PDF herunterladen
Vet Comp Orthop Traumatol 2017; 30(03): 209-218
DOI: 10.3415/VCOT-16-10-0148
Clinical Communication
Schattauer GmbH

Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease

Effect of fixation method on postoperative complication rate and clinical outcome
Albane H. Fauron
1   Michigan State University, Department of Small Animal Clinical Sciences, East Lansing, Michigan, USA
,
Mieghan Bruce
2   The Royal Veterinary College, Department of Production and Population Health, North Mymms, UK
,
Daniel R. James
3   Small Animal Specialist Hospital, North Ryde, Sydney, Australia
,
Mark A. Owen
4   Ossicle Ltd., The Veterinary Hospital, Bristol, UK
,
Karen L. Perry
1   Michigan State University, Department of Small Animal Clinical Sciences, East Lansing, Michigan, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 27. Oktober 2016

Accepted: 31. Januar 2017

Publikationsdatum:
23. Dezember 2017 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Summary

Objectives: To compare complication rates and outcomes between cases of concomitant cranial cruciate ligament (CrCL) disease and medial patellar luxation (MPL) treated using extracapsular stabilization and tibial tuberosity transposition (ECS+TTT) and tibial tuberosity transposition and advancement (TTTA).

Methods: In a multicentre retrospective study, records from four referral hospitals were reviewed for dogs with concomitant CrCL pathology and MPL treated using ECS+TTT or TTTA. Data retrieved included signalment, partial/complete CrCL tear, MPL grade, treatment performed, occurrence of postoperative complications, and postoperative outcome grade. Associations between surgical procedure and risk of complication and surgical procedure and outcome were investigated using univariable logistic regression and proportional odds logistic regression respectively. Multiple logistic regression was used to explore confounding factors.

Results: A total of 72 stifles were evaluated in 66 dogs; 32 stifles were stabilized using ECS+TTT and 40 using TTTA. Overall complications were 2.7 times more frequent in the ECS+TTT group and major complications occurred only in this group. The TTTA group was less likely to suffer complications (17.5%) compared to the ECS+TTT group (46.9%) (p = 0.009) and TTTA cases had lower odds of a poorer clinical outcome (p = 0.047).

Clinical significance: Stifles stabilized using ECS+TTT are more likely to suffer from postoperative complications and a poorer clinical outcome when compared to TTTA.

Supplementary Material to this article is available online at https://doi.org/10.3415/VCOT-16-10-0148

Keywords

Medial patellar luxation - cranial cruciate ligament disease - tibial tuberosity transposition - extracapsular stabilization - tibial tuberosity transposition and advancement

 

