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

Albane H. Fauron; Mieghan Bruce; Daniel R. James; Mark A. Owen; Karen L. Perry

doi:10.3415/VCOT-16-10-0148

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

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

¹Michigan State University, Department of Small Animal Clinical Sciences, East Lansing, Michigan, USA

,

Mieghan Bruce

²The Royal Veterinary College, Department of Production and Population Health, North Mymms, UK

,

Daniel R. James

³Small Animal Specialist Hospital, North Ryde, Sydney, Australia

,

Mark A. Owen

⁴Ossicle Ltd., The Veterinary Hospital, Bristol, UK

,

Karen L. Perry

¹Michigan State University, Department of Small Animal Clinical Sciences, East Lansing, Michigan, USA

› Author Affiliations

Abstract

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

Full Text

References

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.
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.
3 Gibbons SE, Macias C, Tonzing MA. et al. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
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.
5 Harasen G. Diagnosing rupture of the cranial cruciate ligament. Can Vet J 2002; 43: 475-476.
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.
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.
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.
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.
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.
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.
12 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
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.
14 Roush JK. Canine patellar luxation. Vet Clin North Am Small Anim Pract 1993; 23: 855-868.
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.
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.
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.
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.
19 Weese JS. A review of post-operative infections in veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2008; 21: 99-105.
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.
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.
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.
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.
24 Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. New York: Wiley-Blackwell; 2013
25 Core R, Team R. A Language and Environment for Statistical Computing. 3.2.4 ed. Vienna, Austria: R Foundation for Statistical Computing 2016
26 Venables WN, Ripley BD. Modern Applied Statistics with S. 4th Ed. New York: Springer; 2002
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]
28 Yee TW. The VGAM package for categorical data analysis. Journal of Statistical Software 2010; 32: 1-34.
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]
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
41 Maquet P. Advancement of the tibial tuberosity. Clin Orthop Rel Res 1976; 115: 225-230.
42 L’Eplattenier H, Montavon PM. Patellar luxation in dogs and cats: management and prevention. Compend Contin Educ Pract Vet 2002; 24: 292-298.
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.
44 Mendes DG, Soundry M, Iusim M. Clinical assessment of Maquet tibial tuberosity advancement. Clin Orthop Rel Res 1987; 222: 228-238.
45 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.

Supplementary Material

Online Supplementary Material (PDF)