Effect of the number of interference screws for the fixation of an intra-articular cranial cruciate ligament prosthesis in dogs: Biomechanical study

Blanc, Q.; Goin, Bastien; Rafael, P.; Moissonnier, P.; Carozzo, Claude; Buttin, Philippe; Cachon, Thibaut; Viguier, É.

doi:10.1080/10255842.2020.1713496

Cited by 8 publications

(13 citation statements)

References 6 publications

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“…Its combined use with an interference screw fixation system was initially described as a surgical technique for synthetic cranial cruciate ligament reconstruction. Ex vivo biomechanical, pull-out and fatigue studies have reported very encouraging results regarding the strength of the implant itself, as well as the reliability of its interference screw fixation system ( Blanc et al ., 2019 ; Goin et al ., 2019 ). Tunnel drilling, the use of a cortical button and interference screw locking provide greater stability than implanted screws connected with suture or orthopedic wire ( Aron and Purinton, 1985 ; Diamond et al ., 1999 ; Harasen, 2000 ; Martin et al ., 2019 ).…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcome following synthetical reconstruction of the tarsal medial collateral ligament in a dog

Buttin¹,

Santoro²,

Agbalé³

et al. 2022

Open Vet J

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Background: Tibiotarsal instabilities caused by partial or complete rupture of the medial collateral tarsal ligament (MCTL) are commonly treated by arthrodesis techniques with poor functional results and significant complication rates. Case description: This study describes a new surgical technique for synthetic reconstruction of the MCTL in an overweight dog (estimated body condition score 8/9) with an avulsion of the long head of the MCTL. Three bone tunnels were drilled in the distal tibia, the talus and the central tarsal bone, thus respecting the anatomical insertions of the physiological ligament. An Ultra-High Molecular Weight Polyethylene (UHMWPE) implant was fixed with interference screws to reconstruct the long and short heads of the MCTL. Premature weight-bearing was reported at two weeks postoperatively following early removal of the flexible restraint (bivalve resin boot), which had initially been prescribed for six weeks. At 11 weeks postoperatively, the tibiotarsal joint showed good valgus stability and the dog's gait was subnormal. At 12 and 16 months postoperatively, the dog regained full function of the operated limb although no weight loss was initiated as recommended. Conclusion: The use of a UHMWPE implant fixed with interference screws to reconstruct the MCTL allowed a return to full function of the tibiotarsal joint, without complications despite an early return to weight-bearing without external restraint. The success of this isolated surgical technique could lead to improvements in the surgical management of MCTL rupture if these initial results are confirmed by a prospective study with a larger number of patients.

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Section: Discussionmentioning

confidence: 99%

“…1c and d ) (Novetech Surgery, Monaco) for excellent biocompatibility. Its design offers minimal invasiveness as well as strong and immediate fixation ( Blanc et al ., 2019 ; Goin et al ., 2019 ). Finally, the cortical button ( Fig.…”

Section: Case Detailsmentioning

confidence: 99%

Long-term outcome following synthetical reconstruction of the tarsal medial collateral ligament in a dog

Buttin¹,

Santoro²,

Agbalé³

et al. 2022

Open Vet J

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“…The manufacturer reports a strong biomechanical resistance to traction strengths higher than the physiological CCL by more than 8,000 N ( Butler et al , 1983 ; Patterson et al , 1991 ). Based on state-of-the-art biomechanical tests carried out on this intra-articular reconstruction technique of the CCL, no implant rupture was reported in quasi-static pull-out tests ( Blanc et al , 2019 ) or in cyclic loading tests ( Goin et al , 2019 ), with a maximum resistance before implant slippage estimated at 690 ± 115 N. The synthetic ligament was sterilized with ethylene oxide and implanted with four titanium interference screws (diameter: 4.5 mm; length: 20 mm) provided by the same implant manufacturer ( Fig. 1c ).…”

