Inter- and intra-operator variability associated with extracapsular suture tensioning

A. L. Dunn; E. A. Buffa; A. M. Marchevsky; J. Heller; A. P. Moores; M. Farrell

doi:10.3415/VCOT-11-12-0189

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2012; 25(06): 472-477
DOI: 10.3415/VCOT-11-12-0189

Original Research

Schattauer GmbH

Inter- and intra-operator variability associated with extracapsular suture tensioning

An ex vivo study

A. L. Dunn

¹Small Animal Specialist Hospital, North Ryde, New South Wales, Australia

,

E. A. Buffa

¹Small Animal Specialist Hospital, North Ryde, New South Wales, Australia

,

A. M. Marchevsky

¹Small Animal Specialist Hospital, North Ryde, New South Wales, Australia

,

J. Heller

²School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia

,

A. P. Moores

³Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK

,

M. Farrell

⁴Fitzpatrick Referrals, Eashing, Surrey, UK

› Institutsangaben

Abstract

Summary

Objectives: To determine inter- and intra- operator variability associated with extracapsular suture tensioning as performed during lateral fabello-tibial suture placement.

Study design: Ex vivo study.

Methods: Fifteen Greyhound cadaveric pelvic limbs were prepared by cutting the cranial cruciate ligament and placing an extracapsular fabello-tibial suture. On two occasions, three surgeons tensioned the extracapsular suture of each stifle. Stifles were returned to 135 degrees of flexion and the suture tension was measured using a commercially available suture tensioner with inbuilt tensiometer.

Statistical analysis: Intra-operator and inter-operator agreement were assessed using the limits of agreement method. A linear mixed effects model was specified to assess the effect of operator, repeated estimates and stifle order on tension applied.

Results: The mean difference within the three operators ranged from 0 to 14.7N. With 95% limits of agreement, on most occasions for all three operators, the difference was between –31.7 and 41.0 N. The mean difference between the three operators ranged from 6.0 to 30.7 N. With 95% limits of agreement, on most occasions the difference between operators was between –25.6 and 62.5 N.

Clinical significance: Marked variation exists in the tension applied during fabello- tibial suture application, both within and between surgeons. This variation may lead to inconsistent clinical outcomes. Further studies are required to determine the clinical consequences of this marked variation in extracapsular suture tensioning.

