Stifle Joints Of Dogs Research Articles

Low-Field Magnetic Resonance Imaging for the Detection of Medial Meniscal Lesions in Cranial Cruciate-Deficient Stifle Joints in Dogs.

The aim of this study was to substantiate the ability of noninvasive low-field magnetic resonance imaging (lfMRI) to accurately depict meniscal lesions, thereby establishing lfMRI as a viable option for the diagnosis of meniscal pathology. This was a prospective, controlled study. In each of 57 stifle joints, 5 predefined lfMRI sequences using a 0.25 T lfMRI were used. The scans were evaluated by an experienced surgeon (DECVS) and through external assessment by a radiologist (DECVDI). The patients were divided into two groups depending on their meniscal status after lfMRI. Dogs (Group 1; n = 33) without lfMRI evidence of medial meniscal pathology underwent TPLO, whereas concurrent craniomedial mini-arthrotomy was performed in patients with suspected meniscal lesions (Group 2; n = 24). Gait assessment was performed 6 weeks later and 6 months postoperatively. Cohen's kappa value of 0.8571 corresponds to a high level of agreement between the observers. A significant correlation was found between preoperative lameness severity and intraoperative meniscal damage (p < 0.04). The results showed a highly significant correlation between meniscal injuries on MRI and intraoperative findings (p < 0.0001). LfMRI appears to be a noninvasive, reliable imaging tool for the detection of medial meniscal lesions in cranial cruciate-deficient stifle joints, aiming to avoid (minimally) invasive diagnostics in healthy menisci.

Anatomical study of stifle joint in dogs

The stifler is one of the hindlimb joints, described as complicated join consisting of many structures that organized in accurate way to support and stabilize body and hindlimb during the movement. The stifle joint of dogs, equivalent to the knee joint in the human, is a complex composition comprising the tibia, patella femur, menisci, caudal and cranial cruciate ligaments, lateral and medial collateral ligament, also surrounding muscles like hamstring and quadriceps muscles. The long bones (tibia and femur) form this joint, while patella sits in front of it to protect it. The two C-shaped menisci act as shock absorbers, and the supporting ligaments including collateral and cruciate provide stability to the joint. The surrounding muscles, including the quadriceps and hamstring muscles, help to extend and flex the joint, respectively. Together, these structures work in harmony to allow for the complex movement of dogs’ stifle joint.&#x0D; Understanding the anatomical features of the stifle joint in dogs is important for diagnosing and treating injuries or conditions that affect this complex joint

Degree of osteophyte formation seen on radiographs provides useful prognostic information for dogs with cruciate ligament disease.

Concurrent osteoarthritis is generally present in the stifle joints of dogs with cranial cruciate ligament disease (CCLD), but it is not known if the degree of osteoarthritis-related changes affects the prognosis. Development of osteophytes is a key radiographic feature of osteoarthritis. The aim of this study was to evaluate the association between the degree of osteophyte formation seen on radiographs and CCLD-related euthanasia in dogs with CCLD. A retrospective cohort study including 226 dogs treated for CCLD at two university animal hospitals was performed. Clinical and follow-up information was retrieved, and stifle radiographs taken during the 31 days before treatment for the CCLD were graded for osteophyte formation by three veterinary radiologists. A multivariable Cox proportional hazards model was applied to assess the association between the degree of osteophyte formation and CCLD-related euthanasia. An association between the degree of osteophyte formation and CCLD-related euthanasia was found, with increased osteophyte formation associated with an increased hazard of CCLD-related euthanasia (hazard ratio 1.06, 95% confidence interval 1.01-1.11, p = 0.01). No clinical assessment of the outcome was performed. The findings suggest that evaluation of stifle radiographs for osteophyte formation could provide useful prognostic information for dogs with CCLD.

The Effect of Increasing Tibial Tuberosity Advancement and Quadriceps Muscle Force on Cranial Translation of the Tibia in the Cranial Cruciate Deficient Stifle Joint in Dogs.

