Cranial Cruciate Ligament Deficiency Research Articles

Tibial plateau levelling osteotomy using a dome‐shaped saw blade for canine cranial cruciate ligament insufficiency

Tibial plateau levelling osteotomy (TPLO) is commonly used to manage cranial cruciate ligament (CrCL) disease. The use of a spherical osteotomy blade (S-TPLO) enables correction of some tibial deformities with three rotational degrees of freedom. As a proof of concept, this retrospective study included 45 dogs with CrCL disease that were treated with an S-TPLO. The tibial plateau angle (TPA) was measured preoperatively, immediately after surgery (pTPA0 ) and on postoperative days 42 (pTPA42 ) and 56 (pTPA56 ). Lameness and osteotomy healing were assessed until 56 days postoperatively. Thirty-one dogs had complete CrCL ruptures, and 14 dogs had partial ruptures. Thirty-one dogs had medial meniscal damage. The mean TPA, pTPA0 , pTPA42 and pTPA56 were 26.0°, 7.8°, 8.5° and 8.9°, respectively. The TPA from post-op to follow-up did not vary significantly (p>1.365). Minor complications occurred in five dogs. The mean lameness score improved significantly from 3.2 preoperatively to 0.9 on day 56 (p<0.0001). The mean healing score improved significantly from 1.6 on day 42 to 2.2 on day 56 (p<0.001). S-TPLO was successful in treating CrCL disease in stifle joints without tibial deformities, with results comparable to previously reported TPLO outcomes.

Clinical Outcomes and Stifle Osteoarthritis Assessment of Nine Cats Before and After Tibial Plateau Levelling Osteotomy

Abstract This study aimed to evaluate the clinical and radio graphical outcome of cats following TPLO surgery for cranial cruciate ligament deficiency. Each cat underwent orthopedic assessment, pre-operative radio graphical evaluation, surgical procedure, postoperative management and clinical re-examination 1, 2, and 12 months following surgery. Age, body weights, TPAs, meniscal tears, implants and osteoarthritis progression were recorded. Postoperative OA score was compared with that obtained 1 year after surgery using a paired t-test with commercially available software. Radio graphical evaluation performed 1 year after surgery showed no significant OA progression (P-value &gt; 0.1). Minor complications occurred in one case (#7) in which a mild to moderate seroma was observed ten days after surgery. No major complications were recorded. Although TPLO surgery in cats remains controversial, this study suggests that it was a suitable option for surgical treatment of feline cranial cruciate ligament rupture, but considering the ex vivo outcomes recently published, further in vivo evaluation is strongly recommended.

Center of rotation of angulation-based leveling osteotomy combined with a coplanar cranial closing wedge ostectomy to manage cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angle.

To describe outcomes of dogs with excessive tibial plateau angle (eTPA) and cranial cruciate ligament (CrCL) disease treated with center of rotation of angulation-based leveling osteotomy (CBLO) and cranial closing wedge ostectomy (CCWO). Retrospective study. Twenty-one dogs. Medical records of dogs with CrCL disease and eTPA (>34°) treated with CBLO/CCWO were reviewed. Signalment, body weight, intra-articular structure appearance, TPA (preoperatively, postoperatively, and at osteotomy healing), postoperative function, and complications were recorded. Twenty-one dogs (28 stifles) with CrCL disease/eTPA underwent CBLO/CCWO. Twenty stifles had complete CrCL tears and eight tears were partial. Mean age and weight of dogs were 4 years (range, 1-9) and 27 kg (range, 4-65), respectively. Medial menisci were normal in 20 stifles, torn in 5, and degenerative in 3. All lateral menisci were normal. The caudal cruciate ligament was normal in 26 stifles and partially torn in 2. Mean TPA was 43° preoperatively, 10° postoperatively, and 10° at final recheck. Grade 4 healing occurred in all osteotomies by 8 weeks postoperatively. Complications included one pin migration, breakage of two proximal screws (1 case), one late-onset caudolateral band CrCL tear, two late-onset meniscal tears, and one surgical site infection. Eighteen dogs returned to full function, and three dogs achieved acceptable function, at a mean of 27 months. Center of rotation of angulation-based leveling osteotomy/CCWO resulted in grade 4 osteotomy healing by 8 weeks, minimal complications, and acceptable to full return to function. Center of rotation of angulation-based leveling osteotomy/CCWO should be considered to treat canine CrCL disease/eTPA.