Keywords

Orthopaedics - canine - cruciate ligament - extracapsular repair

Volltext

Referenzen

References
1 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
2 Tashman S, Anderst W. Kolowich et al. Kinematics of the ACL-deficient canine knee during gait: serial changes over two years. J Orthopaed Res 2004; 22: 931-941.
3 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 Orthopaed Res 2004; 22: 949-954.
4 Hulse DA, Butler DL, Kay MD. et al. Biomechanics of cranial cruciate ligament reconstruction in the dog I. In vitro laxity testing. Vet Surg 1983; 12: 109-112.
5 Patterson RH, Smith GK, Gregor TP. et al. Biomechanical stability of four cranial cruciate ligament repair techniques in the dog. Vet Surg 1991; 20: 85-90.
6 Vasseur PB. Clinical results following nonoperative management for rupture of the cranial cruciate ligament in dogs. Vet Surg 1984; 13: 243-246.
7 Tivers MS, Commerford E, Owen MR. Does a fabella-tibial suture alter the outcome for dogs with cranial cruciate ligament insufficiency undergoing arthrotomy and caudal pole medial meniscectomy. Vet Comp Orthop Traumatol 2009; 22: 283-288.
8 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.
9 Lampman TJ, Lund EM, Lipowitz AJ. Cranial cruciate disease: current status of diagnosis, surgery, and risk for disease. Vet Comp Orthop Traumatol 2003; 16: 122-126.
10 Conzemius MG, Evans RB, Besancon MF. et al. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226: 232-236.
11 Aragon CL, Budsberg SC. Applications of evidence based medicine: Cranial cruciate ligament injury repair in the dog. Vet Surg 2005; 34: 93-98.
12 Moores AP, Beck AL, Jespers KJ. et al. Mechanical evaluation of two loop tensioning methods for crimp clamp extracapsular stabilization of the cranial cruciate ligament-deficient canine stifle. Vet Surg 2006; 35: 476-479.
13 McKee WM, Miller A. A self-locking knot for lateral fabellotibial suture stabilisation of the cranial cruciate ligament deficient stifle in the dog. Vet Comp Orthop Traumatol 1999; 12: 78-80.
14 Nunamaker DM, Perren SM. Force measurements in screw fixation. J Biomech 1976; 9: 669-675.
15 Bolliger Neto R, Rossi JD, Leivas TP. Experimental determination of bone cortex holding power of orthopedic screw. Rev Hosp Clin 1999; 54: 181-186.
16 Vasseur PB. Stifle joint. In: Slatter DH. editor. Textbook of Small Animal Surgery. Philadelphia: Saunders; 2003. pg. 2090-2133.
17 Piermattei DL, Flo GL, DeCamp CE. The stifle joint. In: Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. Missouri: Saunders; 2006. pg. 562-632.
18 Moores AP, Beck AL, Jespers KJ. et al. Mechanical evaluation of two crimp clamp systems for extracapsular stabilization of the cranial cruciate ligament-deficient canine stifle. Vet Surg 2006; 35: 470-475.
19 Chailleux N, Lussier B, De Guise J. et al. In vitro 3-dimensional kinematic evaluation of 2 corrective operations for cranial cruciate ligament-deficient stifle. Can J Vet Res 2007; 71: 175-180.
20 Tonks CA, Pozzi A, Ling HY. et al. The effects of extra articular suture tension on contact mechanics of the lateral compartment of cadaveric stifles treated with the TightRope CCL® or lateral suture technique. Vet Surg 2010; 39: 343-349.
21 Harper TAM, Martin RA, Ward DL. et al. An in vitro study to determine the effectiveness of a patellar ligament/fascia lata graft and new tibial suture anchor points for extracapsular stabilization of the cranial cruciate ligament-deficient stifle in the dog. Vet Surg 2004; 33: 531-541.
22 Stork CK, Gibson NR, Owen MR. et al. Radiographic features of a lateral extracapsular wire suture in the canine cranial cruciate deficient stifle. J Small Anim Pract 2001; 42: 487-490.
23 Christley RM, Reid SWJ. No significant difference: use of statistical methods for testing equivalence in clinical veterinary literature. J Am Vet Med Assoc 2003; 222: 433-437.
24 Budsberg SC, Verstraete MC, Soutas-Little RW. et al. Force plate analyses before and after stabilization of canine stifles for cruciate injury. Am J Vet Res 1988; 49: 1522-1524.
25 Moore KW, Read RA. Cranial cruciate ligament rupture in the dog-a retrospective study comparing surgical techniques. Aust Vet J 1995; 72: 281-285.
26 Dulisch ML. Suture reaction following extra-articular stifle stabilization in the dog. I. A retrospective study of 161 stifles. J Am Anim Hosp Assoc 1981; 17: 572-574.
27 Elkins AD, Pechman R, Kearney 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.
28 Guenego L, Zahra A, Madelenat A. et al. Cranial cruciate ligoment rupture in large and giant dogs: A retrospective evaluation of a modified lateral extracapsular stabilization. Vet Comp Orthop Traumatol 2007; 20: 43-50.
29 Lewis DD, Milthorpe BK, Bellenger CR. Mechanical comparison of materials used for extra-capsular stabilisation of the stifle joint in dogs. Aust Vet J 1997; 75: 890-896.
30 Wallace AM, Cutting ED, Sutcliffe MP. et al. A biomechanical comparison of six different double loop configurations for use in the lateral fabella suture technique. Vet Comp Orthop Traumatol 2008; 21: 391-399.
31 Huber DJ, Egger EL, James SP. The effect of knotting method on the structural properties of large diameter nonabsorbable monofilament sutures. Vet Surg 1999; 28: 260-267.
32 Anderson CC, Tomlinson JL, Daly WR. et al. Biomechanical evaluation of a crimp clamp system for loop fixation of monofilament nylon leader material used for stabilization of the canine stifle joint. Vet Surg 1998; 27: 533-539.
33 Roe SC, Kue J, Gemma J. Isometry of potential suture attachment sites for the cranial cruciate ligament deficient canine stifle. Vet Comp Orthop Traumatol 2008; 21: 215-220.
34 Fischer C, Cherres M, Grevel V. et al. Effects of attachment sites and joint angle at the time of lateral suture fixation on tension in the suture for stabilization of the cranial cruciate ligament deficient stifle in dogs. Vet Surg 2010; 39: 334-342.
35 Hill CM, Conzemius MG, Smith GK. et al. Bacterial culture of the canine stifle joint following surgical repair of ruptured cranial cruciate ligament. Vet Comp Orthop Traumatol 1999; 12: 1-5.
36 O'Donoghue D, Frank GR, Jeter GL. et al. Repair and reconstruction of the anterior cruciate ligament in dogs: factors influencing long-term results. J Bone Joint Surg 1971; 53: 710-718.
37 Fleming BC, Abate JA, Peura GD, Beynnon BD. The relationship between graft tensioning and the anterior-posterior laxity in the anterior cruciate ligament reconstructed goat knee. J Orthopaed Res 2001; 19: 841-844.