BackgroundCranial cruciate ligament (CCL) disease is a well-known pathology that generates both rotational and translational instability of the stifle joint that leads to osteoarthritis in dogs. Tibial tuberosity advancement (TTA) is a common surgical technique used to dynamically neutralize the tibiofemoral shear forces to achieve stifle joint stability. However, significant persistent instability has been documented in clinical cases. The purpose of this study was to evaluate the effect of increasing quadriceps load, increasing tibial tuberosity advancement, and increasing joint flexion angle on the cranial translation of the tibia relative to the femur in the cranial cruciate ligament deficient stifle joint.Methods and ResultsSix cadaveric hind limbs were collected from six healthy mixed breed dogs of medium build and prepared for biomechanical testing. The specimen was placed into a custom-made joint testing machine, and translation of the tibia relative to the femur was measured at stifle angles of 135°, 120°, and 105°. Cranial tibial thrust was generated by applying a vertical load to the metatarsal pad and the quadriceps muscle was simulated with loads of 0, 5, and 10 kg applied to the patella via a system of weights and pulleys. All specimens were tested with the CCL intact and cut, both of which served as controls. The tibial tuberosity was then advanced using both 6 mm and 9 mm cages, and the specimen was tested using the identical technique. Each specimen was loaded to failure by increasing the load applied to the pes until the sudden marked cranial translation of the tibia. Tibial tuberosity advancement with an applied quadriceps load was successful in limiting cranial tibial translation in 54/62 tests. Under similar loading conditions, TTA failed to limit cranial translation in 8 tests. The failures occurred at all angles of flexion examined. In the cases that failed cranial translation could be limited by either increasing the quadriceps load or increasing the amount of tibial tuberosity advancement.ConclusionThis study showed that TTA with an applied quadriceps load is effective at decreasing cranial tibial translation at functional joint angles.

Thermographic Evaluation of the Duration of Skin Cooling After Cryotherapy in Dogs Following Tibial Plateau Leveling Osteotomy Surgery.

ObjectiveTo evaluate the duration of cooling after cryotherapy on the skin over stifle joints in dogs after tibial plateau leveling osteotomy (TPLO) surgery using thermography.Materials and MethodsSeventeen client-owned dogs of various breeds were enrolled in the study. Dogs underwent TPLO surgeries, and on the next day, thermal imaging was performed on the operated stifle prior to cryotherapy for baseline. Orthogonal views were repeated at 30-min intervals until the skin over the stifle had thermally equilibrated. An ice pack was applied for 20 min on the medial and lateral aspects of the stifle. Each stifle was then re-imaged every 15 min for the first 60 min then every 30 min subsequently until the temperature was within 1°C of the pre-cryotherapy temperature.ResultsMean skin temperature of the medial view showed no significance difference compared to baseline value at 45 min after cryotherapy was discontinued and after 60 min for the lateral and cranial views. Mean skin temperature was overall higher in the medial view compared to the lateral and cranial during the rewarming period (except immediately after cold application). Mean skin temperatures of all views combined showed a significant decrease in temperature during cryotherapy application, with a slow increase until a plateau was reached after 45 min of rewarming.Conclusions and Clinical RelevanceDogs undergoing TPLO for cranial cruciate ligament injury showed quicker rewarming period of superficial tissues compared to previous studies. Cryotherapy is a beneficial modality to reduce superficial tissue temperature in dogs undergoing TPLO, acknowledging that these dogs may require more frequent cryotherapy post-operatively due to more rapid rewarming time compared to dogs without surgery.

Immunoexpression of Relaxin and Its Receptors in Stifle Joints of Dogs with Cranial Cruciate Ligament Disease.