Resistin concentrations in serum and stifle synovial fluid from normal and cruciate deficient dogs with osteoarthritis.

To compare synovial fluid (SF) resistin concentrations in healthy dogs to dogs with osteoarthritis (OA) secondary to cranial cruciate ligament (CrCL) injury and to correlate resistin concentrations with body condition score (BCS) and evaluate resistin release from peripheral blood mononuclear cells (PBMC) and adipocytes. Controlled, prospective, clinical study ANIMALS: Thirty-nine client-owned dogs, 13 healthy and 26 with secondary OA, were enrolled. Blood was collected from six healthy purpose-bred dogs for PBMC culture. An additional six mixed-breed dogs were used for adipocyte collection and culture. Resistin concentrations were measured with a canine-specific enzyme-linked immunoabsorbent assay. Resistin was compared between healthy SF and OA SF with Student's t test. Correlation of resistin concentrations to BCS was performed. Peripheral blood mononuclear cells and adipocytes were cultured under three conditions: negative control, lipopolysaccharide, and concanavalin A (Con A). A linear mixed model was used to determine differences in resistin concentrations among treatments. Resistin concentrations in OA SF were comparable to healthy SF. Neither serum nor SF resistin was correlated with BCS. Cultured PBMC stimulated with Con A released resistin, while adipocytes did not. Neither serum nor SF resistin were altered in dogs with OA secondary to CrCL insufficiency. In addition, resistin was not correlated with canine body fat and did not appear to function as adipocytokine in the dog. Resistin may not be involved in the pathogenesis of OA. However, resistin may be important in inflammation because it is released from inflammatory cells.

Evaluation of Tibial Plateau Levelling Osteotomy in Cats Affected by Cranial Cruciate Ligament Deficiency

Evaluation of Tibial Plateau Levelling Osteotomy in Cats Affected by Cranial Cruciate Ligament Deficiency

Femorotibial kinematics in dogs treated with tibial plateau leveling osteotomy for cranial cruciate ligament insufficiency: An in vivo fluoroscopic analysis during walking.

To determine the ability of tibial plateau leveling osteotomy (TPLO) to address abnormal femorotibial kinematics caused by cranial cruciate ligament (CCL) rupture during walking in dogs. Prospective, clinical. Sixteen dogs (20-40 kg) with unilateral complete CCL rupture. Lateral view fluoroscopy was performed during treadmill walking preoperatively and 6 months after TPLO. Digital three-dimensional (3D) models of the femora and tibiae were created from computed tomographic (CT) images. Gait cycles were analyzed by using a 3D-to-2D image registration process. Craniocaudal translation, internal/external rotation, and flexion/extension of the femorotibial joint were compared between preoperative and 6-month postoperative time points for the affected stifle and 6-month postoperative unaffected contralateral (control) stifles. In the overall population, CCL rupture resulted in 10 ± 2.2 mm (mean ± SD) cranial tibial translation at midstance phase, which was converted to 2.1 ± 4.3 mm caudal tibial translation after TPLO. However, five of 16 TPLO-treated stifles had 4.1 ± 0.3 mm of cranial tibial subluxation during mid-to-late stance phase, whereas 10 of 16 TPLO-treated stifles had 4.3 ± 0.4 mm of caudal tibial subluxation throughout the gait cycle. Overall, postoperative axial rotational and flexion/extension patterns were not different from control, but stifles with caudal tibial subluxation had more external tibial rotation during mid-to-late stance phase compared with stifles with cranial tibial subluxation. TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking. Tibial plateau leveling osteotomy reduces cranial tibial subluxation during walking, but persistent instability is common.

