A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle

Abstract

Extra-articular prosthetic stabilization techniques have been used as a method of stabilization of the cranial cruciate ligament (CrCL)-deficient stifle for decades. During extra-articular prosthetic stabilization, the prosthesis is anchored to the femur and tibia, and tensioned in the attempt to resolve femorotibial instability. The position of the anchor points of the prosthesis is crucial for restoring a normal range of joint motion and mitigating alterations in prosthesis tension during motion. Recently developed techniques offer several innovations with potential advantages such as bone-to-bone fixation, prosthetic materials with better mechanical properties, and improved isometry of the anchor points. Whether these innovations provide clinically superior results to the traditional techniques such as lateral circumfabellar-tibial suture techniques has yet to be determined.

Mechanical Comparison of Loop and Crimp Configurations for Extracapsular Stabilization of the Cranial Cruciate Ligament‐Deficient Stifle

“…Evidence shows that current best available configurations are unable to maintain joint stability when physiologic loads are applied . All tests performed in our study showed evidence of superior biomechanical characteristics of double‐loop double‐crimp configurations (2L2C= and 2L2CX) when compared to previously recommended best configurations (2L1C and W1C) . Double‐loop double‐crimp configurations were the only ones able to consistently resist forces >600 N in all tests before failing.…”

“…Long‐term joint stability is provided by periarticular fibrosis secondary to the surgical procedure and implanted material . It has been suggested that, for the surgical procedure to be effective, the suture material must withstand tension before failure for a minimum of 8 weeks with variability between dogs …”

“…Since the first description of a true circumfabellar suture by Flo in 1975 (modified retinacular imbrication technique), many technique modifications have been developed to improve it . Modifications include the use of different suture materials, methods of sterilization, suture configurations, methods of securing the prosthesis, angle of joint flexion at the time the prosthesis is secured and modifications related to points of anchorage and isometry …”

“…Early loosening of the fabellotibial suture may also occur when positioned around the lateral fabella itself, because of slippage of the suture off the fabella. Current recommendation includes placement of the suture material through the femorofabellar ligament to prevent slippage . Clinically normal cranial drawer displacement reported for the canine stifle ranges from undetectable to 3 mm depending on methodology and forces applied to the stifle at the time of measurement.…”

In Vitro Biomechanical Testing of the Tube Knot

“…Extracapsular stabilization (ECS) is a common surgical procedure for cranial cruciate ligament (CrCL) deficiency . Lateral ECS transiently controls hyperextension, cranial drawer motion, and internal rotation of the tibia while periarticular fibrosis progresses .…”