Simple SummarySpontaneous cranial cruciate ligament rupture is one of the most frequently encountered joint diseases in dogs, often leading to disabling chronic progressive osteoarthritis. The cause of the progressive intra-articular collagen matrix degradation, leading to tear and mechanical failure, is unknown. A variety of contributing factors has been found, however, an initiating mediator triggering the collagen degrading cascade remains to be identified. Our finding of strong relaxin- and relaxin receptor expression on intra-articular target tissues, such as on ligament fibrocytes and synovial membranes, renders relaxin a candidate for pathogenetic involvement, for collagen lysis, and progressive ligament fiber disruption. If confirmed, this opens the way for medical treatment of the disease in its early stages. In addition, further proof of relaxin involvement in canine osteoarthritis and ligament rupture would constitute a useful spontaneous animal model for human disease.The etiology of spontaneous cranial cruciate ligament rupture in dogs is unknown despite being one of the most impacting orthopedic diseases in dogs. Numerous studies have contributed to the understanding of a multifactorial pathogenesis, this, however, without identifying a pivotal link to explain progressive collagen degeneration and osteoarthritic changes. In human medicine, recent reports have identified relaxin as a triggering factor in ligament ruptures in knee and metacarpal joints. We thus hypothesized that relaxin might also play a role in canine cruciate ligament rupture. Relaxin’s primarily known property is connective tissue remodeling through collagenolysis. We therefore investigated relaxin and its cognate receptors LGR7/LGR8 in 18 dogs with cranial cruciate ligament disease (CCLD) and compared them to a group of dogs with normal stifle joints. Applying immunohistochemistry (IHC), double immunofluorescence (dIF), and western blot analysis (WB), we found strong and significantly increased expression of both relaxin and its receptors in ruptured cruciate ligaments, and in synovial membranes. Pattern of immuno-staining on dIF strongly suggests relaxin binding to primed receptors and activation of signaling properties, which in turn may have affected collagen matrix metabolism. Thus, in canine cranial cruciate ligament disease, relaxin/receptor signaling may be a primary trigger for collagen fiber degradation and collagen lysis, eventually followed by ligament rupture.

Investigation of the effects of excessive tibial plateau angle and changes in load on ligament tensile forces in the stifle joints of dogs.

To investigate the effect of an excessive tibial plateau angle (TPA) and change in compressive load on tensile forces experienced by the cranial cruciate, medial collateral, and lateral collateral ligaments (CCL, MCL, and LCL, respectively) of canine stifle joints. 16 cadaveric stifle joints from 16 orthopedically normal Beagles. Stifle joints were categorized into unchanged (mean TPA, 30.4°) and excessive (mean TPA before and after modification, 31.2° and 41.1°, respectively) TPA groups. The excessive TPA group underwent a TPA-increasing procedure (curvilinear osteotomy of the proximal aspect of the tibia) to achieve the desired TPA. A robotic system was used to apply a 30- and 60-N compressive load to specimens. The craniomedial band of the CCL, caudolateral band of the CCL, MCL, and LCL were sequentially transected; load application was repeated after each transection. Orthogonal force components were measured in situ. Forces on ligaments were calculated after repeated output force measurements as the contribution of each component was eliminated. Increasing the compressive load increased tensile forces on the craniomedial and caudolateral bands of the CCL, but not on the MCL or LCL, in specimens of both groups. At the 60-N load, tensile force on the craniomedial band, but not other ligaments, was greater for the excessive TPA group than for the unchanged TPA group. Results indicated that stress on the CCL may increase when the compressive load increases. The TPA-increasing procedure resulted in increased tensile force on the CCL at a 60-N compressive load without affecting forces on the MCL or LCL.

Locking compression plates versus locking plates for tibial plateau levelling osteotomy in dogs: progression of osteoarthritis, bone healing score and lameness degree

