Treatment Of Cruciate Ligament Rupture Research Articles

Investigation of knee joint stability in surgically repaired canine cruciate ligament ruptures by cyclic passive joint motions

Abstract The cranial cruciate ligament (CCL) rupture is a prevalent injury in dogs. A consequence of a cruciate ligament rupture is instability in the affected knee joint. A veterinary, mostly surgical treatment of the cruciate ligament rupture is usually unavoidable. The suitability of an arthroscopic surgical method with ligament replacement material was investigated. The stability of the knee joint was determined several times during 1,200 passive robotic motion cycles with movement radius between 90° flexion and 140° extension. The stability condition was measured by triggering the drawer test. After 300 motion cycles, the drawer test could be triggered (positive drawer test). In the following movement cycles up to 1,200 cycles, the drawer test could also be triggered. However, no significant differences occurred between these triggered drawer tests. The ligament replacement material showed no damage and no loosening after the tests. The first results showed that the developed arthroscopic surgical method could be a promising approach for the surgical treatment of cruciate ligament ruptures in canines.

Surgical treatment of cruciate ligament injuries of the knee joint (retrospective analysis)

Clinical analysis of operative treatment of cruciate ligament ruptures based on forty years experience is presented. During the period from 1962 to 1982 lavsan prosthetic material for the plastic reconstruction of cruciate ligaments was widely used at Sports and Ballet Injury Clinic. Histologic, morphologic, clinical and roentgenologic investigations were performed and data on readaptation of lavsan prosthesis within intrasynovial medium were obtained. Starting from 1983 autoplasty for the restoration of joint stability has been elaborated and introduced into practice. Active dynamic stabilizing operation for chronic posttraumatic knee instability is worked out. Principles of static stabilizing operation on the knee are elaborated. Detailed description of various modifications for knee surgery is presented. The disadvantages of certain surgical techniques and the ways of their avoidance are given. Special attention is paid to arthroscopic intervention. Specific protocol and preventive measures to improve the efficacy of treatment are noted.

Comparison of tension band wiring and other tibial tuberosity advancement techniques for cranial cruciate ligament repair: an experimental study

BackgroundCranial cruciate ligament (CCL) rupture is one of the most common causes of limb lameness in dogs. Surgical techniques based on tibial osteotomies such as tibial plateau leveling osteotomy and tibial tuberosity advancement are used to eliminate dynamic thrust. Tibial tuberosity advancement (TTA) uses an osteotomy fixated by cage, plates, forks and screws to change the relationship of the patellar tendon and tibial plateau angle. Tension band wiring technique is one of the most common surgical methods used to treat a tension fracture and remains the gold standard for the treatment of tibial tuberosity fractures. In this study, we compared experimentally the biomechanical effect of application of tension band wiring compared to other techniques for the fixation of the TTA osteotomy. The techniques compared to are standard commercially available systems for TTA fixation.ResultsTension band wiring (TBW) presented the higher resistance to failure compared to all the other surgical procedures, with the highest values found in the TBW group with 1.47 ± 0.07 N and the lowest in the TTA cage (0.82 ± 0.08) and TTA-2 (0.85 ± 0.06) groups with statistically significant differences in all cases (P < 0.001). TTA rapid and TTA plate groups exhibited a similar strength, and same happened between TTA-2 and TTA cage groups. All the other comparisons by pair were significantly different with P < 0.001.ConclusionsResults suggest that fixating the osteotomy with tension band wiring increases the strength of the fixation and decrease the risk of implant failure. Further clinical studies are needed to demonstrate in vivo reliability and to test different variables such as size and weight of dogs. These results could have important clinical implications in the treatment of CCL ruptures.

Use of a platelet-rich plasma-collagen scaffold as a bioenhanced repair treatment for management of partial cruciate ligament rupture in dogs.

