Biomechanical evaluation of two extracapsular techniques for cranial cruciate ligament reconstruction in cadaver dogs

Abstract

Cranial cruciate ligament rupture (CCLR) is one of the most important orthopedic conditions in dogs, leading to joint instability, pain, osteoarthritis and eventually to meniscal injuries. Several surgical techniques have been described to reestablish joint stability following CCLR, including extracapsular procedures. This study compared the biomechanical effects of two extracapsular stabilization techniques (lateral fabello-tibial suture -LFTS, and modified retinacular imbrication technique -MRIT) using nylon leader line following experimental CCLR in cadaver dogs. Twenty canine cadaveric stifles were used. Joint stiffness, cranial and caudal tibial displacement were evaluated in 4 different experimental scenarios: intact stifle, stifle with CCLR, CCLR treated with lateral fabello-tibial suture (LFTS), and CCLR treated with modified retinacular imbrication technique (MRIT). Results: Mean cranial tibial displacement increased progressively from intact to MRIT, LFTS and CCRL stifles. MRIT resulted in less caudal drawer motion than LFTS. Joint stiffness did not differ significantly between LFTS and MRIT treated stifles. Conclusion: LFTS and MRIT increase joint stability but MRIT is more effective; however none of the techniques studied was able to restore original intact stifle stiffness. Clinical implications of the results presented remain to be determined but kinetic gait analysis studies are warranted to determine whether this biomechanical advantage translates into improved hind limb function in dogs. Key words: Biomechanics. Cranial cruciate ligament. Dogs. Fabellar suture. Stifle. ResumoA ruptura do ligamento cruzado cranial (RLCCr) é uma das principais afecções ortopédicas em cães e resulta na instabilidade do joelho, dor, desenvolvimento de osteoartrose, podendo também causar lesão de menisco. Com o intuito de restabelecer a estabilidade da articulação, muitas técnicas são utilizadas, dentre elas, as extracapsulares. O objetivo do presente trabalho foi realizar a avaliação biomecânica de duas dessas técnicas em 20 joelhos de cadáveres de cães utilizando-se fio de náilon leader line. Nestas peças foram avaliados a rigidez articular e o deslocamento tanto cranial quanto caudal da tíbia em quatro situações distintas: joelho íntegro; joelho com RLCCr e sutura fabelo-tibial lateral (SFTL); joelho com RLCCr e sutura fabelo-tibial lateral e medial (SFTLM); e por fim, o joelho com RLCCr sem as técnicas de estabilização. Houve diferença no deslocamento cranial entre todas as situações, sendo em ordem crescente, o joelho integro, com SFTLM, com SFTL e por fim, o joelho com RLCCr não estabilizado. Na comparação da presença de movimento de gaveta caudal a técnica de SFTLM apresentou menor deslocamento que a técnica de SFTL. Com relação à rigidez tanto cranial quanto caudal, as duas técnicas não apresentaram diferença. As duas técnicas testadas diminuem a instabilidade do joelho, sendo a SFTLM mais efetiva, e nenhuma delas restaurou a rigidez articular de um joelho íntegro. As implicações clínicas dos resultad...

Ex vivo biomechanical evaluation of extracapsular stabilization with quasi-isometric points in canine cranial cruciate ligament-deficient stifles

“…Several preceding studies have revealed notable cranial tibial subluxation after CCLD progression [ 1 – 3 , 24 , 28 – 30 ], but only a few studies have assessed and compared the CTT between different pairs of quasi-IPs [ 19 , 24 , 31 , 32 ]. It is expected that suturing at different positions affects the resistance capability in tibial cranial translation, as sutures with alignment closer to the craniocaudal direction can contribute a greater tensile force component to counteract tibial cranial translational forces [ 12 ].…”

“…Some recent evidence showed that the corrective tibial osteotomy procedures, particularly tibial plateau leveling osteotomy, showed better postoperative outcomes than other treatments in terms of functional recovery and halting OA progression [ 6 – 10 ]. In contrast, while ECS procedures were shown to yield comparable or inferior postoperative outcomes [ 9 – 11 ], they remained common surgical options for CCL diseases due to the lower costs and technical demands [ 1 , 3 , 12 ]. The ECS procedures were also advantageous to enable the provision of immediate internal rotation (IR) stability [ 13 ].…”

Biomechanical cyclic loading test of a synthetic ligament fixation system used for intra-articular stabilization of deficient canine stifles

“…The literature review on ex-vivo biomechanical veterinary studies published on passive stabilization techniques for deficient stifles revealed limited research with very different testing protocols ( Sicard et al , 2002 ; Banwell et al , 2005 ; Burgess et al , 2010 ; Tonks et al , 2010 ; Cabano et al , 2011 ; Rose et al , 2011 ; Choate et al , 2013 ; Oda et al , 2016 ).…”

“…), their fixation technique (Knotted, Crimped, etc. ), or the effect of the sterilization method use for the suture material ( Sicard et al , 2002 ; Banwell et al , 2005 ; Burgess et al , 2010 ; Cabano et al , 2011 ; Rose et al , 2011 ); on the other hand, biomechanical studies on the various passive stabilization techniques for deficient stifles using different types of material and fixation systems on cadaveric canine hind limbs ( Tonks et al , 2010 ; Choate et al , 2013 ; Oda et al , 2016 ). Therefore, the study published by Choate et al (2013) is the only one that deals with a similar subject and allows a general comparison with our work.…”