BackgroundThe partial or complete cranial cruciate ligament rupture is a common skeletal disease affecting the stifle joint in dogs. The tibial plateau levelling osteotomy, performed with several synthesis systems, changed the approach to its treatment in dogs. The aim of this study was to compare two types of fixation implants, locking compression system and locking system, evaluating radiographically the progression of osteoarthritis of the stifle joint in dogs with complete cranial cruciate ligament deficiency treated surgically with tibial plateau levelling osteotomy. Moreover, we evaluated bone healing and lameness scores to show biomechanical effects by the implant used. Twenty-eight dogs, who met the inclusion criteria, were divided into two groups. Group A: 14 dogs treated using locking compression plates; Group B: 14 dogs treated using locking plates. Radiographic osteoarthritis scores were evaluated up to 1 year following tibial plateau levelling osteotomy. At each visit, animals were clinically and radiographically assessed. Each dog was evaluated before (T0) and after two (T2) and twelve (T12) months after the surgery. At T2 the stage of bone healing was evaluated. The clinical follow up was performed before the surgery and at 10, 15 and 20 days after the surgery, grading the lameness at walk and trot.ResultsAn increase in osteoarthritis score at T12 versus T0 in both groups was detected. A decrease of the lameness score was observed in Group A versus Group B. The healing score system at T2 showed a lower score in Group A versus Group B.ConclusionsThe osteoarthritis score following tibial plateau levelling osteotomy did not differ when comparing the two different fixation systems. The locking compression system allowed a more rapid functional recovery of the limb and a quicker bone healing than the locking system. Locking compression system should be carefully considered for dogs subjected to tibial plateau levelling osteotomy surgery, because it may reduce the recovery time.

Post operative stifle range of motion in dogs with medial patellar luxation undergoing either trochlear wedge recession or trochlear block recession surgery

The aim of this study was to evaluate post-operative range of motion of stifle joints in dogs affected with medial patellar luxation in order to compare two surgical techniques: trochlear wedge recession vs. trochlear block recession. The study was done with 67 joints from 54 small breed dogs (21 Mini-Pinschers, 16 Chihuahuas, 11 Pomeranians and 6 Yorkshire terriers). From these, 31 joints underwent wedge recession surgery and the other 36: block recession surgery. In wedge recession surgery, trochlear groove deepening was done by removal of a V-shaped wedge, whereas in block recession, the wedge was rectangular. Block recession is suggested to provide a deeper and wider trochlea with preservation of the major part of the articular cartilage. The results suggested that both trochleoplasty techniques resulted in reduction of joint range of motion and improvement of limb alignment at the first post-operative month.

Role of Tibial Tuberosity Fracture/Fissure through the Maquet Hole in Stifle Osteoarthritis after Porous Tibial Tuberosity Advancement in Dogs at Mid-Term Follow-Up.

Tibial tuberosity advancement (TTA) is used to treat cranial cruciate ligament rupture of the stifle joint in dogs. Tibial tuberosity fracture/fissure is a complication of TTA that may have a favorable prognosis. The aim of this study was to detect how tibial tuberosity fracture/fissure through the Maquet hole worsens the progression of osteoarthritis (OA) in the stifle joint of dogs treated with porous TTA. Seventeen cases were included in the study, divided into two groups. The first group (n = 10) included subjects that had tibial tuberosity fracture/fissure through the Maquet, and the second group included subjects that had no complications (n = 7). Both groups showed significant progression compared to OA at 3 months after surgery. We observed that at T0, the control group showed a higher level of OA. For this reason, we normalized the OA scores, evaluating the percentage difference from T0 and T1. We verified that there were no statistically significant differences between the two groups. The results confirm that OA progression in subjects undergoing TTA was not significantly influenced by fracture/fissure of the tibial tuberosity through the Maquet hole. Therefore, fracture fissure through the Maquet hole should be considered as a common minor complication during TTA.

