Ätiologie, Pathogenese, Diagnostik und Therapie der Ruptur des kranialen Kreuzbandes beim Hund

J. Knebel; A. Meyer-Lindenberg

doi:10.1055/s-0038-1623745

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Inhaltsverzeichnis

Tierarztl Prax Ausg K Kleintiere Heimtiere 2014; 42(01): 36-47
DOI: 10.1055/s-0038-1623745

Übersichtsartikel

Schattauer GmbH

Ätiologie, Pathogenese, Diagnostik und Therapie der Ruptur des kranialen Kreuzbandes beim Hund

Aetiology, pathogenesis, diagnostics and therapy of cranial cruciate ligament rupture in dogs

Autor*innen

J. Knebel

¹Chirurgische und Gynäkologische Kleintierklinik der Ludwig-Maximilians-Universität München
A. Meyer-Lindenberg

¹Chirurgische und Gynäkologische Kleintierklinik der Ludwig-Maximilians-Universität München

Abstract

Zusammenfassung

Die Ruptur des vorderen Kreuzbandes stellt die häufigste Lahmheitsursache der Beckengliedmaße beim Hund dar und ist häufig mit einer Verletzung des medialen Meniskus vergesellschaftet. Die Ätiologie wird kontrovers diskutiert. Im Vordergrund scheint eine Degeneration des Lig. cruciatum craniale zu stehen, die zur Teilruptur des Bandes führt, auf die nach einem unbedeutenden Trauma die komplette Bandruptur folgt. Diagnostisch ist die Auslösung des Schubladenphänomens beweisend, doch lassen sich vor allem partielle Kreuzbandrisse klinisch nur schwer diagnostizieren. Generell kann die Untersuchung des Patienten mit einem Riss des kranialen Kreuzbandes in Narkose die Diagnosesicherheit erhöhen. Sowohl die Kernspintomographie als auch die Arthroskopie können die Ruptur im Zweifelsfall bestätigen und ermöglichen, sekundäre Kniegelenkerkrankungen zu erkennen. Zur Behebung der Instabilität im kranialen Kniegelenkbereich dienen extraund intraartikuläre Stabilisierungsmethoden sowie Umstellungsosteotomien. Das Prinzip der tibialen Umstellungsosteotomien besteht in der muskulären Kompensation der vorderen Schubladenbewegung, wobei die Ergebnisse zufriedenstellend, aber nicht einwandfrei sind. Der Übersichtsartikel stellt die umfangreiche Problematik der Ruptur des vorderen Kreuzbandes beim Hund in Kurzform dar. Die detailliertere Betrachtung der sekundären Erkrankungen und Komplikationen würde den Umfang dieser Arbeit übersteigen und bedarf einer weiteren Aufarbeitung.

Summary

Cranial cruciate ligament rupture is the most common cause of hindlimb disease in dogs and is often associated with an additional lesion of the medial meniscus. The exact aetiopathogenesis of this condition in dogs is unknown. Normally, the degeneration of the ligament first leads to a partial rupture which progresses to a complete rupture following an unspectacular trauma. The positive cranial drawer test confirms the cranial cruciate ligament rupture, however, in some cases, particularly in partial ligament lesions, the diagnosis is not obvious. Therefore, the reexamination of the sedated patient is recommended to generally increase the sensitivity of clinical tests. Magnetic resonance imaging and stifle joint arthroscopy are useful methods to evaluate the cruciate ligaments in indistinct cases or to assess the joint for secondary changes. The therapy of cranial cruciate ligament ruptures can be divided into extraand intracapsular as well as tibial osteotomies. The principle of the different tibial osteotomies is the muscular compensation of stifle joint instability. The results are successful but not uncritical. This article presents a short review on the substantial problems associated with cranial cruciate ligament rupture in dogs. A more detailed description of secondary problems and complications would exceed the scope of this article and should be considered in another study.

