp Assoc 1981; 17: 33-38.
• 6 Leighton RL. Preferred method of repair of cranial cruciate ligament rupture in dogs: a survey of ACVS Diplomates specializing in canine orthopedics. Vet Surg 1999; 28: 194
• 7 Lazar TP, Berry CR, Dehaan J. et al. Long-term, radiographic comparison of tibial plateau levelling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34: 133-141.
• 8 Whitney WO. Arthroscopically Assisted Surgery of the Stifle Joint. In Beale BS, Hulse DA, Schulz KS, Whitney WO. (eds) Small Animal Arthroscopy Philadelphia: W.B. Saunders; 2003: 117-157.
• 9 Fehr M, Behrends I, Meyer-Lindenberg A. Die arthroskopische Untersuchung des Kniegelenkes des Hundes. Tierärztl Prax 1996; 24: 137-143.
• 10 Beale BS, Hulse DA. Arthroscopic-assisted stabilization of the cruciate deficient stifle in dogs using a percutaneous prosthetic ligament suture anchor technique. Vet Surg 2000; 29: 457
• 11 Beale BS, Hulse DA. Arthroscopic-assisted stabilization of the cruciate deficient stifle in dogs using a percutaneous prosthetic ligament suture anchor technique. Proceedings VOS Annual Meeting 2000, Val d’ Isére; Vet Comp Orthop Traumatol 2000; 3: A7
• 12 Guenego L, Zahra A, Madelenat A. et al. Cranial cruciate ligament rupture in large and giant dogs. A retrospective evaluation of a modified lateral extracapsular stabilization. Vet Comp Orthop Traumatol 2007; 20: 43-50.
• 13 Slocum B, Devine Slocum T. Meniscal release. In: Bojrab MJ. (ed): Current Techniques in Small Animal surgery, 5^th ed Baltimore: Williams & Wilkins; 2005: 1197-1199.
• 14 Flo GL, De Young DJ, Tvedten HW. et al. Classification of meniscal injuries in the canine stifle based upon gross pathological appearance. J Am Anim Hosp Assoc 1983; 19: 325-334.
• 15 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Animal Pract 1991; a32: 111-117.
• 16 Flo GL. Classification of meniscal lesions in twenty-six consecutive canine meniscectomies. J Am Anim Hosp Assoc 1983; 19: 335-340.
• 17 Arnoczky SP, GB Tarvin. Physical examination of the musculosceletal system. Vet Clin North Am Small Anim Pract 1981; 11: 575-593.
• 18 Elkins AD, Pechmann R, Kearny MT. et al. A retrospective study evaluating the degree of degenerative joint disease in the stifle joint of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533-540.
• 19 Chauvet AE, Johnson AL, Pijanowski GJ. et al. Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: A retrospective study. J Am Anim Hosp Assoc 1996; 32: 247-255.
• 20 Welzel C. Vergleichende Untersuchung von Hunden mit einer (Teil-)Ruptur des Lig. cruciatum craniale nach Arthroskopie und minimal-invasiv chirurgischer Versorgung mit Patienten nach Arthrotomie und konventionell extrakapsulären Versorgung. Dissertation, Tierärztliche Hochschule Hannover 2000
• 21 Evans R, Horstmann C, Conzemius M. Accuracy and optimization of force platform gait analysis in Labradors with cranial cruciate ligament disease evaluated at a walking gait. Vet Surg 2005; 34: 445-449.
• 22 Flo GL. Meniscal injuries. Vet Clin North Am Small Anim Pract 1993; 23: 831-843.
• 23 Timmermann C, Meyer-Lindenberg A, Nolte I. Zur Meniskusverletzung bei Hunden mit Kreuzbandriss. Dtsch tierärztl Wschr 1998; 105: 374-377.
• 24 Kivumbi CW, Bennett D. Arthroscopy of the canine stifle joint. Vet Rec 1981; 109: 241-259.
• 25 Miller CW, Presnell KR. Examination of the canine stifle joint: arthroscopy versus arthrotomy. J Am Anim Hosp Assoc 1985; 21: 623-629.
• 26 Van Gestel MA. Diagnostic accuracy of the arthroscopy in the dog. J Am Anim Hosp Assoc 1985; 21: 757-763.
• 27 Abercomby R. Examination of arthroscopy as a clinical tool in small animal practice. J Small Anim Pract 1997; 38: 174-178.
• 28 Slocum B, Slocum TD. Tibia plateau levelling osteotomy for cranial cruciate ligament rupture. In: Bojrab MJ (ed.): Current Techniques in Small Animal Surgery. 5^thed Baltimore: Williams & Wilkins; 2005: 1209-1215.
• 29 Whitney WO. Release of the medial meniscus. In: Small Animal Arthroscopy Beale BS, Hulse DA, Schulz KS, Whitney WO. (eds) Philadelphia: W.B Saunders; 2003: 141
• 30 Dulisch ML. Suture reaction following extra-articular stifle stabilization in the dog – part I: A retrospective study of 161 stifles. J Am Anim Hosp Assoc 1981; a17: 569-571.
• 31 Dulisch ML. Suture reaction following extra-articular stifle stabilization in the dog – part II: A prospective study of 66 stifles. J Am Anim Hosp Assoc 1981; b17: 572-574.