The effect of tibial plateau leveling osteotomy on patellofemoral kinematics in dogs: An in vivo study.

To quantitatively evaluate patellofemoral (PF) kinematics during walking in dogs with cranial cruciate ligament (CrCL) deficiency treated by tibial plateau leveling osteotomy (TPLO). Longitudinal observational study. Dogs with unilateral CrCL deficiency treated by TPLO (n = 10). Horizontal beam fluoroscopic images of the stifles during treadmill walking were acquired 6 months after TPLO. Computed tomography was performed, and digitized bone models of both femurs and patellae were created. These digital models were superimposed over the fluoroscopic images with shape-matching software, and sagittal plane PF kinematics for TPLO-treated and normal contralateral stifles were calculated. Patellofemoral kinematics were described according to phase of gait cycle as well as relative to femorotibial flexion angle. In TPLO-treated stifles, there was an approximately 1-mm increase in cranial displacement of the patella (P < .05) compared with the normal stifle at equivalent femorotibial flexion angles between 120° and 140° and predominately during the stance phase. Proximal-distal translation and patellar flexion angle were mostly unaffected by TPLO when they were assessed according to either equivalent phase of gait cycle or femorotibial flexion angles. In vivo PF kinematics in TPLO-treated stifles were subtly different from normal, characterized by slight cranial shifting of the patella relative to the trochlear groove. The clinical significance of these results remains unknown. These results may provide further understanding into extensor mechanism abnormalities associated with TPLO.

Meniscal click in cranial cruciate deficient stifles as a predictor of specific meniscal pathology.

To determine the predictive value of meniscal click for specific meniscal tear morphology. Prospective cohort. Client-owned dogs (104) with cranial cruciate ligament (CCL) deficiency treated with stifle arthroscopy (111). All stifles underwent a standardized examination for meniscal click before anesthesia (EBA) and during anesthesia (EDA). Presence or absence of a medial meniscal tear and diagnosis of tear morphology were confirmed with arthroscopic examination. Complete CCL tears were noted in 93 dogs, and incompetent partial tears were noted in 18 dogs. Medial meniscal tears were noted in 40.5% (55/111) of dogs, including bucket handle tears (BHT) in 65.6% (36/55) of tears. Frays of the lateral meniscus were noted in 6.3% of dogs (7/111). Examination for meniscal click before anesthesia was 38% sensitive and 94.5% specific, and EDA was 38% sensitive and 98.2% specific for all meniscal tear morphologies. Positive meniscal click at EBA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .3515, respectively). Positive meniscal click at EDA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .1909, respectively). A meniscal click is more commonly associated with a meniscal BHT than with a non-BHT. Meniscal tear morphology influences the presence or absence of meniscal click. Because of the high incidence of meniscal disease, this study provides evidence to support joint exploration in the treatment of CCL disease.

Correlation of synovial fluid leptin with body habitus in the healthy and osteoarthritic canine knee

