Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement

Summary

Objectives: Firstly, to investigate the effect that using different landmarks has on the measured stifle angle. Secondly, to determine whether any differences in measured stifle angle would lead to variations in the required extent of tibial tuberosity advancement (TTA).

Methods: Three greyhound stifles were positioned in a total of 66 different angles. Radiographic exposures of each stifle angle were made. For each radiograph i) the stifle angle was measured using each of three sets of landmarks and ii) the extent of TTA required to obtain a patella tendon angle of 90° was measured. Each radiograph was plotted graphically according to the stifle angle and the extent of TTA required. Linear regression analysis was used to calculate the TTA required for a stifle angle of 135° measured using each of the three landmark sets.

Results: On average, the stifle angle determined by the Long Axes method differed by 18° from the stifle angle determined with the Kinematic method. The stifle angle determined using the Eminence method differed from that determined using the Kinematic method by three degrees. The use of the Long Axes of the tibia and femur as landmarks to determine a stifle angle resulted in 5 mm and 4 mm over-advancement of the tibial tuberosity compared to the use of Kinematic or Eminence landmark methods respectively.

Clinical significance: The method used to measure the stifle joint angle can influence the value of the required TTA advancement. This is an additional variable that should be considered during TTA planning and when comparing in vivo and in vitro studies.

Keywords

Tuberosity - advancement - stifle - angle - landmark

• References

• 1 Piermattei D, Flo G, DeCamp C. The Stifle Joint. In: Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. 4th Ed. London: WB Saunders; 2006: pp 582-606.
• 2 Egenvall A, Bonnett BN, Olson P. et al. Gender, Age and breed patterns of diagnoses for veterinary care in insured dogs in Sweden during 1996. Vet Rec 2000; 146: 551-557.
• 3 Arnoczky SP. The cranial cruciate ligament: the enigma of the canine stifle. J Small Anim Pract 1998; 29: 71-90.
• 4 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. Proceedings from the 1^st World Orthopaedic Veterinary Congress. 2002. September 5–8 Munich; Germany: P. 152.
• 5 Nisell R. Mechanics of the knee: a study of joint and muscle load with clinical applications. Acta Orthop Scand Suppl 1985; 216: 1-42.
• 6 Kipfer N, Damur D, Haessig M. et al. Effect of tibial tuberosity advancement on tibiofemoral shear forces in cranial cruciate deficient stifles: In Vitro Study. In: Proceedings of the 15^th Annual Scientific Meeting of the ECVS. 2006. June 29 to July 1 Seville; Spain: p. 447-449.
• 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: 170-177.
• 8 DeCamp CE, Soutas-Little RW, Hauptman J. et al. Kinematic gait analysis of the trot in healthy greyhounds. Am J Vet Res 1993; 54: 627-634.
• 9 Hottinger HA, DeCamp CE, Olivier B. et al. Noninvasive Kinematic analysis of the walk in healthy large-breed dogs. Am J Vet Res 1996; 57: 381-388.
• 10 Schaefer SL, DeCamp CE, Hauptman JG. et al. Kinematic gait analysis of hind limb symmetry in dogs at the trot. Am J Vet Res 1998; 59: 680-685.
• 11 Allen K, DeCamp CE, Braden TD. et al. Kinematic gait analysis of the trot in healthy mixed breed dogs. Vet Comp Orthop Traumatol 1994; 7: 148-153.
• 12 Kim SE, Pozzi A, Banks SA. et al. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 39: 33-39.
• 13 Voss K, Damur DM, Guerrero T. et al. Force plate gait analysis to assess limb function after tibial tube-rosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2008; 21: 243-249.
• 14 Stein S, Schmoekel H. Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. J Small Anim Pract 2008; 49: 398-404.
• 15 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.
• 16 Hoffman DE, Miller JM, Ober CP. et al. Tibial tube-rosity advancement in 65 Stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
• 17 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.
• 18 Warzee CC, Dejardin LM, Arnoczky SP. et al. Effect of tibial plateau levelling on cranial and caudal tibial thrusts in canine cruciate-deficient stifles: An in vitro experimental study. Vet Surg 2001; 30: 278-286.
• 19 Bruce WJ, Rose A, Tuke J. et al. Evaluation of the triple tibial osteotomy. A new technique for the management of the canine cruciate-deficient stifle. Vet Comp Orthop Traumatol 2007; 20: 159-168.
• 20 Renwick AIC, McKee WM, Emmerson TD. et al. Preliminary experiences of the triple tibial osteotomy procedure: tibial morphology and complications. J Small Anim Pract 2009; 50: 212-221.