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Vet Comp Orthop Traumatol 2023; 36(05): 241-249
DOI: 10.1055/s-0043-57046
Original Research

Meniscal Load and Load Distribution in the Canine Stifle after Modified Tibial Tuberosity Advancement with 9 mm and 12 mm Cranialization of the Tibial Tuberosity in Different Standing Angles

Johannes Maximilian Schmutterer
1   Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
,
Peter Augat
2   Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
3   Institute for Biomechanics, Paracelsus Medical University Salzburg, Salzburg, Austria
,
Markus Greinwald
2   Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
,
Andrea Meyer-Lindenberg
1   Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
› Author Affiliations Funding The study was financially supported by the AO trauma.
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Abstract

Objectives The aim of this study was to investigate the kinetic and kinematic changes in the stifle after a modified tibial tuberosity advancement (TTA) with 9 and 12 mm cranialization of the tibial tuberosity in different standing angles.

Study Design Biomechanical ex vivo study using seven unpaired canine cadaver hindlimbs. Sham TTA surgery was performed. Motion sensors were fixed to the tibia and the femur for kinematic data acquisition. Pressure mapping sensors were placed between femur and both menisci. Thirty percent body weight was applied to the limbs with the stifle in 135 or 145 degrees of extension. Each knee was tested in 135 degrees with intact cranial cruciate ligament (CCL) and deficient CCL with 12 mm cranialization of the tibial tuberosity in 135 and 145 degrees of extension. The last two tests were repeated with 9 mm.

Results Transection of the CCL altered kinematics and kinetics. Tibial tuberosity advancement with 12 mm cranialization sufficiently restored stifle kinematics in 135 and 145 degrees but 9 mm TTA failed to do so in 135 degrees. The same effects were seen for internal rotation of the tibia. After TTA, a significant reduction in the force acting on both menisci was detected.

Conclusion Tibial tuberosity advancement could restore stifle kinematics and meniscal kinetics after transection of the CCL ex vivo in the present study. Tibial tuberosity advancement reduced the contact force ratio on both menisci significantly. No changes of peak pressure and peak pressure location occurred following TTA under any of the tested experimental settings. Increased stifle extension (145 degrees) might lead to more stability, contradictory to biomechanical theory.

Keywords

stifle - cranial cruciate ligament - kinetics - TTA - biomechanics - standing angles

Authors' Contribution

J.M.S, A.M.L and P.A contributed to conception of the study, study design, data analysis and interpretation. M.G und J.M.S additionally contributed to data acquisition and data analysis. All authors also drafted, revised and approved the submitted manuscript.