Purpose: Naturally occurring cranial cruciate ligament (CrCL) insufficiency and progressive osteoarthritis (OA) are common in the canine population and can serve to provide useful information to understand both canine and human knee joint disease. Leptin, an adipocytokine, has been shown to be proportional to adipose mass. In humans, leptin has been associated with radiographic progression of knee OA, markers of cartilage damage, and pain in osteoarthritic knees. The primary goal of this study is to evaluate the relationship between serum and synovial fluid (SF) leptin and body condition score and body fat percentage in dogs. The secondary goal was to characterize the relationship between SF leptin and markers of inflammation, such as IL-1β Methods: Forty-eight client-owned dogs, 19 healthy controls and 29 with secondary OA, were enrolled. Any dog with evidence of systemic disease, based on physical exam and routine hematology was excluded from the study. Informed owner consent was obtained and all procedures were approved by the Clinical Research Committee. Sample Collection - Dogs in the control group were sedated and a single femorotibial joint was randomly selected for arthrocentesis. Synovial fluid was collected using aseptic technique. For dogs in the OA group, SF was obtained intra-operatively from the affected limb prior to arthrotomy for correction of CrCL insufficiency. Blood was collected via standard jugular venipuncture. Morphometric Measures - Body condition score, BCS, was determined on a standard 9-point scalea by 3 individual observers, who were unaware of the other raters’ score. Dogs were then divided into to 2 groups, optimal weight (BCS 4-5) and overweight (BCS >5). Additionally trunk and limb measurements were obtained to calculate body fat percentage, as previously reported1. Osteoarthritis Severity Scoring- In the OA group, radiographs were scored for severity of OA by a radiologist utilizing a previously described scoring system2. Owners were required to fill out a clinical metrology questionnaire (Liverpool Osteoarthritis in Dogs, LOAD). Sample Analysis - Canine specific leptinb and IL-1βc ELISAs were used to measure SF and serum leptin and IL-1β. Data Analysis - Student t-tests were used to test for differences in SF leptin means due to CrCL status, presence of SF or serum IL-1β, and the potential confounder non-steroidal anti-inflammatory (NSAID) use. Linear regressions were used to test for association of synovial leptin with BCS, body fat percent, serum leptin concentration, LOAD, and radiographic score. Multiple linear regression was also used to adjust the linear model for the association of synovial leptin and OA status for BCS. Results: SF leptin was significantly lower than serum leptin (p<0.01) and there was a 5.8ng/mL change in SF leptin for every 10ng/ml increase in serum leptin. Overweight dogs had significantly higher concentration of SF leptin than those that were optimal body weight (p<0.01). SF leptin concentration was associated with both BCS and body fat % (p<0.01). For every 1unit increase in BCS there was a 1.7ng/mL increase in SF leptin and for every 10% increase in body fat, there was a 2.7ng/mL increase in SF leptin. Synovial fluid leptin was significantly higher in dogs with OA by a mean amount of 2.8 (95% CI 0.6-5.1) but this difference decreased and became no longer significant when adjusted for differences in body condition score between OA groups (p=0.25). There was a weak association between SF leptin and LOAD; for every 1ng/mL increase in leptin a 10unit increase in LOAD was observed (R2=0.100; p=0.03). There was no significant association between SF leptin and radiographic score (p=0.24), SF IL-1β (p=0.64) or NSAID use (p=0.55). Conclusions: This is the first study to document the presence of leptin in canine SF. As expected, SF leptin was positively correlated with serum leptin and measures of body habitus. However, SF leptin levels in dogs with CrCL insufficiency were not significantly different from control dogs. Still, there was weak positive association between SF leptin and LOAD, in dogs with OA. As all these dogs had CrCL insufficiency at the time of data collection, the pain and dysfunction from joint instability may have masked small changes due to chronic OA and contributed to the weak nature of this link. The results of this study did not correlate leptin levels with severity of OA, or local concentrations of IL-1β. In the canine model of OA, obesity related OA severity may be related to other adipokines or may purely be biomechanical in nature. Further studies are needed in both people and dogs to determine the role of leptin in OA.

Tibial plateau morphology in dogs with cranial cruciate ligament insufficiency.

To identify possible biomechanical causes for the predominantly unilateral presentation of cranial cruciate ligament (CCL) insufficiency by comparing the computed tomographic (CT) features of the tibial plateau of CCL affected and contralateral sound stifles in dogs with unilateral CCL insufficiency. Cross-sectional study. Eighteen dogs, 36 stifles. Eighteen dogs with naturally occurring unilateral CCL insufficiency were included. Stifle CT and radiographs were performed at the time of diagnosis. Follow-up was performed at a minimum of 1 year from the original diagnosis to ensure that there was no evidence of contralateral CCL insufficiency. The medial tibial plateau angle (m-TPA), lateral TPA (and l-TPA), medial tibial plateau midsagittal radius of curvature (m-TPr), and lateral TPr (l-TPr) were measured from the CT images. Variables were compared with paired t tests. A Bonferroni correction was performed, and P < .006 was considered significant. Mean m-TPr was steeper (P = .002) and m-TPr:l-TPr ratio was greater (P < .001) in affected stifles compared with contralateral sound stifles. No other variables differed between groups. Mean l-TPA was steeper than mean m-TPA (P < .001). Tibial plateau convexity differed between the CCL affected and contralateral sound stifle in dogs with unilateral CCL insufficiency. Medial tibial plateau convexity may play a role in the development of CCL insufficiency.

