Ex Vivo Evaluation of the Cranial Tibial Artery and Its Compression through Fragment Rotation during Tibia Plateau Levelling Osteotomy: An Angiographic Three-Dimensional Reconstruction

Lena-Charlott Cieciora; Oliver Harms; Fritjof Freise; Hermann Seifert; Michael Fehr

doi:10.1055/s-0042-1745847

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2022; 35(04): 220-229
DOI: 10.1055/s-0042-1745847

Original Research

Ex Vivo Evaluation of the Cranial Tibial Artery and Its Compression through Fragment Rotation during Tibia Plateau Levelling Osteotomy: An Angiographic Three-Dimensional Reconstruction

Lena-Charlott Cieciora

¹Department for Orthopaedics and Sports Medicine, Small Animal Clinic, University of Veterinary Medicine Hannover Foundation, Hannover, Germany

,

Oliver Harms

¹Department for Orthopaedics and Sports Medicine, Small Animal Clinic, University of Veterinary Medicine Hannover Foundation, Hannover, Germany

,

Fritjof Freise

²Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover Foundation, Hannover, Germany

,

Hermann Seifert

³Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover Foundation, Hannover, Germany

,

Michael Fehr

⁴Clinic for Small Mammals, Reptiles and Birds, University of Veterinary Medicine Hannover Foundation, Hannover, Germany

› Institutsangaben

Abstract

Objective To illustrate the arterial vascularity of the proximal tibia three-dimensionally and to evaluate the impact of fragment rotation on the cranial tibial artery by tibia plateau levelling osteotomy (TPLO).

Methods Radiographic angiography and computed tomography (CT) were performed on 12 pelvic limbs from six large-breed canine cadavers before and after TPLO. Three-dimensional (3D) models of the stifle, including osseous and vascular structures, were obtained, and the integrity of the cranial tibial artery was assessed. Post-TPLO CT images were used to analyze compression of the cranial tibial artery by the rotated fragment.

Results The uncompressed cranial tibial artery caliber, measured proximally and distally to the osteotomy, was 9.52 mm² (6.07–18.90 mm²). In all adequately rotated fragments, the mean caliber of the artery on the level of the osteotomy was 1.57 mm² (0.89–2.93 mm²) after TPLO. This represented a significant decrease of approximately 81%. Only slight cross-sectional area decrease (8.8%) was seen in one limb, which was revealed to have insufficient fragment rotation (2.83 mm). Another limb only showed signs of stretching of the artery (31.51%), which was under-rotated and medially displaced. Pre-TPLO 3D reconstructions were mainly consistent with previous anatomic studies except for the distance between tibial cortex and cranial tibial artery, which appeared closer.

Conclusion Sufficient fragment rotation leads to compression of the cranial tibial artery. Intraoperative hemorrhage can be caused by laceration of the main cranial tibial artery or by multiple small branches reaching craniolaterally.

Keywords

cranial cruciate ligament - cranial tibial artery - angiography - 3D reconstruction - tibial plateau levelling osteotomy