Schlüsselwörter

Kreuzbandriss - degenerative Erkrankung - diagnostische Sensitivität - Arthroskopie

Keywords

Cruciate ligament rupture - degenerative joint disease - diagnostic sensitivity - arthroscopy

Volltext

Referenzen

Literatur
1 Allgoewer I. et al. Zwei intra-extraartikuläre Stabilisationsverfahren zur Therapie der Ruptur des Ligamentum cruciatum craniale im Vergleich: Methode (mod.) nach FLO und Methode nach MEUTSTEGE. Kleintierprax 2000; 45: 95-103.
2 Arnault F. et al. Diagnostic value of ultrasonography to assess stifle lesions in dogs after cranial cruciate ligament rupture: 13 cases. Vet Comp Orthopaed 2009; 22: 479-485.
3 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
4 Arnoczky SP. et al. The “over-the-top” procedure: A technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-290.
5 Arnoczky SP. Pathomechanics of cruciate ligament and meniscal injuries. In: Disease Mechanisms in Small Animal Surgery. Bojrab MJ. ed. Philadelphia: Lea & Febiger; 1993: 764-776.
6 Au KK. et al. Comparison of shortand long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization. Vet Surg 2010; 39: 173-180.
7 Baird DK. et al. Low-field magnetic resonance imaging of early subchondral cyst-like lesions in induced cranial cruciate ligament deficient dogs. Vet Radiol Ultrasound 1998; 39: 167-173.
8 Ballagas AJ. et al. Preand postoperative force plate analysis of dogs with experimentally transected cranial cruciate ligaments treated using tibial plateau leveling osteotomy. Vet Surg 2004; 33: 187-190.
9 Barrett E. et al. A retrospective study of the MRI findings in 18 dogs with stifle injuries. J Small Anim Pract 2009; 50: 448-455.
10 Bennett D. et al. A reappraisal of anterior cruciate ligament disease in the dog. J Small Anim Pract 1988; 29: 275-297.
11 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 1991; 32: 111-117.
12 Blond L. et al. Diagnostic accuracy of magnetic resonance imaging for meniscal tears in dogs affected with naturally occuring cranial cruciate ligament rupture. Vet Radiol Ultrasound 2008; 49: 425-431.
13 Böddeker J. et al. Computer-assisted gait analysis of the dog: comparison of two surgical techniques for the ruptured cranial cruciate ligament. Vet Comp Orthopaed 2012; 25: 11-21.
14 Böttcher P. et al. A novel pin distraction device for arthroscopic assessment of the medial meniscus in dogs. Vet Surg 2009; 38: 595-600.
15 Böttcher P. et al. Value of low-field magnetic resonance imaging in diagnosing meniscal tears in the canine stifle: a prospective study evaluating sensitivity and specificity in naturally occurring cranial cruciate ligament deficiency with arthroscopy as the gold standard. Vet Surg 2010; 39: 296-305.
16 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
17 Brinker WO. et al. Fractures and orthopedic conditions of the hindlimb. In: Handbook of Small Animal Orthopedics and Fracture Repair. Piermattei DLF, Flo GL. eds. Philadelphia: Saunders; 1997: 534-563.
18 Brunel L. et al. Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique. Vet Comp Orthopaed 2013; 26: 47-53.
19 Brunnberg L. Klinische Untersuchungen zu Ätiologie und Pathogenese der Ruptur des Ligamentum cruciatum craniale beim Hund. 3. Mitteilung: Eigene Untersuchungen. Kleintierprax 1990; 35: 377-389.
20 Brunnberg L. et al. Sieben Jahre Erfahrung mit einer modifizierten “Overthe-Top”-Kreuzbandplastik beim Hund. Kleintierprax 1992; 37: 735-746.
21 Buote N. et al. Age, tibial plateau angle, sex, and weight as risk factors for contralateral rupture of the cranial cruciate ligament in Labradors. Vet Surg 2009; 38: 481-489.
22 Carobbi B, Ness MG. Preliminary study evaluating tests used to diagnose canine cranial cruciate ligament failure. J Small Anim Pract 2009; 50: 224-226.
23 Case JB. et al. Meniscal injury following initial cranial cruciate ligament stabilization surgery in 26 dogs (29 stifles). Vet Comp Orthopaed 2008; 21: 365-367.
