Cranial Cruciate Ligament Rupture Research Articles

Single-stage Bilateral Tibial Tuberosity Advancement With Cranial Fixation in an English Bulldog – A Case Report

This article presents a report of single-stage bilateral tibial tuberosity advancement for the treatment of cranial cruciate ligament rupture in an English bulldog. The reconstruction was performed by a new surgical technique involving tibial tuberosity advancement and fixation with two cranially placed lag screws. The patient was able to ambulate normally at a walk without lameness four days postoperatively. Except for bruising of the surgical site, no complications were observed during a six-month follow-up period.

Evaluation, Description of the Technique, and Clinical Outcomes After Tibial Tuberosity Advancement With Cranial Fixation (TTA CF) for Cranial Cruciate Ligament Rupture in 22 Dogs

The objective of this study is to describe a modified surgical technique for tibial tuberosity advancement with cranial fixation (TTA CF) in dogs with cranial cruciate insufficiency and to report long term clinical outcomes and complications.TTA CF was performed with a novel titanium implant. A description of the specific implant with guide, drill and saw guide, instrumentation, and template are provided, along with clinical outcomes, complications, owners’ evaluation, and a 1-year postoperation follow-up.Twenty two mixed breed dogs, with a median body weight of 23 kg (range, 11-45 kg) were included. The median age at surgery was 4 years (range, 1-8 years). Clinical bone healing was seen at a mean 10 weeks (range 6-14 weeks). The minor complication rate was 27% (n = 6). No major complication occurred, and no revision surgery was required. Twenty-one (95%) dogs had a good to excellent outcome 1 year after surgery. Currently there is no accepted best treatment of the canine cranial cruciate ligament deficient stifle. Most of TTA techniques are based on fixing the implant from the medial side of tibia. We report a modified TTA technique with cranial fixation of a titanium implant and suggest that the TTA CF surgical technique may be a feasible alternative to existing surgical procedures.

Factors associated with early tibial tuberosity fracture after tibial plateau leveling osteotomy.

To determine factors contributing to tibial tuberosity fracture (TTF) after tibial plateau leveling osteotomy (TPLO). Retrospective case-control study. Dogs (n = 2490) with cranial cruciate ligament rupture that underwent 3000 TPLO surgeries. Radiographs of 3000 stifles from dogs that underwent TPLO were reviewed for evidence of TTF. Two ratios were generated: (1) the height of the tuberosity over the width of the tibia at the most distal extent of the osteotomy (TW) and (2) the width of the narrowest point of the tuberosity over TW. Twenty-three (0.77%) cases of fracture were identified. Factors that correlated with increased odds of fracture were placement of antirotational pins distal to the insertion of the patellar ligament (PL), tuberosities with the narrowest point below the insertion of PL, placement of multiple pins distal to the PL, and bilateral simultaneous TPLO. Tuberosities that fractured were significantly taller and narrower than those that did not fracture. Rotation past the "safe point" and presence of a gap at the osteotomy were not correlated with fracture. Placement of multiple pins, pin placement distal to the insertion of the PL, location of the narrowest point of the tibial tuberosity distal to the insertion of the PL, and simultaneous bilateral TPLO were all associated with TTF in this study CLINICAL SIGNIFICANCE: Preoperative planning and postoperative assessment of TPLO should take into consideration the predisposing factors identified in this study to prevent TTF.

Average Tibial Plateau Angle of 3,922 Stifles Undergoing Surgical Stabilization for Cranial Cruciate Ligament Rupture

Average Tibial Plateau Angle of 3,922 Stifles Undergoing Surgical Stabilization for Cranial Cruciate Ligament Rupture

Mesenchymal stem cells in osteotomy repair after tibial tuberosity advancement in dogs with cranial cruciate ligament injury