Volltext

Referenzen

References
1 Bennett D, Tennant B, Lewis DG, Baughan J, May C, Carter S. A reappraisal of anterior cruciate ligament disease in the dog. J Small Anim Pract 1988; 29 (05) 275-297
2 Johnson J, Austin C, Breur G. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 07 (02) 56-69
3 Roush JK. Hind limb lameness in the mature dog. Vet Clin North Am Small Anim Pract 2001; 31 (01) 125-141 , vi
4 Brandt KD, Braunstein EM, Visco DM, O'Connor B, Heck D, Albrecht M. Anterior (cranial) cruciate ligament transection in the dog: a bona fide model of osteoarthritis, not merely of cartilage injury and repair. J Rheumatol 1991; 18 (03) 436-446
5 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 1991; 32 (03) 111-117
6 Ness MG, Abercromby RH, May C, Turner BM, Carmichael S. A survey of orthopaedic conditions in small animal veterinary practice in Britain. Vet Comp Orthop Traumatol 1996; 09 (02) 43-52
7 Kowaleski M, Boudrieau R, Pozzi A, Johnston S, Tobias K. Chapter 61: The stifle joint. In: Johnston SA, Tobias KM. Veterinary Surgery: Small Animal Expert Consult. 2nd ed.. Oxford: Elsevier Ltd.; 2017: 2600
8 Slocum B, Slocum TD. Tibial plateau levelling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23 (04) 777-795
9 Priddy II NH, Tomlinson JL, Dodam JR, Hornbostel JE. Complications with and owner assessment of the outcome of tibial plateau levelling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). J Am Vet Med Assoc 2003; 222 (12) 1726-1732
10 Pacchiana PD, Morris E, Gillings SL, Jessen CR, Lipowitz AJ. Surgical and postoperative complications associated with tibial plateau levelling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222 (02) 184-193
11 Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau levelling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42 (01) 44-50
12 Gatineau M, Dupuis J, Planté J, Moreau M. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent ‘pivot shift’, meniscal tear and other complications. Vet Comp Orthop Traumatol 2011; 24 (05) 333-341
13 Coletti TJ, Anderson M, Gorse MJ, Madsen R. Complications associated with tibial plateau levelling osteotomy: a retrospective of 1519 procedures. Can Vet J 2014; 55 (03) 249-254
14 Moles A, Glyde M. Anatomical investigation of the canine cranial tibial artery. Vet Comp Orthop Traumatol 2009; 22 (05) 351-355
15 Farrell M, Calvo I, Clarke SP, Barron R, Courcier E, Carmichael S. Ex vivo evaluation of the effect of tibial plateau osteotomy on the proximal tibial soft tissue envelope with and without the use of protective gauze sponges. Vet Surg 2009; 38 (05) 636-644
16 Mullins RA, Escribano Carrera A, Espinel Rupérez J, Bresciani L, Arthurs GI, Hoey S. Effect of stifle flexion on the position of the cranial tibial artery relative to the proximal tibia in dogs. Vet Surg 2020; 49 (08) 1527-1535
17 Pozzi A, Samii V, Horodyski MB. Evaluation of vascular trauma after tibial plateau levelling osteotomy with or without gauze protection. A cadaveric angiographic study. Vet Comp Orthop Traumatol 2011; 24 (04) 266-271
18 von Pfeil DJ, Edwards MR, Nelson NC. Handling of the tibial muscle envelope in tibial plateau levelling osteotomy - to elevate or not? A clinical study of 40 dogs. Vet Comp Orthop Traumatol 2013; 26 (05) 392-398
19 Clements DN, Broadhurst H, Clarke SP. et al. The effectiveness of 3D animations to enhance understanding of cranial cruciate ligament rupture. J Vet Med Educ 2013; 40 (01) 29-34
20 Gyles C. 3D printing comes to veterinary medicine. Can Vet J 2019; 60 (10) 1033-1034
21 Chen C, Cai L, Zheng W, Wang J, Guo X, Chen H. The efficacy of using 3D printing models in the treatment of fractures: a randomised clinical trial. BMC Musculoskelet Disord 2019; 20 (01) 65
22 Kishimoto M, Yamada K, Shimizu J. et al. Providing an intelligible explanation to pet owners by using three-dimensional CT images: use of clinical imaging for better informed consent. Vet Res Commun 2009; 33 (04) 387-393
23 Kowaleski MP, McCarthy RJ. Geometric analysis evaluating the effect of tibial plateau levelling osteotomy position on postoperative tibial plateau slope. Vet Comp Orthop Traumatol 2004; 17 (01) 30-34
24 Schmerbach KI, Boeltzig CK, Reif U, Wieser JC, Keller T, Grevel V. In vitro comparison of tibial plateau levelling osteotomy with and without use of a tibial plateau levelling jig. Vet Surg 2007; 36 (02) 156-163
25 Matres-Lorenzo L, McAlinden A, Bernardé A, Bernard F. Control of hemorrhage through the osteotomy gap during tibial plateau levelling osteotomy: 9 cases. Vet Surg 2018; 47 (01) 60-65
26 Boudrieau RJ. Tibial plateau levelling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38 (01) 1-22
27 Xu D, Zou L, Xing Y. et al. Diagnostic value of ankle-brachial index in peripheral arterial disease: a meta-analysis. Can J Cardiol 2013; 29 (04) 492-498
28 Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease: morbidity and mortality implications. Circulation 2006; 114 (07) 688-699
29 Anatomy BV. [Updated 2020 Mar 4]. 2020 Accessed April 20, 2020 at: https://www.ncbi.nlm.nih.gov/books/NBK470401/?log$=activity
30 Drum M, Werbe B, McLucas K, Millis D. Nursing care of the rehabilitation patient. In: Millis D, Levine D. eds. Canine Rehabilitation and Physical Therapy. 2nd ed.. St. Louis: W.B. Saunders; 2014: 277-304
31 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39 (04) 460-474
32 Solano MA, Danielski A, Kovach K, Fitzpatrick N, Farrell M. Locking plate and screw fixation after tibial plateau levelling osteotomy reduces postoperative infection rate in dogs over 50 kg. Vet Surg 2015; 44 (01) 59-64
33 Eugster S, Schawalder P, Gaschen F, Boerlin P. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 2004; 33 (05) 542-550
34 Hagen CRM, Singh A, Weese JS, Marshall Q, Linden AZ, Gibson TWG. Contributing factors to surgical site infection after tibial plateau levelling osteotomy: A follow-up retrospective study. Vet Surg 2020; 49 (05) 930-939
35 Atwood C, Maxwell M, Butler R, Wills R. Effects of incision closure method on infection prevalence following tibial plateau levelling osteotomy in dogs. Can Vet J 2015; 56 (04) 375-381
36 Rhinelander FW. Tibial blood supply in relation to fracture healing. Clin Orthop Relat Res 1974; (105) 34-81
37 Tirgari M. The surgical significance of the blood supply of the canine stifle joint. J Small Anim Pract 1978; 19 (08) 451-462
38 Stine SL, Odum SM, Mertens WD. Protocol changes to reduce implant-associated infection rate after tibial plateau levelling osteotomy: 703 dogs, 811 TPLO (2006-2014). Vet Surg 2018; 47 (04) 481-489
39 Warzee CC, Dejardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau levelling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286
40 Kowaleski MP, Apelt D, Mattoon JS, Litsky AS. The effect of tibial plateau levelling osteotomy position on cranial tibial subluxation: an in vitro study. Vet Surg 2005; 34 (04) 332-336
41 Fitzwater KL, Marcellin-Little DJ, Harrysson OL, Osborne JA, Poindexter EC. Evaluation of the effect of computed tomography scan protocols and freeform fabrication methods on bone biomodel accuracy. Am J Vet Res 2011; 72 (09) 1178-1185