Dogs are commonly affected with cruciate ligament rupture (CR) and associated osteoarthritis (OA), and frequently develop a second contralateral CR. Platelet rich plasma (PRP) is a component of whole blood that contains numerous growth factors, which in combination with a collagen scaffold may act to promote bioenhanced primary repair of ligament. This study tested the hypothesis that treatment of partial stable CR stifles with an intra-articular collagen scaffold and PRP would decrease the disease progression, synovitis and risk of complete CR over a 12-month study period. We conducted a prospective cohort study of 29 client-owned dogs with an unstable stifle due to complete CR and stable contralateral stifle with partial CR. All dogs were treated with tibial plateau leveling osteotomy (TPLO) on the unstable stifle and a single intra-articular application of PRP-collagen in the stable partial CR stifle. Dogs were evaluated at the time of diagnosis, and at 10-weeks and 12-months after treatment. We evaluated correlation between both development of complete CR and time to complete CR with diagnostic tests including bilateral stifle radiographs, 3.0 Tesla magnetic resonance (MR) imaging, and bilateral stifle arthroscopy. Additionally, histologic evaluation of synovial biopsies, C-reactive protein (CRP) concentrations in serum and synovial fluid, and synovial total nucleated cell count, were determined. Results indicated that a single application of PRP-collagen in partial CR stifles of client owned dogs is not an effective disease-modifying therapy for the prevention of progression to complete CR. Radiographic effusion, arthroscopic evaluation of cranial cruciate ligament (CrCL) damage, and MR assessment of ligament fiber tearing in partial CR stifles correlated with progression to complete CR over the 12-month follow-up period. We determined that the best predictive model for development of complete CR in PRP-collagen treated partial CR stifles included variables from multiple diagnostic modalities.

Computational design and fabrication of a novel bioresorbable cage for tibial tuberosity advancement application

Tibial tuberosity advancement (TTA) is a promising method for the treatment of cruciate ligament rupture in dogs that usually implies the implantation of a titanium cage as bone implant. This cage is non-biodegradable and fails in providing adequate implant-bone tissue integration. The objective of this work is to propose a new process chain for designing and manufacturing an alternative biodegradable cage that can fulfill specific patient requirements. A three-dimensional finite element model (3D FEM) of the TTA system was first created to evaluate the mechanical environment at cage domain during different stages of the dog walk. The cage microstructure was then optimized using a topology optimization tool, which addresses the accessed local mechanical requirements, and at same time ensures the maximum permeability to allow nutrient and oxygen supply to the implant core. The designed cage was then biofabricated by a 3D powder printing of tricalcium phosphate cement. This work demonstrates that the combination of a 3D FEM with a topology optimization approach enabled the design of a novel cage for TTA application with tailored permeability and mechanical properties, that can be successfully 3D printed in a biodegradable bioceramic material. These results support the potential of the design optimization strategy and fabrication method to the development of customized and bioresorbable implants for bone repair.

LONG‐STANDING AND TRAUMATIC LIGAMENT INJURIES AND MENISCAL RUPTURES OF THE CANINE STIFLE

Stifle joint lesions, especially in large dogs, have been recognized since 1899, but not until 1943 was a detailed study of meniscal lesions published. Further study led to the publication in 1952 of a major study that demonstrated that dogs with long‐standing injury of the stifle joint commonly displayed rupture of the cranial cruciate ligament, medial meniscal tear, and degenerative joint disease. From this study came the well‐known Paatsama operation. Treatment of cruciate ligament rupture has been done using new materials in the intervening years, but the same basic principles have been followed.

BSAVA EDUCATION COMMITTEE COMMISSIONED ARTICLE

ABSTRACTInjury to the cruciate ligaments, especially the cranial cruciate ligament, is one of the most common clinical problems presented to the small animal veterinarian. While there have been many procedures described for the treatment of cruciate ligament rupture no unanimity exists as to which procedure is the best. Therefore, in order to select the reparative technique that might best serve an individual case, the veterinary clinician must be familiar with the anatomy, function, and mechanics of cruciate ligament injury as well as the principles of both extra‐articular and intra‐articular techniques. This paper reviews the current state of knowledge of the cruciate ligaments.“Rupture of the anterior cruciate ligament is the most common injury in the stifle joint of the dog.”Paatsama 1952

Treatment of cruciate ligament ruptures of the dog. Comparative studies

Treatment of cruciate ligament ruptures of the dog. Comparative studies