Effects of early postoperative rehabilitation with physiotherapy in the cranial cruciate ligament ruptured dogs stabilized with extra capsular technique

The aim of the study was to find out the efficacy of rehabilitative techniques postoperatively of extracapsular stabilized cranial cruciate ligament deficiency dogs. Twelve dogs were treated surgically by extracapsular imbrication method. Post operatively six dogs were rehabilitated with neuromuscular electrical stimulation and different therapeutic exercise. The lameness score and weight score and girth of thigh differ significantly between them. Range of motion and girth also improved but non significantly. There was an early recovery in physiotherapy group dogs as compared to dogs in the non physiotherapy group.

Comparison of three imaging modalities used to evaluate bone healing after tibial tuberosity advancement in cranial cruciate ligament-deficient dogs and comparison of the effect of a gelatinous matrix and a demineralized bone matrix mix on bone healing \u2013 a pilot study

BackgroundBone healing and assessment of the state of bone bridging is an important part of clinical orthopedics, whether for fracture healing or for follow up of osteotomy procedures. Tibial tuberosity advancement (TTA) is designed to restore stability in cruciate deficient stifle joints by advancing the tuberosity while creating an osteotomy gap. The current study aims to: 1) compare three different imaging modalities to assess bone healing: ultrasound, radiographs and computed tomography (CT) and, to 2) compare the effect of a gelatinous matrix (GM) versus a demineralized bone matrix mix (DBM mix) on bone healing and bridging of this osteotomy gap in 10 otherwise healthy client-owned dogs with cranial cruciate ligament insufficiency. Osseous union of the osteotomy gap was evaluated with ultrasound, radiographs and CT at one, two, and 3 months postoperatively. Dogs were randomly selected to receive GM or DBM mix to fill the osteotomy gap created during the TTA procedure. Bone healing was assessed subjectively on all modalities as well as scored on radiographs and measured using Hounsfield units (HUs) on CT. Time to heal based on ultrasound, radiographs and CT were statistically compared between groups with significance set at p < 0.05.ResultsAll osteotomy gaps were bridged with bone within 3 months for all modalities. Bridging bone was diagnosed in 5.6 weeks, 10.4 weeks and 9.6 weeks based on ultrasound, radiographs, and CT, respectively, in dogs treated with DBM mix. In dogs treated with GM osseous union was diagnosed in a mean of 4.0 weeks, 9.6 weeks and 7.2 weeks based on ultrasound, radiographs and CT. Ultrasound diagnosed osseous union significantly faster than both CT and radiographs (p < 0.001). The dimensions of the newly formed bone differed between treatment groups with the central portion of the bone only providing a small bridge in GM cases. Although bridging of the osteotomy gap occurred earlier in the group that received GM, no significant statistical difference was found between the two groups.ConclusionsRadiographs overestimate the time needed for osseous union of the osteotomy gap. All osteotomy sites healed radiographically within 3 months.

Femorotibial kinematics in dogs with cranial cruciate ligament insufficiency: a three-dimensional in-vivo fluoroscopic analysis during walking