24 Chauvet AE. et al. Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: A retrospective study. J Am Anim Hosp Assoc 1996; 32: 247-255.
25 Comerford EJ. et al. Distal femoral intercondylar notch dimensions and their relationship to composition and metabolism of the canine anterior cruciate ligament. Osteoarthritis and cartilage/OARS, Osteoarthritis Research Society 2006; 14: 273-278.
26 Comerford EJ. et al. Update on the aetiopathogenesis of canine cranial cruciate ligament disease. Vet Comp Orthopaed 2011; 24: 91-98.
27 Conzemius MG. et al. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226: 232-236.
28 Cook JL. et al. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39: 315-323.
29 Cox JS. et al. The degenerative effects of partial and total resection of the medial meniscus in dogs’ knees. Clin Orthop 1975; 178-183.
30 Crues 3rd JV. et al. Meniscal pathology. The expanding role of magnetic resonance imaging. Clin Orthop 1990; 80-87.
31 De Angelis ML, Lau RE. A lateral retinacular imbrication technique for the surgical correction of anterior cruciate ligament rupture in the dog. J Am Vet Med Assoc 1970; 157: 79-84.
32 Di Stefano VJ. Function, post-traumatic sequelae and current concepts of management of knee meniscal injuries. Clinic Orthop Rel Res 1980; 151: 143-146.
33 Doom M. et al. Immunopathological mechanisms in dogs with rupture of the cranial cruciate ligament. Vet Immunol Immunopathol 2008; 125: 143-161.
34 Duerr FM. et al. Risk factors for excessive tibial plateau angle in large-breed dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2007; 231: 1688-1691.
35 Dupuis J. et al. Evaluation of fibular head transposition for repair of experimental cranial cruciate ligament injury in dogs. Vet Surg 1994; 23: 1-12.
36 Etchepareborde S. et al. Mechanical testing of a modified stabilisation method for tibial tuberosity advancement. Vet Comp Orthopaed 2010; 23: 400-405.
37 Etchepareborde S. et al. Preliminary experience of a modified Maquet technique for repair of cranial cruciate ligament rupture in dogs. Vet Comp Orthopaed 2011; 24: 223-227.
38 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.
39 Flo GL, De Young DJ. Meniscal injuries and medial meniscectomy in the canine stifle. J Am Vet Hosp Assoc 1978; 14: 683-689.
40 Flo GL. et al. Classification of meniscal injuries in the canine stifle based upon gross pathological appearance. J Am Vet Hosp Assoc 1983; 19: 325-334.
41 Flo GL. Meniscal injuries. Vet Clin North Am Small Anim Pract 1993; 23: 831-843.
42 Furman W. et al. The anterior cruciate ligament. A functional analysis based on postmortem studies. J Bone Joint Surg Am 1976; 58: 179-185.
43 Grierson J. et al. An investigation into risk factors for bilateral canine cruciate ligament rupture. Vet Comp Orthopaed 2011; 24: 192-196.
44 Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg 2010; 39: 399-409.
45 Guerrero TG. et al. Effect of conformation of the distal portion of the femur and proximal portion of the tibia on the pathogenesis of cranial cruciate ligament disease in dogs. Am J Vet Res 2007; 68: 1332-1337.
46 Henderson RA, Milton JL. The tibial compression mechanism: A diagnostic aid in stifle injuries. J Am Vet Hosp Assoc 1978; 14: 474-479.
47 Hulse D. et al. Determination of isometric points for placement of a lateral suture in treatment of the cranial cruciate ligament deficient stifle. Vet Comp Orthopaed 2010; 23: 163-167.
48 Hulse D. et al. Second look arthroscopic findings after tibial plateau leveling osteotomy. Vet Surg 2010; 39: 350-354.
49 Hulse DA, Shires PK. The Meniscus – Anatomy, Function, and Treatment. Comp Cont Educ Pract 1983; 05: 765-774.
50 Imholt KM. et al. Lahmheitsund Osteoarthroseentwicklung nach Tibial Plateau Leveling Osteotomy (TPLO) und potenzielle prognostische Einflussfaktoren. Eine retrospektive Langzeitstudie. Tierärztl Prax 2011; 39 (K): 323-335.
51 Inauen R. et al. Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog. Vet Comp Orthopaed 2009; 22: 16-20.
