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Vet Comp Orthop Traumatol 2016; 29(06): 491-498
DOI: 10.3415/VCOT-15-12-0206
Original Research
Schattauer GmbH

Evaluation of an intra-articular synthetic ligament for treatment of cranial cruciate ligament disease in dogs: a six-month prospective clinical trial

Matthew D. Barnhart
1   MedVet Medical and Cancer Centers, Worthington, OH, USA
,
Karl Maritato
2   MedVet Medical and Cancer Centers, Cincinnati, OH, USA
,
Kemal Schankereli
3   Avalon Medical, Stillwater, MN, USA
,
Harry Wotton
4   Everost Inc., Sturbridge, MA, USA
,
Steven Naber
5   The Ohio State University Department of Statistics, Columbus, OH, USA
› Author Affiliations
Further Information

Publication History

Received: 24 December 2015

Accepted: 28 July 2016

Publication Date:
19 December 2017 (online)

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Summary

Objective: Evaluate the short-term outcomes of a novel synthetic ligament for treatment of naturally occurring canine cranial cruciate ligament disease.

Study design: Prospective clinical study.

Animals: Dogs with unilateral cranial cruciate ligament disease (n = 50).

Methods: Patient parameters evaluated included a five-point lameness score, evaluation of craniocaudal stifle instability, and radiographic findings over 24 weeks. Any postoperative complications were recorded.

Results: Thirty-four out of 42 dogs experienced significant improvements in lameness between the preoperative and 24 week time points. Lameness scores in those dogs improved significantly at all measured time intervals after postoperative week 2. Recurrence of stifle instability increased significantly over the study period from immediate postoperative measurements. Cranial drawer recurred in seven out of 42 of dogs by week 4 and 18/42 by week 24. Implant changes were not noted between the immediate and six-month postoperative radiographs except where complications occurred. Overall, 25 dogs experienced a total of 32 complications (22 major and 10 minor). Sixteen dogs had major complications, and nine had minor complications.

Conclusion: The procedure was generally effective at improving lameness scores, but did not consistently maintain postoperative stifle stability and had an unacceptably high complication rate. This synthetic ligament procedure cannot be recommended for use in its current form.

Supplementary Material to this article is available online at http://dx.doi.org/10.3415/VCOT-15-12-0206.

Keywords

Cranial cruciate ligament - synthetic ligament - intra-articular - ligament - canine - dog

 

