Cranial Cruciate Ligament In Dogs Research Articles

Etiopathogenesis of Canine Cruciate Ligament Disease: A Scoping Review.

The spontaneous rupture of the cranial cruciate ligament in dogs remains a pathoetiologic puzzle. Despite much progress in research over the past years, the systemic and local mechanisms leading to ligament degeneration and structural failure remain largely obscure. This scoping review focuses on pathogenesis and aims at summarizing and interpreting today's knowledge on causes of canine cruciate ligament rupture, i.e., the multifactorial mechanisms leading to degenerative stifle joint disease with collagen matrix degeneration and structural failures. Thus, the initial view of traumatic ligament rupture, fostered by "wear and tear", has clearly been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus, the term "cranial cruciate ligament disease" has been coined and is generally accepted. In addition, cruciate ligament rupture in people shares some similarities with the lesion in dogs; therefore, the review also includes comparative studies. The methods used were based on the PRISMA-ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews).

The impact of early postoperative rehabilitation on restoring the functions of the limb after surgery on the cranial cruciate ligament in dogs

Relevance. This research is relevant due to ability to help in improving quality of pets life after surgery on the cranial cruciate ligament.Methods. Descriptive (description dynamics recovery various animals), сomparative (comparisons pace recovery various groups of animals applying different metods) methods were used.Results. Applied rehabilitation activities in early postoperative period accelerate recovery, improves muscle tone, keeps joint movements and helps in its stabilization.

Assessment of the Usefulness of Image Reconstruction in the Oblique and Double-oblique Sagittal Planes for Magnetic Resonance Imaging of the Canine Cranial Cruciate Ligament.

IntroductionThe aim of the study was to determine the quality and significance of the magnetic resonance image of the canine knee after reconstruction in the oblique and double-oblique sagittal plane. This reconstruction and 3D images are rarely used in common protocols due to the longer study time they require. The study aimed to demonstrate significance for such diagnostic images in specific sequences in order to stimulate consideration of their more frequent use in diagnosis of diseases of the cruciate ligament in dogs.Material and MethodsAll tests were carried out using an open magnetic resonance tomography scanner with magnetic field induction. The images obtained from the 30 canine patients examined were reconstructed and evaluated by independent appraisers. Statistical analysis was performed.ResultsThe study showed that MRI of the stifle joint using 3D sequences provides higher quality images of the cranial cruciate ligament in dogs. The results of the statistical analysis showed that multi-faceted reconstruction allows the secondary determination of the oblique imaging planes and obtains images of adequate quality.ConclusionIt can be concluded that multi-faceted reconstruction facilitates the secondary determination of oblique imaging planes. This reconstruction additionally makes images available of better quality compared to the 2D sequence.

Gait and electromyographic alterations due to early onset of injury and eventual rupture of the cranial cruciate ligament in dogs: A pilot study.

Identify relevant electromyography (EMG), kinematic, and kinetic changes resulting from monopolar radiofrequency energy (MRFE)-induced cranial cruciate ligament (CCL) injury and eventual rupture in dogs. Experimental, repeated measures. Five purpose-bred female dogs free of orthopedic and neurologic disease. Surface EMG, joint kinematics, and ground reaction forces were assessed at a trot in the pelvic limbs at baseline, at 2 and 4 weeks after unilateral MRFE-induced CCL injury, and at 4, 8, and 16 weeks after CCL rupture (CCLR). After MRFE-induced injury, average hip joint range of motion (ROM) during stance decreased within the untreated pelvic limb. After CCLR, stifle flexion angles decreased within the treated limb at 8 weeks and within the untreated pelvic limb at all time points, whereas average tarsal joint ROM decreased in the treated limb and increased in the untreated limb. Peak vertical ground reaction force and impulse decreased within the treated limb. Qualitative alterations of many EMG values were noted after MRFE-induced injury and CCLR, although significant differences between limbs or from baseline values were not detected. Monopolar radiofrequency energy-induced injury altered contralateral hip kinematics, suggesting early regional compensatory gait alterations. After CCLR, additional compensatory gait patterns occurred in both pelvic limbs. The qualitative analysis of trial-averaged EMG data in this small population supports a relationship between neuromuscular function and induced CCL injury leading to rupture.