BackgroundThe cranial cruciate ligament rupture (CCLR) is the most commonly encountered orthopedic condition in dogs. Among the various techniques to treat this condition, tibial tuberosity advancement (TTA) has been used to obtain rapid recovery of the affected knee. The objective of this study was to evaluate the viability of the use of mesenchymal stem cells (MSC) implanted in the osteotomy site obtained by TTA in nine dogs diagnosed with CCLR.MethodsThe MSC were isolated from the adipose tissue of the dogs and cultured for eight days, the animals were divided into two groups. Animals from the treated group (GT) received cell transport medium containing about 1.5 millions MSC, and the animals from the control group (GC) received only the cell transport medium. The study was performed in a double-blind manner using radiographs acquired on days 15, 30, 60 and 120 after the procedure. Evaluations of the density of the trabecular bone were performed using image analysis software. The results were subjected to descriptive statistical analysis, followed by the normality test, Chi-square test, Mann-Whitney test and Tukey’s multiple comparison test for p ≤ 0.05.ResultsAfter 30 days of the procedure, the animals of the GT presented an ossification mean 36.45% greater (p ≤ 0.033) than the GC, and there were no statistical differences for the other periods.ConclusionsDespite the total bone ossification within the expected period, there was no minimization of the estimated recovery time with the application of MSC, and inflammatory factors should be considered for reassessment of the therapeutic intervention time.

Radiographic assessment of the proximal tibial angles in dogs and cats with and without cranial cruciate ligament rupture

ABSTRACT: The influence of the proximal tibial angles in the cranial cruciate ligament (CCL) rupture in dogs is still controversial, and little is known regarding this topic in cats. The aim of this study was to evaluate and compare the angles of the proximal portion of the tibia in dogs and cats with and without CCL rupture. Retrospective and prospective radiographs of the stifle joints were obtained and divided into four groups. Group 1 was composed of 70 stifle joint images of dogs without orthopedic disorders (healthy dogs), group 2 had 70 stifle joint images of dogs with CCL rupture, group 3 had 50 stifle joint images of cats without orthopedic disorders (healthy cats) and group 4 had 25 stifle joint images of cats with CCL rupture. Radiographs were taken with the stifle joint in the mediolateral projection, positioned at the angle of hind limb support. Between the two groups of dogs evaluated, the dogs with CCL rupture had statistically greater tibial plateau angle (TPA) compared with healthy dogs. No difference was shown in relation to the TPA between healthy cats and cats with CCL rupture. In relation to the patellar ligament angle by tibial plateau method the values for the healthy dogs were significantly higher than those for the CCL ruptured dogs. Similarly, healthy cats had significantly higher mean values than cats with CCL rupture. In the patellar ligament angle by common tangent method there was no significantly difference between the two groups of dogs. Between the two groups of cats, animals with CCL rupture had statistically higher mean values than healthy cats. In general, the groups of dogs showed higher mean values than the groups of cats. For the patellar ligament insertion angle (PLIA) healthy dogs showed a significantly higher mean than dogs with CCL rupture. There was no significant difference between the groups of cats. In conclusion, the TPA and the PLIA possibly influence the etiology of CCL rupture in dogs but not in cats. The low patellar ligament angle measured by common tangent method may favorably influence the reduced incidence of CCL rupture in cats.

Suture attachment sites on stifle joint of small and large dog breeds for cranial cruciate ligament rupture repair

Suture attachment sites on stifle joint of small and large dog breeds for cranial cruciate ligament rupture repair

Effects of low‐intensity pulsed ultrasound on radiographic healing of tibial plateau leveling osteotomies in dogs: a prospective, randomized, double‐blinded study

To determine the influence of low-intensity pulsed ultrasound (LIPUS) on radiographic healing and limb function after uncomplicated, stable osteotomies in dogs. In vivo, prospective, randomized, double-blinded, placebo-control study. Fifty client-owned dogs. Fifty client-owned dogs with naturally occurring unilateral cranial cruciate ligament rupture were enrolled prior to tibial plateau leveling osteotomy. Dogs were assigned to an active (LIPUS) treatment group or a placebo control (SHAM) treatment group via block randomization on the basis of age, weight, and affected limb. Dogs in the LIPUS treatment group underwent LIPUS treatments for 20 minutes daily: 1.5-MHZ ultrasound wave pulsed at 1 kHZ with a 20% duty cycle at an intensity of 30 mW/cm2 for the duration of the study (12 weeks). Radiographic evaluation was performed at 4, 8, 10, and 12 weeks postoperatively to evaluate bone healing. Limb function was assessed with temporal-spatial gait analysis preoperatively and at 4, 8, and 12 weeks postoperatively by using a pressure-sensitive walkway system. Both groups had significant improvement in radiographic score and limb use over time. However, there was no significant difference in radiographic bone healing, or limb use as measured by objective gait analysis detected between the LIPUS treatment group and SHAM treatment group at any point in the study. LIPUS treatment did not improve healing in this stable osteotomy model. This study does not provide evidence to support the clinical application of LIPUS to stimulate the healing of stable, uncomplicated osteotomies to accelerate bone healing.