Publication History

Received: 19 January 2022

Accepted: 24 March 2023

Article published online:
09 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; (02) 5-18
    PubMedSearch in Google Scholar
  • 2 Pond MJ, Nuki G. Experimentally-induced osteoarthritis in the dog. Ann Rheum Dis 1973; 32 (04) 387-388
    CrossrefPubMedSearch in Google Scholar
  • 3 Marshall JL. Periarticular osteophytes. Initiation and formation in the knee of the dog. Clin Orthop Relat Res 1969; 62 (62) 37-47
    PubMedSearch in Google Scholar
  • 4 Marshall KW, Chan AD. Bilateral canine model of osteoarthritis. J Rheumatol 1996; 23 (02) 344-350
    PubMedSearch in Google Scholar
  • 5 King D. The function of semilunar cartilages. J Bone Joint Surg Am 1936; 18 (04) 1069-1076
    PubMedSearch in Google Scholar
  • 6 Franklin SP, Gilley RS, Palmer RH. Meniscal injury in dogs with cranial cruciate ligament rupture. Compend Contin Educ Vet 2010; 32 (10) E1-E10 , quiz E11
    PubMedSearch in Google Scholar
  • 7 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 1991; 32 (03) 111-117
    CrossrefPubMedSearch in Google Scholar
  • 8 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38 (11) 1807-1814
    PubMedSearch in Google Scholar
  • 9 Tinga S, Kim SE, Banks SA. et al. Femorotibial kinematics in dogs with cranial cruciate ligament insufficiency: a three-dimensional in-vivo fluoroscopic analysis during walking. BMC Vet Res 2018; 14 (01) 85
    CrossrefPubMedSearch in Google Scholar
  • 10 Lazar TP, Berry CR, deHaan JJ, Peck JN, Correa M. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34 (02) 133-141
    CrossrefPubMedSearch in Google Scholar
  • 11 Gordon-Evans WJ, Griffon DJ, Bubb C, Knap KM, Sullivan M, Evans RB. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243 (05) 675-680
    CrossrefPubMedSearch in Google Scholar
  • 12 Nelson SA, Krotscheck U, Rawlinson J, Todhunter RJ, Zhang Z, Mohammed H. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42 (01) 38-50
    CrossrefPubMedSearch in Google Scholar
  • 13 Berger B, Knebel J, Steigmeier-Raith S, Reese S, Meyer-Lindenberg A. Long-term outcome after surgical treatment of cranial cruciate ligament rupture in small breed dogs. Comparison of tibial plateau leveling osteotomy and extra-articular stifle stabilization. Tierarztl Prax Ausg K Klientiere Heimtiere 2015; 43 (06) 373-380
    PubMedSearch in Google Scholar
  • 14 Bergh MS, Sullivan C, Ferrell CL, Troy J, Budsberg SC. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. J Am Anim Hosp Assoc 2014; 50 (05) 315-321
    CrossrefPubMedSearch in Google Scholar
  • 15 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 (02) 232-236
    CrossrefPubMedSearch in Google Scholar
  • 16 Biskup JJ, Conzemius MG. Long-term arthroscopic assessment of intra-articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog. Vet Surg 2020; 49 (04) 764-771
    CrossrefPubMedSearch in Google Scholar
  • 17 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38 (01) 1-22
    CrossrefPubMedSearch in Google Scholar
  • 18 Beer P, Bockstahler B, Schnabl-Feichter E. Tibial plateau leveling osteotomy and tibial tuberosity advancement - a systematic review. Tierarztl Prax Ausg K Klientiere Heimtiere 2018; 46 (04) 223-235
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Duerr FM, Martin KW, Rishniw M, Palmer RH, Selmic LE. Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians. Vet Comp Orthop Traumatol 2014; 27 (06) 478-483
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. 1st World Orthopaedic Veterinary Congress, Munich, 5th - 8th September 2002. 2002:152.
    PubMed
  • 21 Brown NP, Bertocci GE, Marcellin-Little DJ. Canine stifle biomechanics associated with tibial tuberosity advancement predicted using a computer model. Vet Surg 2015; 44 (07) 866-873
    CrossrefPubMedSearch in Google Scholar
  • 22 Apelt D, Kowaleski MP, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study. Vet Surg 2007; 36 (02) 170-177
    CrossrefPubMedSearch in Google Scholar
  • 23 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38 (01) 33-39
    CrossrefPubMedSearch in Google Scholar
  • 24 Hoffmann DE, Kowaleski MP, Johnson KA, Evans RB, Boudrieau RJ. Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement. Vet Surg 2011; 40 (03) 311-320
    CrossrefPubMedSearch in Google Scholar
  • 25 Rey J, Fischer MS, Böttcher P. Sagittal joint instability in the cranial cruciate ligament insufficient canine stifle. Caudal slippage of the femur and not cranial tibial subluxation. Tierarztl Prax Ausg K Klientiere Heimtiere 2014; 42 (03) 151-156
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Schwede M, Rey J, Böttcher P. In vivo fluoroscopic kinematography of cranio-caudal stifle stability after tibial tuberosity advancement (TTA): a retrospective case series of 10 stifles. Open Vet J 2018; 8 (03) 295-304
    CrossrefPubMedSearch in Google Scholar
  • 27 Skinner OT, Kim SE, Lewis DD, Pozzi A. 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 (01) 86-91
