Comparison of autogenous cancellous bone grafting and extra-corporeal shock wave therapy on osteotomy healing in the tibial tuberosity advancement procedure in dogs

Summary

Objectives: To compare optical values in the osteotomy gap created after a tibial tuberosity advancement (TTA) treated with autogenous cancellous bone graft, extracorporeal shock wave therapy, a combination of auto-genous cancellous bone graft and extra -corporeal shock wave therapy, and absence of both autogenous cancellous bone graft and extracorporeal shock wave therapy using densitometry.

Methods: Dogs that were presented for surgical repair of a cranial cruciate ligament rupture were randomly assigned to one of four groups: TTA with autogenous cancellous bone graft (TTA-G), TTA with autogenous cancellous bone graft and extracorporeal shock wave therapy (TTA-GS), TTA with extracorporeal shock wave therapy (TTA-S), and TTA with no additional therapy (TTA-O). Mediolateral radiographs at zero, four and eight weeks after surgery were evaluated to compare healing of the osteotomy gap via densitometry. An analysis of variance was used to compare the densitometric values between groups.

Results: At four weeks after surgery, a significant difference in osteotomy gap density was noted between TTA-GS (8.4 millimetres of aluminium equivalent [mmAleq]) and TTA-S (6.1 mmAleq), and between TTA-GS (8.4 mmAleq) and TTA-O (6.4 mmAleq). There were no significant differences noted between any groups at the eight week re-evaluation.

Clinical significance: There were no significant differences in the osteotomy gap density at eight weeks after surgery regardless of the treatment modality used. The combination of autogenous cancellous bone graft and extracorporeal shock wave therapy may lead to increased radiographic density of the osteotomy gap in the first four weeks after surgery. Densitometry using an aluminium step wedge is a feasible method for comparison of bone density after TTA in dogs.

Keywords

Tibial tuberosity advancement - TTA - extra -corporeal shock wave therapy - cranial cruciate ligament rupture - autogenous cancellous bone graft