Интракапсулярное артроскопически ассистированное протезирование краниальной крестовидной связки у собак in situ

Until 2013 one of scientific directions of clinic of «Endovet™» (Russia, Kurgan) ― research and introduction in veterinary practice of arthroscopic reconstruction of cranial cruciate ligament in dogs. The specialists of clinic researching, implemented and patented methodology of arthroscopic autoimplantation, simultaneously with it began actively to use prothesis cranial cruciate ligament for dogs. In articles the results of the use of one of new variants of CCL prothesis are analysed for dogs.

The Modified Maquet Procedure (MMP) in Dogs: Technical Development and Initial Clinical Experience.

The literature about tibial tuberosity advancement surgery in dogs and humans informed the development of a version of the operation using a wedge-shaped implant of titanium foam. Computer-assisted drawing and stereolithography was used to create instruments and implants that were evaluated by cadaver surgery. A trial, involving 26 client-owned dogs with lameness due to cranial cruciate ligament failure, was started. Follow-up was done by clinical and radiographic examination after 4 wk and clinical examination again 6-11 mo after surgery. The titanium foam implant maintained tibial tuberosity advancement easily and effectively. The same major complication occurred in 2 of the first 6 cases before, a slightly modified technique was used to treat 20 dogs without complication. At mid-term follow-up (6-11 mo), 20/26 dogs (77%) had returned to full function, two dogs (7.7%) had acceptable function, two dogs (7.7%) could not be evaluated due to recent contra lateral modified Maquet procedure surgery, and two (7.7%) dogs had died for reasons unrelated to the study. This is the first clinical report of the use of titanium foam in veterinary orthopaedics. Modified Maquet procedure appears to be an effective treatment for lameness due to failure of the cranial cruciate ligament in dogs.

Radiographic location of the femoral footprint of the cranial cruciate ligament in dogs.

To describe the radiographic location of the center of the femoral footprint of the cranial cruciate ligament (CrCL) in dogs. Using femora from 49 adult, orthopedically sound dogs (bodyweight≥20 kg), a radiopaque marker was placed on the cranial border of the femoral footprint of the CrCL. Computed tomography and threedimensional (3D) reconstruction of each femur was performed subsequently, followed by manual segmentation of the footprint on the 3D models and calculation of its center. Finally, virtual digital radiographs in two planes were produced and the location of the calculated center of the CrCL was expressed using three different methods (4x4 box grid method and percentage position for the medio-lateral projection; o'clock position for the disto-proximal projection). In the medio-lateral radiographs the center of the femoral footprint was consistently located in the second rectangle from the top of the most caudal column of the 4x4 grid. The mean percentage caudo-cranial and proximo-distal location was 20.2% (±2.2) and 33.8% (±3.7), respectively. In the disto-proximal radiograph, the o'clock position of the CrCL center was between 2 and 3 o'clock in 97.6% of cases. The radiographic location of the center of the femoral footprint can be consistently predicted in medio-lateral and disto-proximal stifle radiographs of dogs over 20 kg. The reported data can be used to plan and verify the placement of the femoral tunnel opening for intra-articular anatomic CrCL repair.

Engraftment of autologous bone marrow cells into the injured cranial cruciate ligament in dogs