Arguments for selecting the surgical method for the treatment of cranial cruciate ligament rupture in dogs

The investigation of specialized literature on surgical treatment options for cranial cruciate ligament rupture in dogs (LCrC) remains a preoccupation in these conditions of information abundance. The purpose of the present study was to analyze the evidence in the literature that advocates concrete evidence in favor of/detrimental to a particular method of treating LCrC rupture in a dog.

Once daily oral extended-release hydrocodone as analgesia following tibial plateau leveling osteotomy in dogs.

To determine the efficacy of oral extended-release hydrocodone compared with oral firocoxib for analgesia following tibial plateau leveling osteotomy surgery in dogs in a hospital setting. Prospective, randomized, blinded, clinical trial. Thirty-six client-owned dogs weighing 25-43 kg with unilateral hindlimb lameness and cranial cruciate ligament rupture. Dogs were assigned to 1 of 2 groups (n = 18/group). Group 1 received hydrocodone 3 mg/kg orally every 24 hours, and group 2 received firocoxib 5 mg/kg orally every 24 hours. Both hydrocodone and firocoxib (according to group assignment) were provided as preemptive analgesia 10 hours before induction to anesthesia and then every 24 hours for the remainder of the study period The level of analgesia was compared between treatments on the basis of a modified Glasgow Composite Pain Score (mGCPS) in each dog, the number of dogs requiring rescue analgesia (hydromorphone 0.05 mg/kg subcutaneously), pressure platform stance data, and number of adverse events. Nine of 18 dogs that received hydrocodone and 2/18 dogs that received firocoxib had an mGCPS ≥6 (P = .02). Two dogs had an mGCPS ≥6 three times, and 1 had an mGCPS ≥6 two times; all 3 of these dogs were in the hydrocodone group. Average postoperative peak pressure placed on the affected limb was lower in dogs that received hydrocodone (P = .01). Regurgitation and decreased appetite were more common in the dogs that received hydrocodone. Dogs that were treated with hydrocodone exhibited higher pain scores and lower limb function than dogs treated with firocoxib under the conditions of our study. Our results do not provide evidence to justify the administration of extended-release hydrocodone at 3 mg/kg orally every 24 hours rather than firocoxib at 5 mg/kg orally every 24 hours in dogs undergoing tibial plateau leveling osteotomy.

Use of proteomic analysis to determine the protein constituents of synovial fluid samples from the stifle joints of dogs with and without osteoarthritis secondary to cranial cruciate ligament rupture.

OBJECTIVE To use proteomic analysis to determine the protein constituents of synovial fluid samples from the stifle joints of dogs with and without osteoarthritis secondary to cranial cruciate ligament rupture (CCLR). ANIMALS 12 dogs with clinically normal stifle joints (controls) and 16 dogs with osteoarthritis secondary to CCLR. PROCEDURES A synovial fluid sample was obtained from all dogs. Synovial fluid total protein concentration was determined by the Bradford assay. Proteins were separated by use of a 1-D SDS-PAGE to detect protein bands that differed between dogs with and without osteoarthritis. Those protein bands then underwent trypsin digestion and were analyzed by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry, the results of which were compared with a curated protein sequence database for protein identification. One of the most frequently identified proteins, apoprotein (apo) A-I, was then quantified in all synovial fluid samples by use of a competitive-inhibition ELISA. Results were compared between dogs with and without osteoarthritis. RESULTS Median synovial fluid total protein and apo A-I concentrations for dogs with osteoarthritis were significantly greater than those for control dogs. The most abundant proteins identified in the synovial fluid were albumin and apo A-I. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that quantification of synovial fluid total protein and apo A-I concentrations might facilitate diagnosis of osteoarthritis secondary to CCLR in dogs. Further research and validation of synovial fluid apo A-I concentration as a biomarker for osteoarthritis in dogs are necessary before it can be recommended for clinical use.