BackgroundCranial cruciate ligament (CrCL) insufficiency is a degenerative condition that is a common cause of pelvic limb lameness and osteoarthritis in dogs. Surgical therapies developed to treat dogs with naturally occurring CrCL insufficiency aim to address the resultant instability, but the in-vivo alterations in stifle kinematics associated with CrCL insufficiency have not been accurately defined. The objective of this study was to quantify the 3-dimensional femorotibial joint kinematics of dogs with naturally occurring cranial cruciate ligament (CrCL) insufficiency during ambulation. Eighteen client-owned dogs (20–40 kg) with natural unilateral complete CrCL rupture were included. Computed tomographic scans were used to create digital 3-dimensional models of the femur and tibia bilaterally for each dog. Lateral fluoroscopic images were obtained during treadmill walking and 3 complete gait cycles were analyzed. Stifle flexion/extension angle, craniocaudal translation, and internal/external rotation were calculated throughout the gait cycle using a previously described 3D-to-2D image registration process. Results were compared between the pre-operative CrCL-deficient and 6-month post-operative contralateral stifles (control).ResultsCrCL-deficient stifles were maintained in greater flexion throughout the gait cycle. Cranial tibial subluxation was evident in CrCL-deficient stifles at all time points throughout the gait cycle [9.7 mm at mid-stance (P < 0.0001); 2.1 mm at mid-swing (P < 0.0017)], and the magnitude of cranial tibial subluxation was greater at mid-stance phase than at mid-swing phase (P < 0.0001). Greater internal tibial rotation was present in CrCL-deficient stifles during stance phase (P < 0.0022) but no difference in axial rotation was evident during swing phase.ConclusionsNaturally occurring CrCL rupture causes profound craniocaudal translational and axial rotational instability, which is most pronounced during the stance phase of gait. Surgical stabilization techniques should aim to resolve both craniocaudal subluxation and axial rotational instability.

Innovative, intra-articular, prosthetic technique for cranial cruciate ligament reconstruction in dogs: a cadaveric study.

The purpose of this study was to describe and assess the feasibility of a new intra-articular approach in the treatment of cranial cruciate ligament deficiency in dogs using an artificial ligament and a new bone-anchor system. Twelve canine cadavers weighting 26 to 45 kg were used in this ex-vivo study. Special tibial and femoral screws, two helicoils, and a high resistance artificial fiber compose the implant. Surgery was performed using the cranio-lateral approach to the stifle joint. Helicoil and tibial screw, connected to the fiber, were inserted in the center of the tibial insertion area of the cranial cruciate ligament. The fiber was passed over-the-top, tensioned, and fixed to the femoral screw, previously inserted with the helicoil in the distal part of the femur. Surgery was completed in all the cases. Occasional problems found during the insertion of the helicoils and screws were resolved with simple procedures. Post-operative clinical assessment showed negative cranial drawer test, negative cranial tibial thrust, and normal range of motion. Radiographic evaluation showed an appropriate positioning of both tibial and femoral implants in all the cases. The results of the first surgical appraisal of this new technique are encouraging, although further studies are necessary to demonstrate the in vivo efficacy of this procedure.

Why Owners Choose an Orthosis Over Stifle Surgery for Canine Cranial Cruciate Ligament Deficiency

The objective of this study was to describe the patient population of dogs with cranial cruciate ligament (CrCL) deficiency that were prescribed a stifle orthosis. A total of 215 client-owned dogs with previously diagnosed CrCL deficiency were prescribed a stifle orthosis at a veterinary pain management and mobility clinic. Patient intake data collected included dog signalment, chief medical complaint, home environment and activity description, medical and surgical history, and diagnosing veterinarian. An orthopedic examination was conducted to assess pelvic limb function and determine pelvic limb morphologic measures. Spayed females (57.2%) were most common in our sample. Median age, body weight, and body condition score were 9.00 ± 3.23 years, 32.98 ± 13.37kg, and 6.00 ± 1.04, respectively. Most common breeds prescribed stifle orthoses included Labrador Retriever, Golden Retriever, and German Shepherd. Right and left limbs were equally affected, and 19.5% of dogs previously had stifle stabilization surgery. Primary reasons for seeking a stifle orthosis consultation were surgical concerns, advanced age, and surgery cost. Most common chief complaints included altered gait, decreased weight bearing, and pain following activity. Reduced stifle extension, increased cranial drawer score, and decreased 3-leg stance time characterized the CrCL-deficient stifle. Stifle orthosis represents an alternative approach to surgical stabilization and management of CrCL deficiency. CrCL-deficient dogs prescribed stifle orthoses were generally large breeds of advanced age with above ideal body condition score. Owners commonly sought a stifle orthosis for CrCL deficiency due to reservations regarding surgical management.