  • References

  • 1 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 to 1989. Vet Comp Orthop Traumatol 1994; 7: 56-59.
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Ekins AD, Pechman R, Kearney MT. et al. A retrospective study evaluating the degree of degenerative joint disease in the stifle joint of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533.
    PubMedSearch in Google Scholar
  • 3 Prodromos CC, Rogowksi J, Joyce BT. The economics of anterior cruciate ligament reconstruction. In: Prodromos CC, editor. The Anterior Cruciate Ligament: Reconstruction and Basic Science. Philadelphia, PA: Saunders; 2008: 79-87.
    Search in Google Scholar
  • 4 Conzemius MG, Evans RB, Besancon MF. 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.
    CrossrefPubMedSearch in Google Scholar
  • 5 Vasseur PB, Rodrigo JJ, Stevenson S. et al. Replacement of the anterior cruciate ligament with a bone ligament bone anterior cruciate ligament allograft in dogs. Clin Orthop Relat Res 1987; 219: 268-277.
    PubMedSearch in Google Scholar
  • 6 Lopez I M, Markel MD, Kalscheur V. et al. Hamstring graft technique for stabilization of canine cranial cruciate ligament deficient stifles. Vet Surg 2003; 32: 390-401.
    CrossrefPubMedSearch in Google Scholar
  • 7 Moore KW, Read RA. Cranial cruciate ligament rupture ion the dog a retrospective study comparing surgical techniques. Aust Vet J 1995; 27: 281-285.
    PubMedSearch in Google Scholar
  • 8 Patterson RH, Smith GK, Gregor TP. et al. Biomechanical stability of four cranial cruciate ligament repair techniques in the dog. Vet Surg 1991; 20: 85-90.
    CrossrefPubMedSearch in Google Scholar
  • 9 Hulse DA, Butler DL, Kay MD. et al. Biomechanics of cranial cruciate ligament reconstruction in the dog- in vitro laxity testing. Vet Surg 1983; 12: 109-118.
    CrossrefPubMedSearch in Google Scholar
  • 10 Snow LA, White R, Gustafson S. et al. Ex vivo comparison of three surgical techniques to stabilize the canine cranial cruciate ligament deficient stifles. Vet Surg 2010; 39: 195-207.
    CrossrefPubMedSearch in Google Scholar
  • 11 Johnson RJ, Benynnon BD, Nicholes CE. et al. The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg 1992; 74A: 140-151.
    PubMedSearch in Google Scholar
  • 12 Sachs RA, Daniel DM, Stone ML. et al. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 1989; 17: 760-765.
    CrossrefPubMedSearch in Google Scholar
  • 13 Amiel D, Kleiner JB, Roux RD. et al. The phenomenon of “ligamentization”: anterior ligament reconstruction with autogenous patellar tendon. J Orthop Res 1986; 4: 162-172.
    CrossrefPubMedSearch in Google Scholar
  • 14 Ng GY, Oakes BW, Deacon OW. et al. Long-term study of the biochemistry and biomechanics of anterior cruciate ligament-patellar tendon autografts in goats. J Orthop Res 1993; 14: 851-856.
    PubMedSearch in Google Scholar
  • 15 Vassuer PB, Griffey S, Massat BJ. Evaluation of the Leeds-Keio synthetic replacement for the cranial cruciate ligament in dogs: an experimental study. Vet Comp Orthop Traumatol 1996; 29: 66-74.
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Rooster HD, Vangheluwe L, Bree HV. et al. Biomechanical properties of braided polyester tapes intended for use as intra-articular cranial cruciate ligament prostheses in dogs. Am J Vet Res 2001; 62: 48-53.
    CrossrefPubMedSearch in Google Scholar
  • 17 Denny HR, Goodship AE. Replacement of the anterior cruciate ligament with carbon fibre in the dog. J Small Anim Pract 1980; 21: 279-286.
    CrossrefPubMedSearch in Google Scholar
  • 18 Johnson FL. Prosthetic anterior cruciate ligament. J Am Vet Med Assoc 1960; 137: 646-647.
    PubMedSearch in Google Scholar
  • 19 Barrett GR, Line LL, Shelton WR. et al. The Dacron ligament prosthesis in anterior cruciate ligament reconstruction. A four year review. Am J Sports Med 1993; 21: 367-373.
    CrossrefPubMedSearch in Google Scholar
  • 20 Woods GA, Indelicato PA, Prevot TJ. The Gore-Tex anterior cruciate ligament prosthesis: two versus three year results. Am J Sports Med 1991; 19: 48-55.
    CrossrefPubMedSearch in Google Scholar
  • 21 Ventura A, Terzaghi C, Legnani C. Synthetic grafts for anterior cruciate ligament rupture: 19 year outcome study. The Knee 2010; 17: 108-113.
    CrossrefPubMedSearch in Google Scholar
  • 22 Huang JM, Wang Q, Shen F. et al. Cruciate ligament reconstruction using LARS artificial ligament under arthroscopy: 81 cases report. Chin Med J 2010; 123: 160-164.
    PubMedSearch in Google Scholar
  • 23 Trieb K, Blahovec H, Brand H. et al. In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res 2004; 36: 148-151.
    CrossrefPubMedSearch in Google Scholar
  • 24 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39: 905-908.
    CrossrefPubMedSearch in Google Scholar
  • 25 Kock HJ, Sturmer R, Letsch R. et al. Interface and biocompatibility of polyethylene terephthalate knee ligament prostheses. Arch Orthop Trauma Surg 1994; 114: 1-7.
    CrossrefPubMedSearch in Google Scholar
  • 26 Barnhart MD, Schankereli KM, Getzy D. et al. In vivo rodent cellular ingrowth into a polytetrafluoroethylene/high tenacity polyester artificial ligament implant. Poster session presented at the 2013 American College of Veterinary Surgeons Symposium 2013. October 24-26. San Antonio; Texas, USA:
    Search in Google Scholar
  • 27 Leung V, Yang H, Ko F. Nanofibers for ligament and tendon regeneration. In Blair E. editor Biomedical Textiles for Orthopaedic and Surgical Applications: Fundamentals, Applications and Tissue Engineering. Cambridge, UK: Woodhead Publishing; 2015: 91-112.
    Search in Google Scholar
  • 28 Dericks G. Ligament advanced reinforcement system anterior ligament reconstruction. Op Tech Sports Med 1995; 3: 187-305.
    CrossrefPubMedSearch in Google Scholar
  • 29 Guidon MF, Marois Y, Bejui J. et al. Analysis of retrieved polymer fiber based replacement for the ACL. Biomaterials, 2000; 21: 2461-2474.
    CrossrefPubMedSearch in Google Scholar
  • 30 Rodeo SA, Arnocsky SP, Torzilli PA. et al. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg, 1993; 75A: 1795-1803.
    PubMedSearch in Google Scholar
  • 31 Eagar P, Hull ML, Howell SM. How fixation method stiffness and initial tension affect anterior load-displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft. J Orthop Res, 2004; 22: 613-624.
    CrossrefPubMedSearch in Google Scholar
  • 32 Budsberg SC, Verstraete MC, Soutas-Little RW. et al. Force plate analyses before and after stabilization of canine stifles for cruciate injury. Am J Vet Res, 1988; 49: 1522-1524.
    PubMedSearch in Google Scholar
  • 33 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.
    CrossrefPubMedSearch in Google Scholar
  • 34 Stein S, Schmoekel H. Short-term and eight to 12 months results of a tibial tuberosity advancement as a treatment of canine cruciate ligament damage. J Small Anim Pract, 2008; 49: 398-404.
    CrossrefPubMedSearch in Google Scholar
  • 35 Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). J Amer Vet Med Assoc, 2009; 234: 229-235.
    CrossrefPubMedSearch in Google Scholar
  • 36 Boekhout C, Cross A. Incidence of transcortical tibial Fractures with self-tapping and non-self-tapping screws in a canine TPLO model. Vet Surg, 2012; 41: 898-901.
    CrossrefPubMedSearch in Google Scholar