Ultrasonographic Evaluation of Dogs with Cranial Cruciate Ligament Rupture Undergoing to Arthrotomy

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. One of the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which is a frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the menisci from human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was to compare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscus of dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods &amp; Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. The ultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. In the joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively three and four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the two techniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscal tears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absence of meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicity and echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated by ultrasound were the presence of effusion and synovial membrane thickening.Discussion: The complete and almost complete CrCLR are diagnosed by clinical examination through the evaluation of instability of the stifle joint, which is not possible in partial CrCLR in stable joints. In this study of the five evaluated stable joints, the ultrasound correctly identified the partial CrCLR in three joints and the ligament integrity in one of the joints when compared to arthrotomy. In animals with stifle joint instability the meniscus assessment is fundamental as it is one of the main causes of persistent lameness in dogs subjected to conservative or surgical treatment. Ultrasonography cannot differentiate the types of meniscal tears but identified approximately 1.8 times more medial meniscus tears compared to arthrotomy. Despite the bucket handle being the most common tear of medial meniscus in dogs with CrCLR, four of the six meniscal tears identified by arthrotomy were folded caudal horn. This lesion causes cranial displacement of the caudal horn which may have facilitated its identification by minimally invasive arthrotomy, being the probable reason for its high incidence in this study. Echogenicity and echotexture changes without affecting the meniscus morphology were related with intrasubstance degeneration described in human medicine. Ultrasonography is not the better technique to assess the CrCL but can assist in identifying partial ruptures. Because it has results similar to magnetic resonance imaging, ultrasonography is an important tool in the diagnosis of meniscus tears.

A novel tibial tuberosity advancement technique with cranial implant fixation (TTA CF): a pilot study in sheep

BackgroundCranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals. An array of surgical techniques have been described to stabilize the stifle joint in dogs, including intraarticular stabilization, extraarticular stabilization, and tibial osteotomy techniques. Tibial plateau leveling osteotomy and tibial tuberosity advancement with a lot of modifications are the most common. In this study we report the possibility of fixing the novel titanium implant for tibial tuberosity advancement with two screws in a craniocaudal direction. The aim of our study was to improve the clinical benefit of the tibial tuberosity advancement surgical technique where an attempt was made to reduce the number of screws and obtain a strong implant fixation with minimal bone traumatization. This way of attachment allows to distribute the forces evenly on medial and lateral side of osteotomy gap.ResultsTibial tuberosity advancement with cranial implant fixation was performed in four sheep. Complete radiographic and clinical follow up was recorded. All four sheep had a complete osteotomy line healing at a mean of 10 weeks postoperative (range 8–12 weeks). None of the animals had osteotomy gap healing grades of poor. Minor complication included the minimally cracked Maquet hole on the postoperative radiographs, without displacement of the tibial crest which occurred in 2 sheep. Major complication grade 1, major complication grade 2 and catastrophic were not found.ConclusionsThe novel surgical technique for tibial tuberosity advancement with cranial implant fixation is technically comparable to the recent trend in tuberosity advancement techniques, where partial osteotomy of the cranial tibial tuberosity crest is performed. A cranial implant fixation allows to distribute the forces evenly on medial and lateral side of osteotomy gap, which may result in less number of major complications in dogs. A novel titanium implant decreases the tibial traumatisation by reducing the number of screws.