52 Jerram RM, Walker AM. Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment. New Zeal Vet J 2003; 51: 149-158.
53 Johnson JM, Johnson AL. Cranial cruciate ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Vet Clin North Am Small Anim Pract 1993; 23: 717-733.
54 Kalff S. et al. Incidence of medial meniscal tears after arthroscopic assisted tibial plateau leveling osteotomy. Vet Surg 2011; 40: 952-956.
55 Kim SE. et al. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125.
56 Kim SE. et al. Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion. Vet Surg 2010; 39: 363-370.
57 Kim SE. et al. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing. Vet Surg 2012; 41: 465-470.
58 Korvick DL. et al. Three-dimensional kinematics of the intact and cranial cruciate ligament-deficient stifle of dogs. 1994; 27 (01) 77-87.
59 Kowaleski MP. et al. Stifle joint. In: Veterinary Surgery Small Animal. Tobias KMJ, et al. eds. Canada: Elsevier; 2012: 906-998.
60 Krause WR. et al. Mechanical changes in the knee after meniscectomy. J Bone Joint Surg Am 1976; 58: 599-604.
61 Lafaver S. 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.
62 Lazar TP. et al. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34: 133-141.
63 Luther JK. et al. Meniscal release in cruciate ligament intact stifles causes lameness and medial compartment cartilage pathology in dogs 12 weeks postoperatively. Vet Surg 2009; 38: 520-529.
64 Mahn MM. et al. Arthroscopic verification of ultrasonographic diagnosis of meniscal pathology in dogs. Vet Surg 2005; 34: 318-323.
65 Metelmann LA. et al. An evaluation of three different cranial cruciate ligament surgical stabilization procedures as they relate to postoperative meniscal injuries. Vet Comp Orthopaed 1995; 08: 118-123.
66 Monahan JJ. et al. In vivo strain patterns in the four major canine knee ligaments. J Orthop Res 1984; 02: 408-418.
67 Montavon PM. et al. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient stifle. 1st World Orthopedic Veterinary Congress, München. 2002
68 Montgomery RD. et al. Comparison of over-the-top and tunnel techniques for anterior cruciate ligament replacement. Clin Orthop 1988; 231: 144-153.
69 Moore KW, Read RA. Cranial cruciate ligament rupture in the dog – a retrospective study comparing surgical techniques. Austr Vet J 1995; 72: 281-285.
70 Nelson SA. et al. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42: 38-50.
71 Nickel R. et al. Lehrbuch der Anatomie der Haustiere, 6. Aufl., Band 1: Bewegungsapparat. Berlin, Hamburg: Parey; 1992
72 Niebauer GW, Menzel EJ. Immunological changes in canine cruciate ligament rupture. Res Vet Sci 1982; 32: 235-241.
73 Noyes FR. et al. Biomechanics of anterior cruciate ligament failure: an analysis of strain-rate sensitivity and mechanisms of failure in primates. J Bone Joint Surg Am 1974; 56: 236-253.
74 Noyes FR. Functional properties of knee ligaments and alterations induced by immobilization: a correlative biomechanical and histological study in primates. Clin Orthop 1977; 123: 210-242.
75 Olmstead ML. The use of orthopedic wire as a lateral suture for stifle stabilization. Vet Clin North Am Small Anim Pract 1993; 23: 735-753.
76 Paatsama S. Ligament injuries in the canine stifle joint. A clinical and experimental study. Veterinary College. Helsinki 1952
77 Pond MJ, Campbell JR. The canine stifle joint. I. Rupture of the anterior cruciate ligament. An assessment of conservative and surgical treatment. J Small Anim Pract 1972; 13: 1-10.
78 Pozzi A. et al. Comparison of arthroscopy and arthrotomy for diagnosis of medial meniscal pathology: an ex vivo study. Vet Surg 2008; 37: 749-755.
79 Pozzi A. et al. Effect of transection of the caudal menisco-tibial ligament on medial femorotibial contact mechanics. Vet Surg 2010; 39: 489-495.
80 Practice TDV. Review article: The Modified Maquet Procedure. http:// www.downsvets.co.uk/review-article-the-modified-maquet-procedure
