Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles

Summary

Objectives: This in vitro study compares the femorotibial shear in canine stifles with intact and transected cranial cruciate ligaments (CrCL), before and after tibial tuberosity advancement (TTA) by measuring the distance between origin and insertion of the cruciate ligaments. Methods: Radiodense markers were inserted into bones at the attachment sites of the cruciate ligaments in sixteen cadaveric stifles of adult dogs. Each stifle was then mounted in a testing apparatus. The distances between the markers were measured on mediolateral radiographs, performed on each stifle under three different situations: intact, after CrCL transection, and after performing a TTA. Stifles were loaded to create a constant tibiofemoral reaction force by maintaining the load parallel to the patellar ligament. Radiographs were taken in a preloaded and loaded state in the intact stifle and only in a loaded state after CrCL transection, and after performing a TTA. Results: Loading the stifle joints after transection of the CrCL resulted in a mean lengthening of the CrCL marker distance of 22.4%. Loading the transected CrCL stifles after performing a TTA resulted in a mean shortening of the CrCL marker distance by 3.0% compared to the loaded intact condition.Clinical significance: This study demonstrates that, in loaded stifles with transected CrCLs, TTA causes a caudal shift in the cranial shear force, counteracting cranial subluxation of the tibia.

Keywords

In vitro study - cruciate ligament - stifle - tibial tuberosity advancement - dog

• References

• 1 Amoczky SP. Pathomechanics of cruciate ligament and meniscal injuries.. In: Disease Mechanism in Small Animal Surgery. 2nd ed. Bojrab MJ. Philadelphia: Lea&Febiger; 1993: 764-776.}
• 2 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
• 3 Moore KW, Read RA. Rupture of the cranial cruciate ligament in dogs .1. Comp Cont Educ Pract 1996; 18: 223-234.
• 4 Moore KW, Read RA. Rupture of the cranial cruciate ligament in dogs .2. Diagnosis and management. Comp Cont Educ Pract 1996; 18: 381-405.
• 5 Johnson JM, Johnson AL. Cranial cruciate ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Vet Clin North Am Small Anim Pract 1993; 23: 717-733.
• 6 Geyer H. Treatment of cruciate ligament ruptures of the dog. Comparative studies. Schweiz Arch Tierheilkd 1967; 109: 240-251.
• 7 Vasseur PB. Stifle joint.. In: Slatter, editor Textbook of Small Animal Surgery. 2090-2116.
• 8 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.
• 9 Smith GK, Torg JS. Fibular head transposition for repair of cruciate-deficient stifle in the dog. J Am Vet Med Assoc 1985; 187: 375-383.
• 10 Arnoczky SP, Tarvin GB, Marshall JL. et al. Over-the-top procedure - Technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-290.
• 11 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-569.
• 12 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
• 13 Damur D, Tepic S, Montavon PM. Proximal tibial osteotomy for the repair of cranial cruciate-deficient stifle joints in dogs. Vet Comp Orthop Traumatol 2003; 16: 211-216.
• 14 Nisell R. Mechanics of the knee. A study of joint and muscle load with clinical applications. Acta Orthop Scand 1985; (Suppl. 01) 216: 1-42.
• 15 Tepic S, Damur D, Montavon PM. Biomechanics of the stifle joint.. Abstracts of the 1st World Orthopedic Veterinary Congress ESVOT-VOS; September 5-8, 2002, Munich, Germany.
• 16 Dennler R, Kipfer NM, 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.
• 17 Warzee CC, Dejardin LM, Arnoczky SP. et al. 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: 278-286.
• 18 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.
• 19 Guerrero T, Montavon PM. Advancement of the tibial tuberosity of cranial cruciate-deficient canine stifle [video production].. Zurich: University of Zurich; 2003 .
• 20 Montavon PM, Damur D, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficit canine stifle. 1st World Orthopedic Veterinary Congress ESVOT-VOS; September 5-8, 2002, Munich, Germany. Vet Comp Orthop Traumatol 2002; 15 (04) A27.
• 21 Hoffmann DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
• 22 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.
• 23 Moon DK, Woo SL, Takakura Y. et al. The effects of refreezing on the viscoelastic and tensile properties of ligaments. J Biomech 2006; 39: 1153-1157.
• 24 Hottinger HA, DeCamp CE, Olivier NB. et al. Noninvasive kinematic analysis of the walk in healthy large-breed dogs. Am J Vet Res 1996; 57: 381-388.
• 25 Kowaleski MP, Apelt D, Mattoon JS. et al. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study. Vet Surg 2005; 34: 332-336.
• 26 Colborne GR, Innes JF, Comerford EJ. et al. Distribution of power across the hind limb joints in Labrador Retrievers and Greyhounds. Am J Vet Res 2005; 66: 1563-1571.
• 27 Shahar R, Banks-Sills L. Biomechanical analysis of the canine hind limb: calculation of forces during three-legged stance. Vet J 2002; 163: 240-250.
• 28 Jerram RM, Walker AM. Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment. N Z Vet J 2003; 51: 149-158.
• 29 Zachos TA, Arnoczky SP, Lavagnino M. et al. The effect of cranial cruciate ligament insufficiency on caudal cruciate ligament morphology: An experimental study in dogs. Vet Surg 2002; 31: 596-603.