Lateral Suture Technique Research Articles

Comparison of an intra-articular suture technique and a lateral suture technique in toy breed dogs with cranial cruciate ligament rupture

Comparison of an intra-articular suture technique and a lateral suture technique in toy breed dogs with cranial cruciate ligament rupture

Long-term clinical and goniometric follow-up of lateral suture surgery in dogs with cranial cruciate ligament rupture

The aim of this study was to evaluate the complications and the short-, medium-, and long-term outcomes following treatment of cranial cruciate ligament (CCL) rupture in dogs using the lateral fabello-tibial suture technique. The patients were ten dogs of various breeds, 62.5 ± 18.8 months of age, weighing 30.2 ± 3.3 kg, with unilateral CCL rupture. At 2, 6, 12, 24, and 52 weeks after surgery, the dogs were re-evaluated with clinical examination, gait and pain analysis, and radiography. A major complication was identified in one dog (10%), requiring second surgery due to implant failure and destabilisation of stifle joint. Minor complications occurred in two dogs postoperatively (one late meniscal injury and one case of seroma formation). The short-term outcome at two and six weeks postoperatively was considered good in six dogs and satisfactory in four dogs, while the mid-term outcome (between 12 and 24 weeks) was good to excellent in eight dogs and satisfactory in two dogs. All ten dogs had a good to excellent outcome 52 weeks after surgery. The lateral suture technique is generally safe and given the major benefits, such as lower costs, lower technical difficulty, and minimal requirement for specialised equipment, will probably remain a popular and alternative method for treatment of CCL insufficiency in dogs with good degree of owner satisfaction.

Treatment of cranial cruciate ligament rupture in the feline stifle. Biomechanical comparison of a standard fabella-tibial suture and lateral sutures placed between quasi-isometric points.

To determine whether a lateral suture placed with bone anchors between quasi-isometric points in a cat is superior to a standard fabella-tibial suture for the stabilization of cranial cruciate ligament (CrCL) rupture compared to an intact stifle joint. Biomechanical cadaveric study. Six stifle joints with intact cruciate ligaments from three skeletally mature cats were placed in a loading mounting set and tested with axial loads of 20N and 60N at three different joint angles (75°,130° and 160°). The procedure was repeated with a transected CrCL; a stabilized stifle joint after a combination of three lateral suture techniques (fabella-tibial suture technique [SFT]; femoro-tibial suture technique 1 [FTS-1] and femoro-tibial suture technique 2 [FTS-2]). Radiographic examination of the relative position of the tibia to the fixed femur was compared. Stabilization of the stifle joint with lateral sutures had comparable stability to the intact specimens in the cranio-caudal direction (p = 0.2) but not in the proximo-distal direction for the SFT (p = 0.04) and FTS-2 technique (p = 0.03). There was no significant difference between the three stabilization techniques (p >0.05). Lateral sutures placed with bone anchors at quasi-isometric points performed better than SFT and FTS-2 in stabilizing the feline stifle after CrCL rupture in the proximo-distal plane. Biomechanical stability in the cranio-caudal plane after placement of a lateral suture across the feline stifle was similar to the intact CrCL.

The Effects of Extra‐Articular Suture Tension on Contact Mechanics of the Lateral Compartment of Cadaveric Stifles Treated with the TightRope CCL®or Lateral Suture Technique

To determine the effect of suture tension on contact pressures in the lateral compartment of the stifle for the TightRope CCL((R)) (TR) and circumfabellar-tibial suture (LS) techniques. Ex vivo biomechanical study. Pelvic limbs (n=12) from dogs weighing 21-24 kg. A pressure sensor was used to record peak contact pressure (PCP) and mean contact pressure (MCP) and contact area (CA) in limbs mounted in a materials testing machine. Stifles were stabilized using either a TR or LS technique and the prosthesis was tensioned increasingly from 25 to 70 N. PCP, MCP, and CA were collected at each applied tension before and after applying an axial load of 150 N. In the unloaded condition, LS stabilization resulted in a significant increase (P=.034) in PCP at >or=40 N tensions, whereas TR stabilization resulted in a significant increase (P=.047) in PCP at 70 N tension. There was a significant increase in CA at tensions >or=60 N in the LS group. No effect on MCP was noted. No significant differences in contact pressures were observed in the loaded condition. There were no significant differences in normalized PCP and CA between stabilization groups at any of the tension increment. The application of high tension to the extra-articular prosthesis alters lateral compartment contact pressures in the unloaded stifle in this ex vivo model. Over tightening of an extra-articular prosthesis may increase lateral compartment pressure at the time of surgery. The clinical implications of this finding are unknown, as weight bearing may negate any detrimental effect of high prosthesis tension.

Relationship of Tibial Plateau Slope to Limb Function in Dogs Treated with a Lateral Suture Technique for Stabilization of Cranial Cruciate Ligament Deficient Stifles

To evaluate the effect of a lateral suture technique (LST) on tibial plateau angle (TPA) measurement and to compare TPA with functional outcome in dogs treated for cranial cruciate ligament (CrCL) rupture with LST. Prospective clinical study. Dogs (n=34) with unilateral CrCL instability. All dogs had lameness examination, survey stifle radiographs, and force plate analysis before and at 6, 12, 24, and 48 weeks after surgery. Radiographic osteoarthritis (OA) scores and lameness scores were assigned using previously reported methods. Preoperative radiographs were performed in all dogs, and postoperative serial radiographs were performed in 6 dogs for measurement of TPA. Differences in TPA measurements were evaluated with a random effects repeated measures model. The significance of LST on TPA measurement was established in 6 dogs and the effect of TPA on vertical impulse, peak vertical force, progression of radiographic scores, and lameness score were analyzed by general linear models in all dogs. Differences were considered significant if P<.05. Significant differences were not noted between pre- and serial postoperative measurements of TPA. A significant correlation was not established between TPA and postoperative vertical impulse, peak vertical force, lameness score, or radiographic OA scores. TPA values were unchanged after LST and TPA does not affect outcome measures in dogs treated with LST. TPA has no predictive value on clinical outcome in dogs treated with LST for stabilization of CrCL deficient stifles.

Injuries of the inferior vena cava

Injuries of the IVC, whether caused by blunt or penetrating mechanisms, are usually fatal. Patients who arrive in shock and fail to respond to initial resuscitative measures, those who are still actively bleeding at the time of laparotomy, and those with wounds of the retrohepatic vena cava have a low probability of survival. Death most commonly is caused by intraoperative exsanguination. Knowledge of the anatomy and exposure techniques for the five different segments of the intra-abdominal vena cava is very important to trauma surgeons. Although some wounds of the vena cava, especially those of the retrohepatic vena cava, are best left unexplored, most injuries inferior to this level can be exposed and repaired by lateral suture technique. Preservation of a lumen of at least 25% of normal is probably important in the suprarenal vena cava but is of no provable value inferior to the renal veins. No evidence supports the need to expose and repair vena caval wounds that have spontaneously stopped bleeding. Such wounds, especially in the retrohepatic area, may be managed expectantly provided that there is no strong suspicion of an associated injury to a major artery or hollow viscus.