Luxação lateral de patela em um Poodle toy

Background: Luxating patella is one of the most frequent conditions of the stifle joint in dogs and it can evolve into a degenerative joint disease. The occurrence of the condition can be medial or lateral, unilateral or bilateral. Its origin can be traumatic or congenital and, additionally, it may undergo genetic and environmental influence. Lateral luxation is more common in large breed dogs, and it can rarely affect medium and small breeds, whilst medial luxation is more common in small breed dogs. The classification of patellar luxation comprises four grades, according to the patellar position, clinical signs and seriousness of the bone deformities found. The diagnosis is made based on the clinical evaluation, associated with a radiographic evaluation. The present study aims at describing a case of bilateral grade 3 lateral luxating patella in a Toy Poodle dog. Case: A five-month-old female Toy Poodle dog was presented for difficulty standing and claudication of hind limbs. Orthopedic evaluation revealed internal rotation of the stifle, claudication of hind limbs during walking and “jumps” during trotting, in addition to a lateral grade 3 luxating patella and slight restriction of the joint motion upon extension of the right and left hind limbs. Radiographic evaluation of both stifles evidenced an ectopic (lateral) position of the right and left patellas. The animal was referred to the surgery department, where it was submitted to surgical intervention of both stifles. A reduction of luxation in both stifles was achieved through medial arthrotomy, wedge recession trochleoplasty, lateral desmotomy and medial imbrication of the articular capsule techniques. Tramadol hydrochloride, dipyrone and meloxicam were prescribed as postoperative medication. Daily wound care, resting and mild walks using a lead were recommended for the animal. On the tenth postoperative day, the stitches were removed from the skin and the animal seemed to be in a good general state, using adequately its hind limbs when walking and trotting. Discussion: The medial form of the congenital patellar luxation is common both in large and small breeds. However, the lateral form is more common in large or giant breeds, differently to the findings of the present case, in which luxation occurred in a Toy Poodle. Surgery is recommended in animals with a luxating patella grade starting from 2, as even the smallest luxation grades may evolve into higher grades, causing functional inability of the limb and degenerative joint disease. Surgery was justified in this case, because the animal presented a grade 3 luxating patella. The decision on which technique should be used will depend on the luxating patella grade and on soft tissue compromise. The most recommended procedure is a combination of various techniques in the same articulation. In this case, the use of wedge recession trochleoplasty and medial imbrication of the articular capsule techniques was successful, as a few days after surgery the animal was able to walk adequately without presenting any instability of the patellas, thus improving its quality of life. Moreover, upon reaching adulthood, the animal maintained an adequate gait, without excessive patellar motion.

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.

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.

Cruciate ligament degeneration and stifle joint synovitis in 56 dogs with intact cranial cruciate ligaments: Correlation of histological findings and numbers and phenotypes of inflammatory cells with age, body weight and breed

The majority of dogs with ruptured cranial cruciate ligaments (crCLs) have inflammatory changes of the stifle joint suggesting that synovitis is an important factor which is involved in the development of degenerative ligament changes. Detailed information is not available concerning the possible occurrence of inflammatory changes in the stifle joint synovium of dogs with macroscopically intact crCLs and its correlation with presence and severity of degenerative changes of the crCLs. Therefore, the purpose of this study was to examine post mortem tissue samples of 56 dogs with non-ruptured crCLs histologically for the presence of inflammatory and degenerative changes of the stifle joint synovium and cruciate ligaments, respectively. In 25/56 (44.6%) dogs, histology showed that both lymphoplasmacytic synovitis and degenerative alterations of the crCLs were present. In these dogs, there was a significant positive statistical correlation between the severity of synovitis and degenerative crCL lesions. The results suggest that synovitis in the stifle joints of dogs with non-ruptured crCLs is a frequent event and probably is involved in the development of degenerative lesions occurring in canine crCLs. Also, the severity of crCL degeneration in these 25 dogs was significantly correlated with their age and body weight. In 2/56 (3.6%) cases, only lymphoplasmacytic synovitis was found in the absence of degenerative crCL lesions. In 15/56 (26.8%) dogs, only degenerative lesions of the crCLs without synovitis were present. Statistically, a significant correlation was found between the severity of degenerative alterations and age and body weight of these dogs. Phenotyping of inflammatory cells by immunohistochemistry showed that the synovium of dogs which histologically had lymphoplasmacytic synovitis was infiltrated with CD3+ T lymphocytes, CD79+ B lymphocytes, major histocompatibility class II antigen (MHC class II)+ cells and macrophages expressing CD163 or S100/A8/S100A9 (calprotectin), while tartrate-resistant acid phosphatase (TRAP)+ cells were absent. Quantification and statistical evaluation of inflammatory cell types in the inflamed synovium revealed that the numbers of lymphocytic cells and macrophages were significantly correlated with the severity of synovitis. These findings indicate that, besides T and B lymphocytes, both pro- and anti-inflammatory macrophages play a role in the development of degenerative crCL alterations.

Correlation between osteoarthritic changes in the stifle joint in dogs and the results of orthopedic, radiographic, ultrasonographic and arthroscopic examinations.