Aquatic treadmill water level influence on pelvic limb kinematics in cranial cruciate ligament-deficient dogs with surgically stabilised stifles.

To compare pelvic limb joint kinematics and temporal gait characteristics during land-based and aquatic-based treadmill walking in dogs that have undergone surgical stabilisation for cranial cruciate ligament deficiency. Client-owned dogs with surgically stabilised stifles following cranial cruciate ligament deficiency performed three walking trials consisting of three consecutive gait cycles on an aquatic treadmill under four water levels. Hip, stifle and hock range of motion; peak extension; and peak flexion were assessed for the affected limb at each water level. Gait cycle time and stance phase percentage were also determined. Ten client-owned dogs of varying breeds were evaluated at a mean of 55·2 days postoperatively. Aquatic treadmill water level influenced pelvic limb kinematics and temporal gait outcomes. Increased stifle joint flexion was observed as treadmill water level increased, peaking when the water level was at the hip. Similarly, hip flexion increased at the hip water level. Stifle range of motion was greatest at stifle and hip water levels. Stance phase percentage was significantly decreased when water level was at the hip. Aquatic treadmill walking has become a common rehabilitation modality following surgical stabilisation of cranial cruciate ligament deficiency. However, evidence-based best practice guidelines to enhance stifle kinematics do not exist. Our findings suggest that rehabilitation utilising a water level at or above the stifle will achieve the best stifle kinematics following surgical stifle stabilisation.

Second-look arthroscopic findings after CORA-based leveling osteotomy.

To describe the arthroscopic appearance of intra-articular structures mid-term (9 months) and long-term (>12 months) after CORA-based leveling osteotomy (CBLO). Case series. Dogs (n = 41) with second-look arthroscopy of the stifle after CBLO for treatment of a cranial cruciate ligament (CCL) deficiency. Both stifles were re-evaluated (stifles n = 42) in 1 dog. Medical records of dogs that had second-look arthroscopy after CBLO were reviewed. Arthroscopic images of the femoral condyles were independently reviewed. The surgical report documented the integrity of menisci and articular cartilage of the tibial plateaus. The population included 7 stifles with stable partial CCL tears, 35 stifles with complete CCL tears (n = 28), or incompetent partial CCL tears (n = 7). Median time to second look arthroscopy was 16 months (9-24 months) for stable partial tears. The CCL remained intact in 6 stifles. The Outerbridge score of the articular cartilage of the femoral condyles was as 0 (6) or 1 (1). The articular cartilage of the tibial plateaus appeared normal in all stifles. Median time to second look arthroscopy of stifles with complete tears was 12 months (range, 9-34 months). The caudal cruciate ligament was normal or mildly fibrillated. The appearance of the articular cartilage of the femoral condyles was scored as 0 or near normal (grade 1-2) in all dogs. The articular cartilage of the tibial plateaus appeared normal, except in 1 dog with grade 4 lesion. CBLO results in minimal to no change in articular cartilage in at a median time of 14 months after surgery. Postoperative clinical lameness is often attributed to late onset meniscal pathology.

Patellofemoral kinematics in dogs with cranial cruciate ligament insufficiency: an in-vivo fluoroscopic analysis during walking