• References

• 1 Maquet P. Advancement of the tibial tuberosity. Clin Orthop Relat Res 1976; 225-230.
• 2 Montavon P, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate cruciate deficient canine stifle. Proceedings of the 1st World Orthopaedic Veterinary Congress. 2002. September 5-8 Munich, Germany:
• 3 Hoffmann DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
• 4 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.
• 5 MacDonald TL, Allen DA, Monteith GJ. Clinical assessment following tibial tuberosity advancement in 28 stifles at 6 months and 1 year after surgery. Can Vet J 2013; 54: 249-254.
• 6 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.
• 7 Guerrero TG, Makara MA, Katiofsky K. et al. Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft. Vet Surg 2011; 40: 27-33.
• 8 Bisgard SK, Barnhart MD, Shiroma JT. et al. The effect of cancellous autograft and novel plate design on radiographic healing and postoperative complications in tibial tuberosity advancement for cranial cruciate-deficient canine stifles. Vet Surg 2011; 40: 402-407.
• 9 Atala A, Steinbock GS. Extracorporeal shock-wave lithotripsy of renal calculi. Am J Surg 1989; 157: 350-358.
• 10 Segura JW, Patterson DE, LeRoy AJ. et al. Percutaneous lithotripsy. J Urol 1983; 130: 1051-1054.
• 11 Danova NA, Muir P. Extracorporeal shock wave therapy for supraspinatus calcifying tendinopathy in two dogs. Vet Rec 2003; 152: 208-209.
• 12 Gallagher A, Cross AR, Sepulveda G. The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy. Vet Surg 2012; 41: 482-485.
• 13 Wang CJ, Huang HY, Chen HH. et al. Effect of shock wave therapy on acute fractures of the tibia: a study in a dog model. Clin Orthop Relat Res 2001; 112-118.
• 14 Johannes EJ, Kaulesar Sukul DM, Matura E. High-energy shock waves for the treatment of nonunions: an experiment on dogs. J Surg Res 1994; 57: 246-252.
• 15 Laverty P, McClure S. Initial experience with extracorporeal shock wave therapy in six dogs - part I. Vet Comp Orthop Traumatol 2002; 15: 177-183.
• 16 Dahlberg JA, McClure SR, Evans RB. et al. Force platform evaluation of lameness severity following extracorporeal shock wave therapy in horses with unilateral forelimb lameness. J Am Vet Med Assoc 2006; 229: 100-103.
• 17 Kirkby KA, Lewis DD. Canine hip dysplasia: reviewing the evidence for nonsurgical management. Vet Surg 2012; 41: 2-9.
• 18 Mueller M, Bockstahler B, Skalicky M. et al. Effects of radial shockwave therapy on the limb function of dogs with hip osteoarthritis. Vet Rec 2007; 160: 762-765.
• 19 Bolt DM, Burba DJ, Hubert JD. et al. Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses. Am J Vet Res 2004; 65: 1714-1718.
• 20 Da Costa Gomez TM, Radtke CL, Kalscheur VL. et al. Effect of focused and radial extracorporeal shock wave therapy on equine bone microdamage. Vet Surg 2004; 33: 49-55.
• 21 Ogden JA, Alvarez RG, Levitt R. et al. Shock wave therapy (Orthotripsy) in musculoskeletal disorders. Clin Orthop Relat Res 2001; 22-40.
• 22 Bolt DM, Burba DJ, Hubert JD. et al. Evaluation of cutaneous analgesia after non-focused extracorporeal shock wave application over the 3rd metacarpal bone in horses. Can J Vet Res 2004; 68: 288-292.
• 23 Thiel M. Application of shock waves in medicine. Clin Orthop Relat Res 2001; 18-21.
• 24 van der Jagt OP, Piscaer TM, Schaden W. et al. Unfocused extracorporeal shock waves induce anabolic effects in rat bone. J Bone Joint Surg Am 2011; 93: 38-48.
• 25 Wang L, Qin L, Lu HB. et al. Extracorporeal shock wave therapy in treatment of delayed bone-tendon healing. Am J Sports Med 2008; 36: 340-347.
• 26 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.
• 27 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. Reliability of the common tangent and tibial plateau methods of measurement. Vet Comp Orthop Traumatol 2013; 26: 469-478.
• 28 Preston Stubbs W. Tibial Tuberosity Advancement. Surgical Technique [PDF of Powerpoint Presentation]. Provided by KYON AG: Members Area; September 2011 Available from http://www.kyon.ch/members-area/members-tta
• 29 Kuipers von Lande RG, Worth AJ, Guerrero TG. et al. Comparison between a novel bovine xenoimplant and autogenous cancellous bone graft in tibial tuberosity advancement. Vet Surg 2012; 41: 559-567.
• 30 Grassl U, Schulze RK. In vitro perception of low-contrast features in digital, film, and digitized dental radiographs: a receiver operating characteristic analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endol 2007; 103: 694-701.
• 31 Ostlere SJ, Gold RH. Osteoporosis and bone density measurement methods. Clin Orthop Relat Res 1991; 149-163.
• 32 Watts DC, McCabe JF. Aluminium radiopacity standards for dentistry: an international survey. J Dent 1999; 27: 73-78.
• 33 Souza TF, Andrade AL, Ferreira GT. et al. Healing and expression of growth factors (TGF-beta and PDGF) in canine radial ostectomy gap containing platelet-rich plasma. Vet Comp Orthop Traumatol 2012; 25: 445-452.
• 34 Goldberg VM, Stevenson S. Natural history of autografts and allografts. Clin Orthop Relat Res 1987; 7-16.
• 35 Ragetly GR, Griffon DJ. The rationale behind novel bone grafting techniques in small animals. Vet Comp Orthop Traumatol 2011; 24: 1-8.
• 36 DeVries WJ, Runyon CL, Martinez SA. et al. Effect of volume variations on osteogenic capabilities of autogenous cancellous bone graft in dogs. Am J Vet Res 1996; 57: 1501-1505.
• 37 Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res 2001; 90-94.
• 38 Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991; 15: 181-184.
• 39 Haupt G, Haupt A, Ekkernkamp A. et al. Influence of shock waves on fracture healing. Urology 1992; 39: 529-532.
• 40 McClure SR, Van Sickle D, White MR. Effects of extracorporeal shock wave therapy on bone. Vet Surg 2004; 33: 40-48.
• 41 Dahlberg J, Fitch G, Evans RB. et al. The evaluation of extracorporeal shockwave therapy in naturally occurring osteoarthritis of the stifle joint in dogs. Vet Comp Orthop Traumatol 2005; 18: 147-152.
• 42 Wang CJ, Wang FS, Yang KD. et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res 2003; 21: 984-989.
• 43 McClure SR, VanSickle D, Evans R. et al. The effects of extracorporeal shock-wave therapy on the ultrasonographic and histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis. UltrasoundMed Biol 2004; 30: 461-467.
• 44 Millis DL, Francis D, Adamson C. Emerging modalities in veterinary rehabilitation. Vet Clin North Am Small Anim Pract 2005; 35: 1335-1355. viii.
• 45 Rompe JD, Kirkpatrick CJ, Kullmer K. et al. Dose-related effects of shock waves on rabbit tendo Achillis. A sonographic and histological study. J Bone Joint Surg Br 1998; 80: 546-552.