Preliminary Clinical and Radiographic Evaluation of a Novel Resorbable Implant of Polylactic Acid (PLA) for Tibial Tuberosity Advancement (TTA) by Modified Maquet Technique (MMT).

Victoria Valiño-Cultelli,Antonio González-Cantalapiedra,Óscar Varela-López

doi:10.3390/ani11051271

Victoria Valiño-Cultelli, Antonio González-Cantalapiedra + Show 1 more

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https://doi.org/10.3390/ani11051271

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Abstract

Simple SummaryThe metallic implants carry many problems as infections, bone resorption, pain at the site, etc. Removing these metallic implants is an expensive procedure, and it entails risks. Due to the costs, the most common in veterinary medicine is to remove metallic implants only when a problem occurs. The rupture of the cranial cruciate ligament (RCrCL) is the most common orthopedic pathology in dogs and the most frequent cause of arthrosis, pain, and limp on the knee joint. Those are the reasons that encouraged us to develop a new type of biodegradable implant comprised of polylactic acid (PLA). This is a non-toxic material that can be eliminated by natural metabolic pathways and use the PLA implant in tibial tuberosity advancement (TTA), which is a technique for the resolution of RCrCL in dogs. In our study, PLA implants for TTA provide good functional results, presenting an acceptable number of complications. The implants show a faster ossification than metallic implants, which was not affected by age or by body weight. The PLA implants have a clinical recovery time similar to metallic implants.Our objectives were to determine whether PLA implants can be used in TTA with successful results; secondly, to observe whether they provide a faster bone healing; finally, to determine whether weight or age influences bone healing scores. PLA cages were created with a 3D printer. TTA by MMT with PLA implants was performed in 24 patients. Follow-ups were carried out pre-surgical, at 1, 2, and 5 months and consisted of a radiographic study and a lameness assessment. A comparison was performed in terms of weight and age. Patients data, time between follow-up examinations, healing score, and lameness score were compared between patients using commercial software for statistically significant differences p < 0.05. Eighteen dogs finished the study. The ossification degrees presented statistically significant differences between each other. PLA implants maintained the advancement in 100% of cases. Comparing weight and age did not present any statistically significant differences between groups. Lameness presented statistically significant differences between follow-up examinations. Complications were observed in 20.8%. PLA implants for TTA provide good functional results, presenting an acceptable rate of complications. They provide a faster bone healing of the osteotomy gap, which was not affected by age or body weight, and have a clinical recovery time similar to metallic implants.

Highlights

The rupture of the cranial cruciate ligament (RCrCL) is the most common orthopedic pathology in dogs [1,2,3] and the most frequent cause of secondary degenerative arthrosis, pain, and limp on the knee joint [4,5]
Among this type of technique, there is the tibial tuberosity advancement (TTA) [10], which neutralizes cranial tibiofemoral shear force by advancing the insertion of the patellar ligament until it is perpendicular to the tibial plateau with the joint in extension
The population in the study was effectively randomized, which made it possible to compare the ossification in patients of different weights and ages, which is something that was not possible in other similar studies [34], demonstrating that these parameters do not affect the ossification degree, which was our last hypothesis

Summary

Introduction

The rupture of the cranial cruciate ligament (RCrCL) is the most common orthopedic pathology in dogs [1,2,3] and the most frequent cause of secondary degenerative arthrosis, pain, and limp on the knee joint [4,5]. The CrCL is not replaced, instead of that the neutralization of tibio-femoral forces allows for the dynamic stability of the knee and does not allow its subluxation with weight-bearing [9] Among this type of technique, there is the tibial tuberosity advancement (TTA) [10], which neutralizes cranial tibiofemoral shear force by advancing the insertion of the patellar ligament until it is perpendicular to the tibial plateau with the joint in extension. This 90o patellar tendon angle (PTA) is typically maintained by stabilizing the osteotomy of the proximal tibia with procedure-specific stainless steel or titanium plate and cage implants [10]. These implants avoid the osteotomy collapse, allowing for the maintenance of the desired PTA, once the osteotomy is healed, they are not needed anymore

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