  • References

  • 1 Ness MN, Abercomby RH, May C. et al. A survey of orthopaedic conditions in small animal veterinary practice in Britain. Vet Comp Orthop Traumatol 1996; 9: 43-52.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 2 Johnson JM, Johnson AL. Cranial cruciate ligament rupture: pathogenesis, diagnosis and postoperative rehabilitation. Vet Clin North Am Small Anim Pract 1993; 23: 717-733.
    CrossrefPubMedGoogle Scholar
  • 3 Gibbons SE, Macias C, Tonzing MA. et al. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
    CrossrefPubMedGoogle Scholar
  • 4 Campbell CA, Horstman CL, Mason DR. et al. Severity of patellar luxation and frequency of concomitant cranial cruciate ligament rupture in dogs: 162 cases (2004-2007). J Am Vet Med Assoc 2010; 236: 887-891.
    CrossrefPubMedGoogle Scholar
  • 5 Harasen G. Diagnosing rupture of the cranial cruciate ligament. Can Vet J 2002; 43: 475-476.
    PubMedGoogle Scholar
  • 6 Roy RG, Wallace LJ, Johnston GR. et al. A retrospective evaluation of stifle osteoarthritis in dogs with bilateral medial patellar luxation and unilateral surgical repair. Vet Surg 1992; 21: 475-479.
    CrossrefPubMedGoogle Scholar
  • 7 Newman M, Bertollo N, Walsh W. et al. Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: an ex vivo canine study. Vet Comp Orthop Traumatol 2014; 27: 271-276.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Langenbach A, Marcellin-Little DJ. Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling. J Small Anim Pract 2010; 51: 97-103.
    CrossrefPubMedGoogle Scholar
  • 9 Leonard KC, Kowaleski MP, Saunders WB. et al. Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation. Vet Comp Orthop Traumatol 2016; 29: 536-540.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 10 Piermattei DL, Flo GL, DeCamp CE. The Stifle Joint. In: Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopaedics and Fracture Repair. 5th ed. Philadelphia: Elsevier; 2016. Pg 597-669.
    Google Scholar
  • 11 McCartney WT, O’Connor JV, McCann WM. Incidence of infection and premature crimp failure after repair of cranial cruciate ligament-deficient stifles in 110 dogs. Vet Rec 2007; 161: 232-233.
    CrossrefPubMedGoogle Scholar
  • 12 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
    CrossrefPubMedGoogle Scholar
  • 13 Yeadon R, Fitzpatrick N, Kowalski M. Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Vet Comp Orthop Traumatol 2011; 24: 18-26.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Roush JK. Canine patellar luxation. Vet Clin North Am Small Anim Pract 1993; 23: 855-868.
    CrossrefPubMedGoogle Scholar
  • 15 Perry KL, Bruce M, Woods S. et al. Effect of fixation method on postoperative complication rates after surgical stabilization of lateral humeral condylar factures in dogs. Vet Surg 2015; 44: 246-255.
    CrossrefPubMedGoogle Scholar
  • 16 Hamilton MH, Langley Hobbs SJ. Use of the AO veterinary mini ‘T’-plate for stabilization of distal radius and ulna fractures in toy breed dogs. Vet Comp Orthop Traumatol 2005; 18: 18-25.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 17 Comerford E, Forster K, Gorton K. et al. Management of cranial cruciate ligament rupture in small dogs: a questionnaire study. Vet Comp Orthop Traumatol 2013; 26: 493-497.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Guénégo L, Zahra A, Madelénat A. et al. Cranial cruciate ligament rupture in large and giant dogs - a retrospective evaluation of a modified lateral extracapsular stabilization. Vet Comp Orthop Traumatol 2007; 20: 43-50.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Weese JS. A review of post-operative infections in veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2008; 21: 99-105.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
    CrossrefPubMedGoogle Scholar
  • 21 Fox SM, Bray JC, Guerin SR. et al. Antebrachial deformities in the dog: treatment with external fixation. J Small Anim Pract 1995; 36: 315-320.
    CrossrefPubMedGoogle Scholar
  • 22 Sauerbrei W, Royston P, Binder H. Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Stat Med 2007; 26: 5512-5528.
    CrossrefPubMedGoogle Scholar
  • 23 Collins GS, Ogundimu EO, Cook JA. et al. Quantifying the impact of different approaches for handling continuous predictors on the performance of a prognostic model. Stat Med 2016; 35: 4124-4135.
    CrossrefPubMedGoogle Scholar
  • 24 Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. New York: Wiley-Blackwell; 2013
    Google Scholar
  • 25 Core R, Team R. A Language and Environment for Statistical Computing. 3.2.4 ed. Vienna, Austria: R Foundation for Statistical Computing 2016
    PubMedGoogle Scholar
  • 26 Venables WN, Ripley BD. Modern Applied Statistics with S. 4th Ed. New York: Springer; 2002
    Google Scholar
  • 27 Amber G, Benner A. MPF: Multivariable Fractional Polynomials. R package version 1.5.1. 2015. Available at. https://CRAN.R-project.org/package=mfp [Accesssed: 2015 August 10]
    PubMedGoogle Scholar
  • 28 Yee TW. The VGAM package for categorical data analysis. Journal of Statistical Software 2010; 32: 1-34.
    PubMedGoogle Scholar
  • 29 Lele SR, Keim JL, Solymos P. ResourceSelection: Resource Selection (Probability) Functions for Use-Availability Data. [Website page]. R package version 0.2-6. 2016. Available at. https://CRAN.R-project.org/package=ResourceSelection [Accessed on 31st July 2016]
    PubMedGoogle Scholar
  • 30 Cashmore RG, Havlicek M, Perkins NR. et al. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs. Vet Comp Orthop Traumatol 2014; 27: 263-270.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). J Am Vet Med Assoc 2009; 234: 229-235.
    CrossrefPubMedGoogle Scholar
  • 32 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle Joint. In Tobias KM, Johnston SA. Editors Veterinary Surgery Small Animal. 1st ed. St Louis, MO: Elsevier Saunders; 2012: 973-988.
    Google Scholar
  • 33 Hulse D, Hyman W, Beale B. et al. Determination of isometric points for placement of a lateral suture in treatment of the cranial cruciate ligament deficient stifle. Vet Comp Orthop Traumatol 2010; 23: 163-167.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 34 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.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Stanke NJ, Stephenson N, Hayashi K. Retrospective risk factor assessment for complications following tibial tuberosity transposition in 137 canine stifles with medial patellar luxation. Can Vet J 2014; 55: 349-356.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 37 Guerrero TG, Pozzi A, Dunbar N. et al. Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints. Vet Surg 2011; 40: 839-848.
    PubMedGoogle Scholar
  • 38 Hirshenson MS, Krotscheck U, Thompson MS. et al. Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs. Vet Comp Orthop Traumatol 2012; 25: 402-409.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 39 Lafaver S, Miller NA, Preston-Stubbs W. et al. Tibial tuberosity advancement for stabilization of the cranial cruciate ligament-deficient stifle joint: surgical technique, early results and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
    CrossrefPubMedGoogle Scholar
  • 40 Linney WR, Hammer DL, Shott S. Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009). J Am Vet Med Assoc 2011; 238: 1168-1172.
    CrossrefPubMedGoogle Scholar
  • 41 Maquet P. Advancement of the tibial tuberosity. Clin Orthop Rel Res 1976; 115: 225-230.
    PubMedGoogle Scholar
  • 42 L’Eplattenier H, Montavon PM. Patellar luxation in dogs and cats: management and prevention. Compend Contin Educ Pract Vet 2002; 24: 292-298.
    PubMedGoogle Scholar
  • 43 Hunter DJ, Zhang YQ, Niu JB. et al. Patella malalignment, pain and patellofemoral progression: The Health ABC Study. Osteoarthritis and Cartilage 2007; 15: 1120-1127.
    CrossrefPubMedGoogle Scholar
  • 44 Mendes DG, Soundry M, Iusim M. Clinical assessment of Maquet tibial tuberosity advancement. Clin Orthop Rel Res 1987; 222: 228-238.
    PubMedGoogle Scholar
  • 45 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
    CrossrefPubMedGoogle Scholar