Posturography and dynamic pedobarography in lame dogs with elbow dysplasia and cranial cruciate ligament rupture

BackgroundThe usefulness of studying posture and its modifications due to locomotor deficiencies of multiple origins has been widely proven in humans. To assess its suitability in the canine species, static posturography and dynamic pedobarography were performed on lame dogs affected with unilateral elbow dysplasia and cranial cruciate ligament rupture by using a pressure platform. With this objective, statokinesiograms and stabilograms, the percentage of pressure distribution between limbs, paw area, mean pressure, and peak pressure, were obtained from lame and sound dogs. These data were compared with Peak Vertical Force values originated from a force platform in the same recording sessions.ResultsSignificant differences were found in the parameters mentioned above between sound and lame dogs and limbs.ConclusionsPosturography and pedobarography are useful and reliable for the monitoring of fore and hindlimb lameness in dogs, providing a new set of parameters for lameness detection.

Treatment Options for Cranial Cruciate Ligament Rupture In Dog - A Literature Review

Treatment Options for Cranial Cruciate Ligament Rupture In Dog - A Literature Review

Effect of leukocyte-reduced platelet-rich plasma on osteoarthritis caused by cranial cruciate ligament rupture: A canine gait analysis model.

The goal of this study was to objectively assess the effect of a platelet-rich plasma (PRP) derivate in English bulldogs with stifle degenerative joint disease secondary to cranial cruciate ligament rupture (CCLR). We used a force platform and affixed electrogoniometers to measure peak vertical force (PVF), vertical impulse (VI), stance time (ST), and angular range of motion (AROM), from 12 lame client-owned English bulldogs with post-CCLR stifle joint abnormalities. The 12 affected subjects were treated with 4 intra-articular injections of PRP, at 30-day intervals. Ten untreated, sound English bulldogs were used as a reference group. Clinical outcomes were evaluated using a linear mixed effects model. Mean values of PVF, VI, ST, and AROM were improved within the first 3 months post-treatment in the CCLR group, with mean measured changes increasing to maximum 4.56% body weight gain, 1.5% body weight/second, 0.07 seconds, and 6.18 degrees, respectively. The effects declined progressively after the treatment interval, ending at nearly initial levels after 6 months. This study demonstrates that dogs with CCLR treated with intra-articular PRP had improved PVF, VI, ST, and AROM over time; the duration of effect was waning by the end of the post-treatment period.

Short-term evaluation of an intra-articular technique for cranial cruciate ligament rupture in dogs using nylon or polyester

Cranial cruciate ligament rupture (CCrLR) is a common condition found in the small animal routine, being correlated to traumas, obesity, genetic factors, and primary osteoarthritis (OA) in dogs. Affected animals show articular instability that, if not corrected surgically, may cause secondary OA and loss of limb function. The aim of this study was to compare short-term results of the intra-articular technique for knee stabilization after CCrLR using a surgical button associated with polyester yarn (Group A), the surgical button associated with nylon yarn (Group B), and surgical toggle associated with polyester yarn (Group C). Eighteen dogs presenting CCrLR, weight varying from 5 to 35 kg, and different sex and breed were divided into three groups of six individuals. OA radiographic grade, pre- and post-operative lameness, surgical time, and the macroscopic aspect of cartilage were assessed. The intra-articular technique was performed by passing a suture through two tunnels, drilled in the femoral condyle and tibial crest to stabilize the knee joint. Twelve animals presented a decreased lameness and normal limb function after 15 days. On the other hand, four dogs from Group B presented complications: two dogs had suture rupture after 30 days and other two showed muscular contracture with decreased range of motion, followed by loss of limb function. In Group A, one dog showed suture rupture after 15 days and other had suture infection after 30 days. In Group C, dogs recovered normal limb function without complications. Therefore, surgical toggle associated with polyester yarn was better than the other studied materials.

