Tibial anatomy in normal small breed dogs including anisometry of various extracapsular stabilizing suture attachment sites

Summary

Objectives: To investigate proximal tibial anatomy and its influence on anisometry of extracapsular stabilizing sutures in small dog breeds.

Materials and methods: Mediolateral radiographs of the femora, stifles, and tibiae of 12 small breed dogs were acquired with the stifles positioned at various angles. Measurements taken included tibial plateau angle (TPA), diaphyseal: proximal tibial angle (DPA), patellar tendon angle (PTA), Z-angle, relative tibial tuberosity width (rTTW), and the distance between six combinations of two femoral and three tibial extra-capsular stabilizing suture (ECS) attachment sites. Theoretical strain through stifle range-of- motion was recorded.

Results: The TPA (32° ± 5.8°), DPA (10.2° ± 7.3°), PTA (103.7° ± 6.2°), and Z-angle (70.4° ± 9.0°) were positively correlated with one another (R >0.7), but none were correlated with rTTW (0.93 ± 0.10). The F2-T1 combination of ECS attachment sites had lowest strain for nine stifles. The shortest attachment site separation was at a stifle flexion of 50° for nine stifles. Proximal tibial anatomy measurements could not predict optimal attachment site combination, optimal stifle angle for suture placement, or ECS strain.

Clinical significance: There is individual variation in the optimal attachment site combination and stifle angle for suture placement, which may influence consistency of outcomes with ECS.

Keywords

Cranial cruciate ligament rupture - isometry - extracapsular suture - tibial plateau angle - TPA - diaphyseal proximal tibial angle - DPA

