Measurement of the patellar tendon-tibial plateau angle and tuberosity advancement in dogs with cranial cruciate ligament rupture

M. Millet; C. Bismuth; A. Labrunie; B. Marin; A. Filleur; P. Pillard; J. Sonet; T. Cachon; S. Etchepareborde

doi:10.3415/VCOT-13-01-0018

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2013; 26(06): 469-478
DOI: 10.3415/VCOT-13-01-0018

Original Research

Schattauer GmbH

Measurement of the patellar tendon-tibial plateau angle and tuberosity advancement in dogs with cranial cruciate ligament rupture

Reliability of the common tangent and tibial plateau methods of measurement

Autoren

M. Millet

¹Department of Small Animal Surgery, National Veterinary School of Lyon, VetAgro Sup – Campus Vétérinaire de Lyon, Université de Lyon, Marcy L´Etoile, France
C. Bismuth

¹Department of Small Animal Surgery, National Veterinary School of Lyon, VetAgro Sup – Campus Vétérinaire de Lyon, Université de Lyon, Marcy L´Etoile, France
A. Labrunie

²CHU Limoges, Pôle Santé Publique, Service de l´Information Médicale et de l´Evaluation, Unité Fonctionnelle de Recherche Clinique et de Biostatistiques, Limoges, France
B. Marin

²CHU Limoges, Pôle Santé Publique, Service de l´Information Médicale et de l´Evaluation, Unité Fonctionnelle de Recherche Clinique et de Biostatistiques, Limoges, France
A. Filleur

¹Department of Small Animal Surgery, National Veterinary School of Lyon, VetAgro Sup – Campus Vétérinaire de Lyon, Université de Lyon, Marcy L´Etoile, France
P. Pillard

¹Department of Small Animal Surgery, National Veterinary School of Lyon, VetAgro Sup – Campus Vétérinaire de Lyon, Université de Lyon, Marcy L´Etoile, France
J. Sonet

³Departmehnt of Diagnostic Imaging, National Veterinary School of Lyon, VetAgro Sup-Campus Vétérinaire de Lyon, Université de Lyon, Marcy L´Etoile, France
T. Cachon

¹Department of Small Animal Surgery, National Veterinary School of Lyon, VetAgro Sup – Campus Vétérinaire de Lyon, Université de Lyon, Marcy L´Etoile, France
S. Etchepareborde

⁴CHV des Cordeliers, Meaux, France

Abstract

Summary

Objectives: To (i) compare agreement of the common tangent (CT) and tibial plateau angle (TP) methods in terms of measuring the patellar tendon angle (PTA) and required advancement and (ii) determine the intraand inter-observer reliability of observers who measured PTA and the advancement.

Methods: Six observers were divided into three groups based on their level of experience. They measured the PTA and the required advancement on 43 radiographic images of the tibiae of dogs affected by cranial cruciate ligament rupture. Each observer repeated the measurements three times with each method. The inter-technique (interT), intra-observer (intraO), and interobserver (interO) reliabilities were evaluated, assessed by calculating the intraclass correlation coefficient (ICC), and represented by Jones plots.

Results: The agreement between PTA-CT and PTA-TP was low (the ICC interT values ranged from 0.11 to 0.4). The PTA-CT was associated with moderate intra-observer reliability (ICC intraO, CT = 0.61) and poor interobserver reliability (ICC interO, CT = 0.33). The PTA-TP was associated with good intra-observer reliability (ICC intraO, TP = 0.75) and moderate interobserver reliability (ICC interO, TP = 0.59). Interobserver reliability did not depend on the level of experience. The advancement measurements were associated with reliability results similar to those obtained for PTA. Jones’ plots showed that the CT method consistently yielded lower PTA and advancement values than the TP method.

Conclusion: Given its poor reliability, the CT method is not recommended.