Intraobserver and interobserver agreement on the radiographical diagnosis of canine cranial cruciate ligament rupture

Even though radiography is one of the most frequently used imaging techniques for orthopaedic disorders, it has been demonstrated that the interpretation can vary between assessors. As such, the purpose...

Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°

Tibial plateau levelling osteotomy (TPLO) is commonly performed for surgical management of cranial cruciate ligament (CCL) disease. It has been suggested that small dogs may have steeper tibial plateau angles...

Technique of Tibial Tuberosity Transposition and Advancement (TTTA) With Use of TTA-Maquet Cage-Only in Dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinary technique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibial tuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition and advancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatment of a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in the left pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests, and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographs of the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurements were taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and a titanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity with the aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and the cage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tapping cortical screws. At the moment of the cage attachment to the tibial tuberosity, orthopedic washers of 2 mm wide were placed between the cranial ears of the cage and the tibial tuberosity, thus promoting a lateral transposition of the tibial tuberosity. The patient was maintained in the early postoperative period with Robert Jones bandage, and with antibiotic, analgesic and anti-inflammatory drugs. On the second day after the procedure partial limb support with presence of mild lameness was observed. At three months postoperatively, the animal had no claudication and MPL was corrected. The radiographic examination showed the proper process of bone repair at the osteotomy site. In the clinical evaluation performed at one year after surgery the patient was in good condition without lameness and with proper limb support and muscular gain.Discussion: The studies that evaluated the association of tibial tuberosity transposition and tibial tuberosity advancement techniques (TTTA) for the simultaneous treatment of MPL and CCL rupture demonstrated that this is a viable and effective procedure. In this report, the accomplishment of tibial osteotomy based on the Maquet hole and the advancement of the tibial tuberosity with the TTA-Maquet cage-only allowed the dynamic stabilization of the CCL deficient stifle and the early use of the affected limb. In addition, the TTTA technique proved to be effective for the correction of grade 3 of MPL in a large dog, allowing adequate recovery of the limb function without complications during a one year evaluation period.

Patellar luxation and articular lesions in dogs: a retrospective: study research article

ABSTRACT This study describes lesions that occur in the stifle joints of dogs with patellar luxation. These lesions are associated with the animal’s age, body weight, and degree of luxation. The rate of redislocation was also evaluated. The patellar lesions found include articular cartilage erosion, subchondral bone exposure, a flattened or concave patellar surface, and enthesophytes. Extra-patellar lesions included synovitis, osteophytes, blunting of the trochlear groove, an absent trochlea, erosion of the condylar margins, capsule thickening, a long digital extensor tendon injury, cranial cruciate ligament rupture, and meniscal prolapse. Such lesions were frequently found in animals with Grade II or III luxation who were aged 24 months or more, and they were more severe in dogs weighing more than 15 kg. Patellar luxation causes changes that favor articular degeneration and should be treated surgically. Conservative treatment relieves pain, but does not address tissue alterations.

Cranial cruciate ligament structure in relation to the tibial plateau slope and intercondylar notch width in dogs.

Cranial cruciate ligament (CCL) rupture is one of the most common orthopedic conditions in dogs. The pathogenesis of CCL rupture is not fully described and remains to be elucidated fully. Several hypotheses have been proposed to explain the etiology of these changes. The objective of this study was to investigate structural changes in the CCL in relation to the tibial plateau angle (TPA) and the intercondylar notch (ICN) width in dogs. Fifty-five skeletally mature dogs were included in this study. ICN width and TPA measurements were obtained from intact CCL stifles. Samples of the CCL, caudal cruciate ligament (CaCL), and femoral head ligament (FHL) were harvested and stained for routine histological and immunohistochemical analysis. Microscopic changes in the ligaments were observed and were found to correlate with the TPA and ICN width values. The degree of structural changes within the CCL was observed to correlate with an increasing TPA and a narrowing ICN width. Changes in the CCL are likely to be caused by excessive forces acting through the ligament in stifles with a high TPA. Chondroid metaplasia of the CCL is an adaptation to abnormal mechanics within the stifle joint caused by altered bone morphology.