Comparison of radiographic measurements of the patellar tendon-tibial plateau angle with anatomical measurements in dogs

Summary

Objective: To evaluate the validity of the common tangent and conventional tibial plateau angle methods for measuring the patellar tendon angle (PTA) in dogs.

Methods: Radiographs of cadaveric stifles (n = 20) placed at 135° in true lateral position were obtained to measure the PTA with both methods. A Kirschner wire was inserted perpendicularly to the patellar tendon at its insertion on the tibia and the stifle was dissected. Two Kirschner wires were then used to identify the anatomical landmarks of the tibial plateau. A digital image was obtained of the proximal tibia in true lateral position. Six blinded observers measured each PTA digitally while the anatomical PTA was determined by an independent blinded observer from the angle between the line representing the tibial plateau and the Kirschner wire representing the perpendicular to the patellar tendon. The agreement between the methods was determined statistically from an intraclass correlation coefficient (ICC).

Results: The global ICC for the common tangent method (0.44) and for the conventional method (0.4) indicated that their overall validity is poor. The measurements obtained by common tangent method and conventional method were respectively below and above the anatomical measurements. The reproducibility of the PTA measurements based on images of the dissected stifles was very good.

Clinical significance: Both the common tangent and conventional methods show poor concordance with the anatomical measurement of PTA. Further studies are needed to determine if errors in measurements affect the clinical outcome.

Keywords

Patellar tendon angle - common tangent - tibial plateau - dog - anatomic - validity

• References

• 1 Apelt D, Kowaleski M, 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, Damur DM, Guerrero T. 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 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.:
• 4 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.
• 5 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.
• 6 Tepic S, Damur DM, Montavon PM. Biomechanics of the Stifle Joint. Proceedings of the 1st World Orthopedic Veterinary Congress. 2002. September 5-8 Munich, Germany.:
• 7 Warzee CC, Déjardin 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.
• 8 Dennler R, Kipfer NM, Tepic S. et al. Inclination of the patellar ligament in relation to flexion angle in the stifle joints of dogs without degenerative joint disease. Am J Vet Res 2006; 67: 1849-1854.
• 9 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
• 10 Schwandt CS, Bohorquez-Vanelli A, Tepic S. et al. Angle between patellar ligament and the tibial plateau in dogs with partial rupture of the cranial cruciate ligament. Am J Vet Res 2006; 67: 1855-1860.
• 11 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.
• 12 Grierson J, Sanders M, Guitan J. et al. Comparison of anatomical tibial plateau angle versus observer measurement from lateral radiographs in dogs. Vet Comp Orthop Traumatol 2005; 18: 215-219.
• 13 Boudrieau RJ. TTA laboratory. Veterinary Symposium- the surgical summit, Pre-symposium Laboratories. 2007. October 17 Chicago, Illinois, USA.:
• 14 Evans HE, De Lahunta A. In: Guide to the Dissection of the Dog. Missouri, USA: Saunders Elsevier; 2009. pg. 321.
• 15 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.
• 16 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.
• 17 Ocal MK, Sabanci SS. Effect of anatomic variation in caudal tibial plateau on the tibial plateau angle in dogs: a cadaveric study. J Small Anim Pract 2013; 54: 537-540.
• 18 Hoffman DE, Kowaleski MP, Johnson KA. et al. Ex vivo biomechanical evaluation of the canine CrCL deficient stifle with varying angles of stifle joint flexion and axial loads after TTA. Vet Surg 2011; 40: 311-320.
• 19 Millet M, Bismuth C, Labrunie A. et al. Measurement of the patellar tendon-tibial plateau angle and tuberosity advancement in dogs with cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2013; 26: 469-478.
• 20 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.
• 21 Shrout P, Fleiss J. Intraclass correlations: uses in assessing rater reliability. Psycho Bull 1979; 420: 428-486.
• 22 Jones M, Dobson A, O’Brian S. A graphical method for assessing agreement with the mean between multiples observers using continuous measures. Int J Epidemiol 2011; 40: 1308-1313.
• 23 Burns CG, Bourdieau RJ. Modified tibial tuberosity advancement procedure with tibial 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.
• 24 Miller JM, Shires PK, Lanz OI. et al. Effects of 9 mm tibial tuberosity advancement on cranial tibial translation in the canine cranial cruciate ligament-deficient stifle. Vet Surg 2007; 36: 335-340.
• 25 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.
• 26 Hottinger HA, DeCamp CE, Olivier B. et al. Non-invasive kinematic analysis of the walk in healthy large-breed dogs. Am J Vet Res 1996; 57: 381-388.
• 27 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.
• 28 Agostinho FS, Rahal SC, Miqueleto ML. et al. Kinematic analysis of Labrador Retrievers and Rottweilers trotting on a treadmill. Vet Comp Orthop Traumatol 2011; 3: 185-191.
• 29 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.
• 30 Hoffman DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
• 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 complication in 101 dogs. Vet Surg 2007; 36: 573-586.
• 32 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.
• 33 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.
• 34 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.
• 35 Robinson DA, Mason DR, Evans R. et al. The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau leveling osteotomy in Labrador Retrievers. Vet Surg 2006; 35: 294-299.
• 36 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.
• 37 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 329-334.
• 38 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 1983; 184: 564-569.
• 39 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.
• 40 Kim SE, Pozzi A, Banks SA. et al. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38: 33-39.