    CrossrefPubMedSearch in Google Scholar
  • 28 Hoffmann DE, Miller JM, Ober CP, Lanz OI, Martin RA, Shires PK. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19 (04) 219-227
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Krotscheck U, Nelson SA, Todhunter RJ, Stone M, Zhang Z. Long term functional outcome of tibial tuberosity advancement vs. tibial plateau leveling osteotomy and extracapsular repair in a heterogeneous population of dogs. Vet Surg 2016; 45 (02) 261-268
    CrossrefPubMedSearch in Google Scholar
  • 30 Knebel J, Eberle D, Steigmeier-Raith S, Reese S, Meyer-Lindenberg A. Outcome after tibial plateau levelling osteotomy and Modified Maquet Procedure in dogs with cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2020; 33 (03) 189-197
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Ness MG. The Modified Maquet Procedure (MMP) in dogs: technical development and initial clinical experience. J Am Anim Hosp Assoc 2016; 52 (04) 242-250
    CrossrefPubMedSearch in Google Scholar
  • 32 Brunel L, Etchepareborde S, Barthélémy N, Farnir F, Balligand M. Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique. Vet Comp Orthop Traumatol 2013; 26 (01) 47-53
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 McCartney W, Ober C, Benito M, MacDonald B. Comparison of tension band wiring and other tibial tuberosity advancement techniques for cranial cruciate ligament repair: an experimental study. Acta Vet Scand 2019; 61 (01) 44
    CrossrefPubMedSearch in Google Scholar
  • 34 Samoy Y, Verhoeven G, Bosmans T. et al. TTA rapid: description of the technique and short term clinical trial results of the first 50 cases. Vet Surg 2015; 44 (04) 474-484
    CrossrefPubMedSearch in Google Scholar
  • 35 Bleakley S, Palmer RH, Bresina S, Roca SP, Tepic S. The effect of polydioxanone hemicerclage suture on the occurrence of fracture during tibial tuberosity advancement with an elongated bi-directional hinged osteotomy. Vet Surg 2017; 46 (04) 486-493
    CrossrefPubMedSearch in Google Scholar
  • 36 Dennler R, Kipfer NM, Tepic S, Hassig M, Montavon PM. Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease. Am J Vet Res 2006; 67 (11) 1849-1854
    CrossrefPubMedSearch in Google Scholar
  • 37 Koch DA, Kiefer O, Richter H. Comparison of four methods to -determine cage width in tibial tuberosity advancement. Schweiz Arch Tierheilkd 2022; Feb; 164 (02) 177-184
    CrossrefPubMedSearch in Google Scholar
  • 38 Warzee CC, Dejardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286
    CrossrefPubMedSearch in Google Scholar
  • 39 Fischer MS, Lehmann SV, Andrada E. Three-dimensional kinematics of canine hind limbs: in vivo, biplanar, high-frequency fluoroscopic analysis of four breeds during walking and trotting. Sci Rep 2018; 8 (01) 16982
    CrossrefPubMedSearch in Google Scholar
  • 40 Budsberg SC, Verstraete MC, Soutas-Little RW. Force plate analysis of the walking gait in healthy dogs. Am J Vet Res 1987; 48 (06) 915-918
    PubMedSearch in Google Scholar
  • 41 Wu JZ, Herzog W, Epstein M. Effects of inserting a Pressensor film into articular joints on the actual contact mechanics. J Biomech Eng 1998; 120 (05) 655-659
    CrossrefPubMedSearch in Google Scholar
  • 42 Lopez MJ, Kunz D, Vanderby Jr R, Heisey D, Bogdanske J, Markel MD. A comparison of joint stability between anterior cruciate intact and deficient knees: a new canine model of anterior cruciate ligament disruption. J Orthop Res 2003; 21 (02) 224-230
    CrossrefPubMedSearch in Google Scholar
  • 43 Kanno N, Amimoto H, Hara Y. et al. In vitro evaluation of the relationship between the semitendinosus muscle and cranial cruciate ligament in canine cadavers. Am J Vet Res 2012; 73 (05) 672-680
    CrossrefPubMedSearch in Google Scholar
  • 44 Beveridge JE, Atarod M, Heard BJ, O'Brien EEJ, Frank CB, Shrive NG. Relationship between increased in vivo meniscal loads and abnormal tibiofemoral surface alignment in ACL deficient sheep is varied. J Biomech 2016; 49 (16) 3824-3832
    CrossrefPubMedSearch in Google Scholar
  • 45 Kanno N, Hara Y, Fukano S. et al. Tibial displacement with stifle joint flexion and cranial cruciate ligament transection in the dog. An ex vivo study using a robotic simulator. Vet Comp Orthop Traumatol 2014; 27 (04) 277-284
    Thieme ConnectPubMedSearch in Google Scholar
  • 46 Ober C, Berger C, Cohen L, Milgram J. The effect of increasing tibial tuberosity advancement and quadriceps muscle force on cranial translation of the tibia in the cranial cruciate deficient stifle joint in dogs. Front Vet Sci 2022; 9: 914763
    CrossrefPubMedSearch in Google Scholar
  • 47 Kowaleski MP, Apelt D, Mattoon JS, Litsky AS. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study. Vet Surg 2005; 34 (04) 332-336
    CrossrefPubMedSearch in Google Scholar
  • 48 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial plateau leveling osteotomy on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38 (01) 23-32
    CrossrefPubMedSearch in Google Scholar