Current research indicates that exogenous stem cells may accelerate reparative processes in joint disease but, no previous studies have evaluated whether bone marrow cells (BMCs) target the injured cranial cruciate ligament (CCL) in dogs. The objective of this study was to investigate engraftment of BMCs following intra-articular injection in dogs with spontaneous CCL injury. Autologous PKH26-labelled BMCs were injected into the stifle joint of eight client-owned dogs with CCL rupture. The effects of PKH26 staining on cell viability and PKH26 fluorescence intensity were analysed in vitro using a MTT assay and flow cytometry. Labelled BMCs in injured CCL tissue were identified using fluorescence microscopy of biopsies harvested 3 and 13 days after intra-articular BMC injection.The intensity of PKH26 fluorescence declines with cell division but was still detectable after 16 days. Labelling with PKH26 had no detectable effect on cell viability or proliferation. Only rare PKH26-positive cells were present in biopsies of the injured CCL in 3/7 dogs and in synovial fluid in 1/7 dogs. No differences in transforming growth factor-β1, and interleukin-6 before and after BMC treatment were found and no clinical complications were noted during a 1 year follow-up period. In conclusion, BMCs were shown to engraft to the injured CCL in dogs when injected into the articular cavity. Intra-articular application of PKH26-labelled cultured mesenchymal stem cells is likely to result in higher numbers of engrafted cells that can be tracked using this method in a clinical setting.

Evidence for the use of post-operative physiotherapy after surgical repair of the cranial cruciate ligament in dogs

Physiotherapy is well utilised and evidenced in human practice. However, the use of physiotherapy in veterinary practice is a relatively new concept with much of the current treatment based on human evidence. Currently the evidence base for the use of physiotherapy in dogs in the post-operative period after surgery for ruptured cranial cruciate ligament (CCL) is minimal. Published evidence does indicate that the use of cold therapy in the immediate post-operative period can result in reduced swelling, reduced pain and increased range of motion (ROM). Additionally, post-operative physiotherapy programmes were shown to improve ROM, muscle mass and limb use post operatively when compared with a restricted exercise programme. However, there are some inconsistencies in results, which may in part be due to experiment design — data collection methods and sample numbers. More research is required in this field of veterinary medicine to provide evidence that the benefits of post-operative physiotherapy, widely recognised in human medicine, are truly applicable to the canine patient.

Métodos de diagnóstico y tratamientos utilizados para la ruptura del ligamento cruzado craneal en perros: encuesta a médicos veterinarios de Chile

The cranial cruciate ligament (CrCL) is an important anatomical structure of the stifle that contributes to joint stability. Tears of the CrCL are frequent orthopaedic lesions in dogs and the diagnosis is based on orthopaedic examination. Despite the large number of surgical methods described, no treatment has been universally accepted in veterinary medicine and the treatment is based on the preferences of the surgeon. With regard to diagnosis and treatment, the aim of the present study was to assess the preferred method in Chile to diagnose and treat the rupture of CrCL in dogs. Out of 307 surveys handed out, 206 questionnaires were obtained and 49 (23%) of them stated that one or more methods were performed to diagnose and treat CrCL rupture in dogs, while twenty one (10, 19%) questionnaires were answered in full. The diagnosis is mainly based on palpation and radiography is the most common complementary method used. Regarding the treatment for the CrCL rupture, the extraarticular surgical technique was the most common method of treatment (90, 47%). In conclusion, we found out that few veterinarians in Chile diagnose and treat CrCL rupture in dogs. The diagnoses for CrCL rupture is mostly performed through palpation of the affected stifle while imaging diagnostic methods are scarcely or not applied. The extraarticular technique is the preferred method to treat CrCL rupture in dogs in Chile.

Comparison of Kinematic Variables in Defining Lameness Caused by Naturally Occurring Rupture of the Cranial Cruciate Ligament in Dogs

To (1) discover kinematic variables that differ between dogs with cranial cruciate ligament rupture (CCLR) and control dogs and (2) to identify suitable outcome variables for longitudinal studies on the effects of surgical interventions for CCLR in dogs. In vivo case-control comparison. Dogs with unilateral CCLR (n=16), and no other detectable neurologic or orthopedic disease and 10 dogs without CCLR, neurologic, or orthopedic disease. Kinematic data was collected from dogs as they walked at constant speed on a treadmill, using an infrared camera system and adhesive reflective markers applied to the pelvic limbs. Data on 5 selected variables was extracted and comparisons made between paired pelvic limbs in both CCLR and control dogs and between control and CCLR dogs. Comparisons in CCLR dogs revealed significant differences between affected and unaffected limbs for many examined variables; the largest differences were in paw velocity and stifle angular velocity. There were highly significant differences between CCLR and control dogs when examining paired limb ratios for 4 of the variables, the largest differences were in stride length and paw velocity. Kinematic analysis provides straightforward and objective methods for defining the lameness associated with CCLR in dogs. Paw velocity and stride length were most notably reliable and not susceptible to systematic alterations in stifle joint dynamics that might be associated with specific surgical procedures. This study identifies several variables that can provide the objective measurements essential to evaluate the efficacy of surgical interventions for CCLR in dogs.