81 Pujol E. et al. Anatomic study of the canine stifle using low-field magnetic resonance imaging (MRI) and MRI arthrography. Vet Surg 2011; 40: 395-401.
82 Ralphs SC, Whitney WO. Arthroscopic evaluation of menisci in dogs with cranial cruciate ligament injuries: 100 cases (1999–2000). J Am Vet Med Assoc 2002; 221: 1601-1604.
83 Roe SC. et al. Isometry of potential suture attachment sites for the cranial cruciate ligament deficient canine stifle. Vet Comp Orthopaed 2008; 21: 215-220.
84 Scavelli TD. et al. Partial rupture of the cranial cruciate ligament of the stifle in dogs: 25 cases (1982–1988). J Am Vet Med Assoc 1990; 196: 1135-1138.
85 Schnell EM. Kreuzbandersatz beim Hund mit an der Tuberositas tibiae gestielter Faszie und lateralem Drittel des Ligamentum patellae. Diss med vet, Veterinärmedizinische Fakultät, Ludwig-Maximilians-Universität München. 1986
86 Skinner OT. 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.
87 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 1984; 184: 564-569.
88 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.
89 Slocum B, Slocum TD. Knee. In: Current Techniques in Small Animal Surgery. Bojrab MJ. ed. Baltimore: Williams and Wilkins; 1998: 1187.
90 Smith GK, Torg JS. Fibular head transposition for repair of cruciate-deficient stifle in the dog. J Am Vet Med Assoc 1985; 187: 375-383.
91 Smith GN. et al. Severity of medial meniscus damage in the canine knee after anterior cruciate ligament transection. Osteoarthr Cartilage 2002; 10: 321-326.
92 Stone EA. et al. Folding of the caudal horn of the medial meniscus secondary to severance of the cranial cruciate ligament. Vet Surg 1980; 09: 121-124.
93 Talaat MB. et al. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. Vet Surg 2006; 35: 729-739.
94 Tashman S. et al. Kinematics of the ACL-deficient canine knee during gait: serial changes over two years. J Orthop Res 2004; 22: 931-941.
95 Thieman KM. et al. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35: 705-710.
96 Thieman KM. et al. Contact mechanics of simulated meniscal tears in cadaveric canine stifles. Vet Surg 2009; 38: 803-810.
97 Timmermann C. et al. [Maintenance of the cranial cruciate ligament rupture in the dog using an intra-articular (“over-the-top”) and an extra-articular (“fascia-doubling”) method]. Tierärztl Prax 1996; 24: 590-595.
98 Tivers MS. et al. Canine stifle positive contrast computed tomography arthrography for assessment of caudal horn meniscal injury: a cadaver study. Vet Surg 2008; 37: 269-277.
99 Tivers MS. et al. Diagnostic accuracy of positive contrast computed tomography arthrography for the detection of injuries to the medial meniscus in dogs with naturally occurring cranial cruciate ligament insufficiency. J Small Anim Pract 2009; 50: 324-332.
100 Tonks CA. et al. A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle. Vet Comp Orthopaed 2011; 24: 167-177.
101 Vasseur PB. et al. Replacement of the anterior cruciate ligament with a bone-ligament-bone anterior cruciate ligament allograft in dogs. Clin Orthop 1987; 268-277.
102 Voss K. et al. Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthopaed 2008; 21: 243-249.
103 Whitehair JG. et al. Epidemiology of cranial cruciate ligament rupture in dogs. J Am Vet Med Assoc 1993; 1016-1019.
104 Whitney WO. Arthroscopically assisted surgery of the stifle joint. In: Small Animal Arthroscopy. Beale BH. eds. Philadelphia: Saunders; 2003: 117-157.
105 Wilke VL. et al. Identification of chromosomal regions associated with cranial cruciate ligament rupture in a population of Newfoundlands. Am J Vet Res 2009; 70: 1013-1017.
106 Witsberger TH. et al. Prevalence of and risk factors for hip dysplasia and cranial cruciate ligament deficiency in dogs. J Am Vet Med Assoc 2008; 232: 1818-1824.
107 Zahm H. Die Ligamenta decussata im gesunden und arthrotischen Kniegelenk des Hundes. Diss med vet, Veterinärmedizinische Fakultät, Ludwig-Maximilians-Universität München. 1964