• References

• 1 Ness MG, Abercromby 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 Pond M, Nuki G. Experimentally induced osteoarthritis in the dog. Annals Rheumatic Diseases 1973; 32: 387-388.
• 3 McDevitt C, Muir H. Biochemical changes in the cartilage of the knee in experimental and natural osteoarthritis in the dog. J Bone Joint Surg Br 1976; 58: 24-35.
• 4 Macias C, McKee WM, May C. Caudal proximal tibial deformity and cranial cruciate ligament rupture in small breed dogs. J Small Anim Pract 2002; 43: 433-438.
• 5 Kunkel KA, Basinger RR, Suber JT. et al. Evaluation of a transcondylar toggle system for stabilisation of the cranial cruciate ligament deficient stifle in small dogs and cats. Vet Surg 2009; 38: 975-982.
• 6 Tamburro R, Pinna S, Tribuiani AM. et al. Biceps femoris muscle transposition for treatment of cranial cruciate ligament rupture in small breed dogs. J Vet Science 2008; 13: 93-98.
• 7 Witte PG, Scott HW. Tibial plateau levelling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5mm locking T-plate. Vet Surg 2014; 43: 549-557.
• 8 Slocum B, Slocum TD. Tibial plateau levelling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin Small Anim 1993; 23: 777-795.
• 9 Garnet SD, Daye RM. Short-term complications associated with TPLO in dogs using 2.0 and 2.7mm plates. J Am Anim Hosp Assoc 2014; 50: 396-404.
• 10 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.
• 11 DeAngelis M, 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.
• 12 Olmstead ML. The use of orthopaedic wire as a lateral suture for stifle stabilization. Vet Clin Small Anim 1993; 23: 735-753.
• 13 Roe SC, Kue J, Gemma J. Isometry of potential suture attachment sites for the cranial cruciate ligament deficient stifle. Vet Comp Orthop Traumatol 2008; 21: 215-220.
• 14 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.
• 15 Fischer C, Cherres M, Grevel V. et al. Effects of attachment sites and joint angles at the time of lateral suture fixation on tension in the suture for stabilization of the cranial cruciate ligament deficient stifle in dogs. Vet Surg 2010; 39: 334-342.
• 16 Williams A, Logan M. Understanding tibio-femoral motion. Knee 2004; 11: 81-88.
• 17 Tonks CA, Lewis DD, Pozzi A. A review of extra-articular prosthetic stabilization of the cruciate ligament-deficient stifle. Vet Comp Orthop Traumatol 2010; 24: 166-177.
• 18 Vedrine B, Guillemot A, Fontaine D. et al. Comparative anatomy of the proximal tibia in healthy Labrador Retrievers and Yorkshire Terriers. Vet Comp Orthop Traumatol 2013; 26: 266-270.
• 19 Piermattei DL, Flo GL. The stifle joint. In: Piermattei DL, Flo GL.. editors. Hand-Book of Small Animal Orthopaedics and Fracture Repair Philadelphia: W.B. Saunders; 1997: 516-580.
• 20 Stork CK, Gibson NR, Owen MR. et al. Radiographic features of a lateral extracapsular wire suture in the canine cranial cruciate deficient stifle. J Small Anim Pract 2001; 42: 487-490.
• 21 Blackburn TA. Rehabilitation of anterior cruciate ligament injuries. Orthop Clin N Am 1985; 16: 241-269.
• 22 Ihara H, Nakayama A. Dynamic joint control training for knee ligament injuries. Am J Sports Med 1986; 14: 309-315.
• 23 Adrian CP, Haussler KK, Kawcak C. et al. The role of muscle activation in cruciate disease. Vet Surg 2013; 42: 765-773.
• 24 Guenego L, Zahra A, Madelenat 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.
• 25 Bush MA, Bowlt K, Gines JA. et al. Effect of use of different landmarks on determining stifle angle and on calculated tibial tuberosity advancement. Vet Comp Orthop Traumatol 2011; 24: 205-210.
• 26 Reif U, Dejardin LM, Probst CW. et al. Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. Vet Surg 2004; 33: 368-375.
• 27 Osmond CS, Marcellin-Little DJ, Harrysson OLA. et al. Morphometric assessment of the proximal portion of the tibia in dogs with and without cranial cruciate ligament rupture. Vet Radiol Ultrasound 2006; 47: 136-141.
• 28 Glassman M, Hofmeister E, Weh JM. et al. Radiographic quantitative assessment of caudal proximal tibial angulation in 100 dogs with cranial cruciate ligament rupture. Vet Surg 2011; 40: 830-838.
• 29 Schwandt CS, Bohorquez-Vanelli A, Tepic S. et al. Angle between the patellar ligament and tibial plateau in dogs with partial rupture of the cranial cruciate ligament. Am J Vet Res 2006; 67: 1855-1860.
• 30 Inauen R, Koch D, Bass M. et al. Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog. Vet Comp Orthop Traumatol 2009; 22: 16-20.
• 31 Renwick AIC, McKee WM, Emmerson TD. et al. Preliminary experiences of the triple tibial osteotomy procedure: tibial morphology and complications. J Small Anim Pract 2009; 50: 212-221.
• 32 Guastella DB, Fox DB, Cook JL. Tibial plateau angles in four common canine breeds with cranial cruciate ligament rupture, and its relationship to meniscal tears. Vet Comp Orthop Traumatol 2008; 21: 125-128.
• 33 Fujita Y, Hara Y, Ochi H. et al. The possible role of the tibial plateau angle for the severity of osteoarthritis in dogs with cranial cruciate ligament rupture. J Vet Med Sci 2006; 68: 675-679.
• 34 Venzin C, Howard J, Rytz U. et al. Tibial plateau angles with and without cranial cruciate ligament rupture- comparison between difference dog populations and a wolf population. Vet Comp Orthop Traumatol 2004; 17: 232-236.
• 35 Read RA, Robins GM. Deformity of the proximal tibia in dogs. Vet Record 1982; 111: 295-298.
• 36 Selmi A, Padhila Filho J. Rupture of the cranial cruciate ligament associated with deformity of the proximal tibia in five dogs. J Small Anim Pract 2001; 42: 390-393.
• 37 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
• 38 Flo GL. Modification of the lateral retinacular imbrication technique for stabilizing cruciate ligament injuries. J Am Anim Hosp Assoc 1975; 11: 570-576.
• 39 Koh J, Koo SS, Leonard J. et al. Anterior cruciate ligament (ACL) tunnel placement: a radiographic comparison between navigated versus manual ACL reconstruction. Orthopedics 2006; 29 (Suppl. 10) S122-124.
• 40 Korvick DL, Johnson Al, Schaeffer DJ. Surgeons’ preferences in treating cranial cruciate ligament ruptures in dogs. J Am Vet Med Assoc 1994; 205: 1318-1324.
• 41 Ragetly CA, Griffon DJ, Mostafa AA. et al Inverse dynamics analysis of the pelvic limbs in Labrador retriever with and without cranial cruciate ligament disease. Vet Surg 39: 513-522.
• 42 Gordon-Evans WJ, Griffon DJ, Bubb C. et al. Comparison of lateral fabellar suture and tibial plateau levelling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243: 675-680.
• 43 Bergh MS, Sullivan C, Ferrell CL. et al. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. J Am Anim Hosp Assoc 2014; 50: 315-321.