Development and In Situ Application of an Adjustable Aiming Device to Guide Extra‐ to Intraarticular Tibial Tunnel Drilling for the Insertion of the Cranial Cruciate Ligament in Dogs

To develop and test an arthroscopic aiming device for extra- to intraarticular tibial tunnel drilling emerging at the center of the tibial insertion (CenterTib) of the cranial cruciate ligament (CCL) in medium to large breed dogs. Descriptive experimental study. Fifty-two cadaveric hind limbs of dogs >or=20 kg BW. The mediolateral position and craniocaudal position (ccPos) of CenterTib in relation to the caudomedial meniscotibial ligament were measured on photographs of 46 dissected tibial plateaus. The proximal tibial depth (TibDepth) was determined on lateral radiographs and its correlation with ccPos was assessed using linear regression analysis. Extra- to intraarticular arthroscopic tibial tunnel drilling was performed in 6 independent cadaveric stifles. A C-guide with an adjustable craniocaudal offset was constructed and adjusted according to ccPos estimated based on TibDepth. The position of the resulting bone tunnels was compared with the position of the CenterTib. Pearson's correlation between TibDepth and ccPos was strong (R=0.86; P<.001). ccPos (y) as a function of TibDepth (x) can be expressed as y=-4.8+0.3x. Arthroscopic tunnel drilling resulted in a median deviation of the drill tunnels around the CenterTib of 1 mm. The regression equation and aiming device permit localization and targeting of CenterTib during extra- to intraarticular tibial bone tunnel drilling in vitro. The proposed technique may reduce tibial tunnel misplacement when performing intraarticular CCL repair using a tibial bone tunnel.

Inflammatory changes in ruptured canine cranial and human anterior cruciate ligaments

To compare expression of tartrate-resistant acid phosphatase (TRAP) and cathepsin K and histologic changes in canine cranial cruciate ligaments (CCLs) and human anterior cruciate ligaments (ACLs). Sections of cruciate ligaments from 15 dogs with ruptured CCLs, 8 aged dogs with intact CCLs, 14 human beings with ruptured ACLs, and 11 aged human beings with intact ACLs. The CCLs and ACLs were evaluated histologically, and cells containing TRAP and cathepsin K were identified histochemically and immunohistochemically, respectively. The proportion of ruptured CCLs that contained TRAP+ cells was significantly higher than the proportion of intact ACLs that did but similar to proportions of intact CCLs and ruptured ACLs that did. The proportion of ruptured CCLs that contained cathepsin K+ cells was significantly increased, compared with all other groups. Numbers of TRAP+ and cathepsin K+ cells were significantly increased in ruptured CCLs, compared with intact ACLs. The presence of TRAP+ cells was correlated with inflammatory changes, which were most prominent in ruptured CCLs. Results suggest that synovial macrophage-like cells that produce TRAP are an important feature of the inflammation associated with CCL rupture in dogs. Identification of TRAP and cathepsin K in intact CCLs and ACLs from aged dogs suggests that these enzymes have a functional role in cruciate ligament remodeling and repair. We hypothesize that recruitment and activation of TRAP+ macrophage-like cells into the stifle joint synovium and CCL epiligament are critical features of the inflammatory arthritis that promotes progressive degradation and eventual rupture of the CCL in dogs.

Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States

To estimate the economic impact to veterinary clients for the medical and surgical treatment of rupture of the cranial cruciate ligament (RCCL) in dogs for the year 2003. Economic impact survey. 501 diplomates of the American College of Veterinary Surgeons (ACVS) indicating that their area of surgical emphasis was small animal orthopedic surgery or small animal general and orthopedic surgery and 4,000 veterinarians indicating to the AVMA that their professional area was small animal practice exclusive or mixed animal practice (at least 80% small animal). Veterinarians were surveyed concerning the cost for medical and surgical treatment of RCCL for 2003. The economic impact was calculated by multiplying the number of RCCL surgeries performed by the mean cost of surgery. This was added to the number of RCCL cases managed medically multiplied by the mean cost of medical management. This estimate for survey responders was extrapolated to the total number of veterinarians in the study population for the ACVS or AVMA. Estimates for the total cost of surgery were $171,730,134.72 and $1,020,167,907 for veterinarians in the ACVS and AVMA populations, respectively. The cost of medical management was $2,885,687.86 and $126,558,155.16 for veterinarians in the ACVS and AVMA populations, respectively. After combining the ACVS and AVMA populations, we estimated that owners spent $1.32 billion for the treatment of RCCL in the United States in 2003. RCCL is a prevalent, costly injury. Results may motivate veterinary and consumer agencies to prioritize funding for a better understanding of the injury.

Localization of Cathepsin K and Tartrate‐Resistant Acid Phosphatase in Synovium and Cranial Cruciate Ligament in Dogs with Cruciate Disease

To localize cathepsin K and tartrate-resistant acid phosphatase (TRAP) in synovium and cranial cruciate ligament (CCL) of dogs with cruciate disease. Dogs (n=15) with cruciate disease and ruptured CCL, and 12 dogs with intact CCL. Synovium and CCL were examined histologically and cells containing cathepsin K or TRAP were identified immunohistochemically and histochemically, respectively. Increased cellular localization of cathepsin K and TRAP was detected in synovium and ruptured CCL in dogs with cruciate disease, when compared with tissues from dogs with intact CCL. Inflammation of synovium with TRAP+ macrophage-like cells was seen in 73% of dogs with CCL disease, but was not seen in dogs with intact CCL. The presence of cathepsin K and TRAP protein in synovium and CCL tissues was significantly correlated in dogs with CCL rupture. Inflammation of the epiligament of ruptured CCL with cathepsin K+ and TRAP+ macrophage-like cells forms part of a similar, more generalized chronic inflammatory change within the periarticular tissues of the stifle of a large proportion of dogs with CCL rupture. Production of matrix-degrading enzymes by the synovium may induce progressive pathologic rupture of the CCL. Therefore, these collagenolytic pathways may offer a novel target for medical therapy of joint inflammation in canine patients with cruciate disease.

Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs

To determine the outcome and effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament (RCCL) and injury to the medial meniscus in Labrador Retrievers. Prospective clinical study. 131 Labrador Retrievers with unilateral RCCL and injury to the medial meniscus and 17 clinically normal Labrador Retrievers. Affected dogs had partial or complete medial meniscectomy and lateral suture stabilization (LSS), intracapsular stabilization (ICS), or tibial plateau leveling osteotomy (TPLO). Limb function was measured before surgery and 2 and 6 months after surgery. Treated dogs were evaluated to determine the probability that they could be differentiated from clinically normal dogs and tested to determine the likelihood that they achieved improvement. No difference was found between LSS or TPLO groups, but dogs treated with ICS had significantly lower ground reaction forces at 2 and 6 months. Compared with clinically normal dogs only, 14.9% of LSS-, 15% of ICS-, and 10.9% of TPLO-treated dogs had normal limb function. Improvement was seen in only 15% of dogs treated via ICS, 34% treated via TPLO, and 40% treated via LSS. Surgical technique can influence limb function after surgery. Labrador Retrievers treated via LSS, ICS, or TPLO for repair for of RCCL and medial meniscal injury managed with partial or complete meniscectomy infrequently achieve normal function. Results of LSS and TPLO are similar and superior to ICS.