Osteoarthritis (OA) is a chronic, degenerative disease affecting the articular cartilage and subchondral bone that causes pain and inhibits movement. The stifle's joint fibrous capsule contains the synovial membrane, which produces cartilage nutrients. A ruptured cranial cruciate ligament injures the joint and produces OA. Osteoarthritis diagnosis starts with clinical radiographic and ultrasonographic tests, although the latter is not used very much in dog and cat clinics for this purpose. The objective of this study was to establish the correlation among the results of orthopedic, radiographic, ultrasonographic examinations and structural anatomical changes revealed by arthroscopic evaluation to diagnose stifle joint OA and determine risk factors in the dogs affected. Of 44 clinical cases of OA included in the study, 88.64% had ruptured of cranial cruciate ligaments. The correlation between synovial fluid effusion and osteophytosis was of 0.84. It was concluded that there is good diagnostic agreement between synovial fluid effusion and osteophytosis when dealing with stifle joint OA. Risk factors for dogs regarding the development of stifle joint OA included: ruptured cranial cruciate ligaments or patella luxation, female dogs and weight over 10kg.

Evaluation of a distractor to increase joint space of the stifle joint in dogs: a cadaveric study.

To evaluate the technical feasibility and efficacy of a joint distraction technique to increase the stifle joint space and assess potential soft tissue damage due to the distraction. Twenty stifle joints of twelve canine cadavers without evidence of disease were radiographically evaluated by medio-lateral, cranio-caudal and varus-valgus stressed projections. Joint distraction was applied with loads from 40 N up to 200 N, and the joint space achieved was measured on radiographic images. Distraction plus distension with saline was subsequently applied and measured. Varus-valgus stressed projections were repeated after distraction to evaluate a potential increase in joint laxity. Distraction produced a significant increase of the joint space for most of the evaluated loads. Distraction plus distension produced a significant increase for most of the loads compared to the distraction alone. No ensuing joint laxity could be inferred from the post-distraction radiographic evaluation. Stifle distraction produces an increase of the joint space, which is wider when intra-articular saline is injected. This may be potentially useful for improving joint structure visualization and facilitating arthroscopic procedures, thus reducing the potential for iatrogenic damage to intra-articular structures. No soft tissue damage could be inferred by radiographic pre- and post-procedure comparison. Further clinical studies are required to evaluate potential neurovascular complications.

Application of a 3D printed customized implant for canine cruciate ligament treatment by tibial tuberosity advancement

Fabrication of customized implants based on patient bone defect characteristics is required for successful clinical application of bone tissue engineering. Recently a new surgical procedure, tibial tuberosity advancement (TTA), has been used to treat cranial cruciate ligament (CrCL) deficient stifle joints in dogs, which involves an osteotomy and the use of substitutes to restore the bone. However, limitations in the use of non-biodegradable implants have been reported. To overcome these limitations, this study presents the development of a bioceramic customized cage to treat a large domestic dog assigned for TTA treatment. A cage was designed using a suitable topology optimization methodology in order to maximize its permeability whilst maintaining the structural integrity, and was manufactured using low temperature 3D printing and implanted in a dog. The cage material and structure was adequately characterized prior to implantation and the in vivo response was carefully monitored regarding the biological response and patient limb function. The manufacturing process resulted in a cage composed of brushite, monetite and tricalcium phosphate, and a highly permeable porous morphology. An overall porosity of 59.2% was achieved by the combination of a microporosity of approximately 40% and a designed interconnected macropore network with pore sizes of 845 μm. The mechanical properties were in the range of the trabecular bone although limitations in the cage's reliability and capacity to absorb energy were identified. The dog's limb function was completely restored without patient lameness or any adverse complications and also the local biocompatibility and osteoconductivity were improved. Based on these observations it was possible to conclude that the successful design, fabrication and application of a customized cage for a dog CrCL treatment using a modified TTA technique is a promising method for the future fabrication of patient-specific bone implants, although clinical trials are required.