BackgroundComplete rupture of the cranial cruciate ligament (CrCL) in dogs causes profound disturbance to stifle joint biomechanics. The objective of this study was to characterize the effects of cranial cruciate ligament (CrCL) insufficiency on patellofemoral (PF) kinematics in dogs during walking. Ten client-owned dogs (20-40 kg) with natural unilateral complete CrCL rupture were included. Dogs underwent computed tomographic scans to create digital bone-models of the patella and femur. Lateral projection fluoroscopy of the stifles was performed during treadmill walking. Sagittal plane PF kinematics were calculated throughout the gait cycle by overlaying digital bone models on fluoroscopic images using a previously described 2D-3D registration technique. For acquisition of kinematics in the contralateral (control) stifle, fluoroscopy was repeated 6-months after stabilizing surgery of the affected side. Results were compared between the pre-operative CrCL-deficient and 6-month post-operative control stifles.ResultsCraniocaudal PF translation was similar between CrCL-deficient and control stifles throughout the gait cycle. The patella was more distal and positioned in greater flexion throughout the gait cycle in CrCL-deficient stifles when compared to the control stifle at equivalent time points. There was no significant difference in PF poses between CrCL-deficient and control stifles at equivalent femorotibial flexion angles; however, common femorotibial flexion angles were only found over a small range during the swing phase of gait.ConclusionsCrCL insufficiency altered PF kinematics during walking, where the changes were predominately attributable to the femorotibial joint being held in more flexion. Abnormal PF kinematics may play a role in the development of osteoarthritis that is commonly observed in the PF joint CrCL-deficient stifles.

Factors contributing to the variability of a predictive score for cranial cruciate ligament deficiency in Labrador Retrievers

BackgroundWe recently reported that a conformation score derived from the tibial plateau angle (TPA) and the femoral anteversion angle (FAA), best discriminates limbs predisposed to, or affected by cranial cruciate ligament disease (CCLD), from those that are at low risk for CCLD. The specificity and sensitivity of this score were high enough to support further investigations toward its use for large-scale screening of dogs by veterinarians. The next step, which is the objective of the current study, is to determine inter-observer variability of that CCLD score in a large population of Labrador Retrievers. A total of 167 Labradors were enrolled in this cross-sectional study. Limbs of normal dogs over 6 years of age with no history of CCLD were considered at low risk for CCLD. Limbs of dogs with CCLD were considered at high risk for CCLD. Tibial plateau and femoral anteversion angles were measured independently by two investigators to calculate a CCLD score for each limb. Kappa statistics were used to determine the extent of agreement between investigators. Pearson’s correlation and intraclass coefficients were calculated to evaluate the correlation between investigators and the relative contribution of each measurement to the variability of the CCLD score.ResultsThe correlation between CCLD scores calculated by investigators was good (correlation coefficient = 0.68 p < 0.0001). However, interobserver agreement with regards to the predicted status of limbs was fair (kappa value = 0.28), with 37% of limbs being assigned divergent classifications. Variations in CCLD scores correlated best with those of TPA, which was the least consistent parameter between investigators. Absolute interobserver differences were two times greater for FAAs (4.19° ± 3.15) than TPAs (2.23° ± 1.91).ConclusionsThe reproducibility of the CCLD score between investigators is fair, justifying caution when interpreting individual scores. Future studies should focus on improving the reproducibility of TPA and FAA measurements, as strategies to improve the agreement between CCLD scores.

Use of a novel extracapsular bone anchor system for stabilisation of cranial cruciate ligament insufficiency.

To evaluate early clinical experiences using the novel extracapsular bone anchor Ruby system for stabilisation of the cranial cruciate ligament deficient stifle in the dog and report short-term outcome and complications for 17 clinical cases. Seventeen dogs with cranial cruciate ligament insufficiency were treated using the Ruby system. Dogs were eligible if diagnosed via orthopaedic examination with unilateral or bilateral cranial cruciate ligament instability without any comorbidities. Subjective lameness assessments on a 0 to 4 scale were made pre-operatively and at six to eight weeks post-operatively; complications were also recorded. Lameness was also assessed on a visual analogue scale at six to eight months post-operatively. All cases had substantial improvement in lameness following surgery. Mean post-operative lameness grade was 1·18 (±0·53) out of 4, compared to a grade of 3·06 (±0·9) before surgery, and owner assessment at six to eight months after surgery was also positive. There were major complications that required surgical intervention in one dog. The Ruby system is a feasible method of extracapsular stabilisation with comparable outcomes and complication rates to previously reported methods of addressing cranial cruciate ligament insufficiency. Further work is required to acquire more data on objective outcome measurement and mechanisms of failure.