Evaluation of changes in vertical ground reaction forces as indicators of meniscal damage after transection of the cranial cruciate ligament in dogs

To determine whether decreases in peak vertical force of the hind limb after transection of the cranial cruciate ligament (CrCL) would be indicative of medial meniscal damage in dogs. 39 purpose-bred adult male Walker Hounds. The right CrCL was transected arthroscopically. Force plate measurements of the right hind limb were made prior to and 2, 4, 10, and 18 weeks after transection of the CrCL. Only dogs with > or =10% decreases in peak vertical force after week 2 were considered to have potential meniscal damage. Dogs that did not have > or =10% decreases in peak vertical force at any time point after week 2 were assigned to group 1. Group 2 dogs had > or =10% decreases in peak vertical force from weeks 2 to 4 only. Group 3 and 4 dogs had > or =10% decreases in peak vertical force from weeks 4 to 10 only or from weeks 10 to 18 only, respectively. Damage to menisci and articular cartilage was graded at week 18, and grades for groups 2 to 4 were compared with those of group 1. The percentage change in peak vertical force and impulse area was significantly different in groups 2 (n = 4), 3 (4), and 4 (4) at the end of each measurement period (weeks 4, 10, and 18, respectively) than in group 1 (27). The meniscal grade for groups 2 to 4 was significantly higher than for group 1. A > or =10% decrease in peak vertical force had sensitivity of 52% and accuracy of 72% for identifying dogs with moderate to severe medial meniscal damage. In dogs with transected or ruptured CrCLs, force plate analysis can detect acute exacerbation of lameness, which may be the result of secondary meniscal damage, and provide an objective noninvasive technique that delineates the temporal pattern of medial meniscal injury.

Pre‐ and Postoperative Force Plate Analysis of Dogs with Experimentally Transected Cranial Cruciate Ligaments Treated Using Tibial Plateau Leveling Osteotomy

Quantitative and objective assessment of hindlimb kinetics after cranial cruciate ligament (CrCL) transection and subsequent stifle stabilization using the tibial plateau leveling osteotomy (TPLO) in normal dogs. In vivo experimental biomechanical evaluation. Six healthy adult foxhounds. Dogs were screened by orthopedic and radiographic examination before study entry. Force plate analysis of gait was measured before extirpation of the right CrCL and TPLO and again at 8 and 18 weeks after surgery. There was a significant decrease in peak vertical forces (PVFs) and vertical impulse (VI) of the treated hindlimb at 8 weeks when compared with preoperative and 18-week measurements. When compared with preoperative values, there was no significant difference in 18 week PVF and VI in dogs that had TPLO. TPLO can restore kinetic measures of limb function at 18-weeks after surgery when compared with preoperative values after experimental transection of the CrCL in dogs. TPLO induces lameness that returns to near normal at 18 weeks. The severity and duration of lameness was similar to that reported for other experimental models of stifle instability repaired by different techniques.

Results of single-session bilateral tibial plateau leveling osteotomies as a treatment for bilaterally ruptured cranial cruciate ligaments in dogs: 25 cases (2000-2001).

The records of 25 dogs with bilaterally ruptured cranial cruciate ligaments (CrCL) treated with single-session bilateral tibial plateau leveling osteotomies (TPLOs) were reviewed. The mean age and body weight at presentation were 4.9 years and 36.1 kg, respectively. Minor complications occurred in five dogs. Good or excellent function occurred in 19 of 25 dogs at a mean of 6.9 weeks postoperatively. Owner evaluation revealed that the 88% of dogs had good or excellent function at an average of 14.3 months postoperatively. This study demonstrated that single-session bilateral TPLOs are an effective treatment for bilaterally ruptured CrCLs with minimal morbidity and complications.

Proximal tibial osteotomy for the repair of cranial cruciate-deficient stifle joints in dogs

SummaryA proximal tibial osteotomy technique for the repair of complete or partial rupture of the cranial cruciate ligament in dogs is described and the results of a series of 100 consecutively operated stifle joints are presented. Although the majority of dogs regained full function of the operated limb within four months of surgery, the overall complication rate was high.