Keywords

Patellar tendon angle - tibial tuberosity advancement - dog - common tangent - reliability

Volltext

Referenzen

References
1 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.
2 Kipfer NM, Tepic S, Damur DM. et al. Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles. An in vitro study. Vet Comp Orthop Traumatol 2008; 21: 385-390.
3 Reif U, Hulse DA, Hauptman JG. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31: 147-154.
4 Slocum B, Devine T. Cranial tibial thrust: a primary force in the canine stifle. J Am Vet Med Assoc 1983; 183: 456-459.
5 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.
6 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. Proceedings of the 1st World Orthopedic Veterinary Congress. 2002. September 5-8 Munich, Germany.:
7 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.
8 Tepic S, Damur DM, Montavon PM. Biomechanics of the stifle joint. Proceedings of the 1st World Orthopaedic Veterinary Congress. 2002 September 5-8 Munich, Germany.:
9 Unis MD, Johnson AL, Griffon DJ. et al. Evaluation of intra- and inter-observer variability and repeatability of tibial plateau angle measurements with digital radiography using a novel digital radiographic program. Vet Surg 2010; 39: 187-194.
10 Serwa D, Lorinson K, Lorinson D. et al. Comparison of conventional and digital measurements of tibial plateau angle in dogs. J Am Vet Med Assoc 2009; 234: 622-624.
11 Fettig AA, Rand WM, Sato AF. et al. Observer variability of tibial plateau slope measurement in 40 dogs with cranial cruciate ligament-deficient stifle joints. Vet Surg 2003; 32: 471-478.
12 Caylor KB, Zumpano CA, Evans LM. et al. Intra- and inter-observer measurement variability of tibial plateau slope from lateral radiographs in dogs. J Am Anim Hosp Assoc 2001; 37: 263-268.
13 Lister SA, Roush JK, Renberg WC. Digital measurement of radiographic tibial plateau angle. A comparison to measurement on printed digital images. Vet Comp Orthop Traumatol 2008; 21: 129-132.
14 Baroni E, Matthias RR, Marcellin-Little DJ. et al. Comparison of radiographic assessments of the tibial plateau slope in dogs. Am J Vet Res 2003; 64: 586-589.
15 Trochim W. The Research Methods Knowledge Base. Cincinnati, OH: Atomic Dog Publishing; 2000
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 Bush MA, Bowlt K, Gines JA. et al. Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement. Vet Comp Orthop Traumatol 2011; 24: 205-210.
18 Reif U, Dejardin LM, Probst CW. et al. Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. Vet Surg 2004; 33: 368-375.
19 Morris E, Lipowitz AJ. Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries. J Am Vet Med Assoc 2001; 218: 363-366.
20 Shrout P, Fleiss J. Intraclass correlations: uses in assesing rater reliability. Psychol Bull 1979; 420: 428-486.
21 Jones M, Dobson A, O’Brian S. A graphical method for assessing agreement with the mean between multiple observers using continuous measures. Int J Epidemiol 2011; 40: 1308-1313.
22 Hoffmann DE, Kowaleski Johnson KA. et al. Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement. Vet Surg 2011; 40: 311-320.
23 Hoffmann DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
24 Duerr FM, Duncan CG, Savicky RS. et al. Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37: 49-62.
25 Voss K, Damur DM, Guerrero T. et al. Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2008; 21: 243-249.
26 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.
27 Burns CG, Boudrieau RJ. Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints. Vet Comp Orthop Traumatol 2008; 21: 250-255.
28 Etchepareborde S, Mills J, Busoni V. et al. Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2011; 24: 27-31.
29 Steinberg EJ, Prata RG, Palazzini K. et al. Tibial tuberosity advancement for treatment of CrCL injury: Complications and owner satisfaction. J Am Anim Hosp Assoc 2011; 47: 250-257.
30 Hirshenson MS, Krotscheck U, Thompson MS. et al. Evaluation of complications and short-term outcome after unilateral or single-sesion bilateral tibial tuberosity advancement for cranial cruciate ligament rupture in dogs. Vet Comp Orthop Traumatol 2012; 25: 402-409.
31 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.
32 Wolf RE, Scavelli TD, Hoelzler MG. et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007-2009). J Am Vet Med Assoc 2012; 240: 1481-1487.
33 Christopher SA, Beetem J, Cook JL. Comparision of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 329-334.
34 Skinner OT, Kim SE, Lewis DD. et al. In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. Vet J 2013; 196: 86-91.
35 Colborne GR, Ines JF, Comerford EJ. et al. Distribution of power across the hind limb joints of Labrador Retrievers and Greyhounds. Am J Vet Res 2005; 66: 1563-1571.
36 Agostino FS, Rahal SC, Miqueleto ML. et al. Kinematics analysis of Labrador Retrievers and Rottweilers trotting on a treadmill. Vet Comp Orthop Traumatol 2011; 3: 185-191.