Section: Methodsmentioning

confidence: 99%

“…The samples were thawed at room temperature for 24 hours. They were implanted with the UHMWPE synthetic implant according to the recommended “Out-In” surgical procedure, in which interference screws are implanted from the epiphyseal surface of the femur and the tibia toward the intra-articular space ( Blanc et al , 2019 ). Once the CCL was entirely resected, the implantation was performed on specific anatomical regions of the in vivo CCL insertion to ensure its physiological reconstruction.…”

Section: Methodsmentioning

confidence: 99%

“…According to this recent trend, brand new intra-articular devices have been developed for passive stabilization of the stifle, composed of an ultrahigh molecular weight polyethylene (UHMWPE) artificial ligament fixed on the bones with interference screws ( Blanc et al , 2019 ; Goin et al , 2019 ; Rafael et al , 2020 ). This approach seems to be spreading among the international veterinary community ( Barnhart et al , 2016 ; Cook et al , 2017 ; Barnhart et al , 2018 ; Prada et al , 2018 ; Barnhart et al , 2019a; Biskup and Conzemius, 2020 ), although it remains marginal in the treatment of CCL rupture ( von Pfeil et al , 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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

Goin¹,

Buttin²,

Lafon³

et al. 2022

Open Vet J

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Background: Cranial cruciate ligament rupture (CCLr) is the most common cause of hindlimb lameness in dogs. Currently, surgical management of CCLr is mostly performed using tibial osteotomy techniques to modify the biomechanical conformation of the affected stifle. These surgical techniques have a significant complication rate, associated with persistent instability of the stifle which may lead to chronic postoperative pain. Over the last decade, studies have been published on various techniques of anatomical CCL reconstruction in veterinary practice, using physiological autografts or woven synthetic implants. Aim: The aim of this ex vivo biomechanical study is to investigate the ex vivo dynamic biomechanical behavior of a synthetic implant (ultra-high molecular weight polyethylene implant) fixed with interference screws for the treatment of cranial cruciate ligament rupture in dogs, according to a fatigue protocol (48h per test). Methods: Seven stifles from four skeletally mature canine cadavers were implanted with the synthetic implant. It was fixed with four interference screws inserted in transversal and oblique tunnels in both the distal femur and the proximal tibia. For each case, 100 000 cycles were performed at 0.58Hz, with traction loads ranging from 100N to 210N. Results: Neither screw-bone assembly rupture nor a pull-out issue were observed during the dynamic tests. The linear stiffness of the implants associated with a fixation system with four interference screws increased over time. The final displacement did not exceed 3mm for five of the seven specimens. Five of the seven synthetic implants yielded to a lengthening in functional range [0: 3 mm]. Linear stiffness was homogeneous among samples, showing a strong dynamic strength of the interference screw-based fixations of the UHMWPE implant in the femoral and tibial bones. Conclusion: This study completes the existing literature on the biomechanical evaluation of passive stifle stabilization techniques with a testing protocol focused on cyclic loading at a given force level instead of driven by displacement. These biomechanical results should revive interest in intra-articular reconstruction after rupture of the cranial cruciate ligament in dogs.

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Long-Term Clinical Outcome of Medial Shoulder Instability in a Dog Treated with Synthetic Implant, Cortical Button, and Interference Screw

Letesson,

Crumière,

Goin

2024

VCOT Open

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Objective The objective of this study was to describe the surgical procedure and long-term outcome of traumatic medial shoulder instability in one dog treated with an ultra-high molecular weight polyethylene implant.A Fox Terrier had traumatic medial shoulder instability caused by the disruption of the subscapularis muscle and medial glenohumeral ligament. The joint was stabilized through a medial approach with an ultra-high molecular weight polyethylene implant secured on the glenoid by a cortical button and on the humerus by an interference screw. Postoperative and follow-up examinations were performed at 1, 2, 4.5 months, and 2.5 years. Results The patient bore weight after surgery and resumed normal gait after 2 months. Both the scapular and humeral tunnels had widened, essentially at their medial entrance, at 1 month postoperatively.Entrance diameter increased for 2 months and remained unchanged thereafter. An increase of 35 degrees in the abduction angle was observed in the long term at the 2.5-year control with minor osteoarthritis. No implant loosening, medial laxity, excessive abduction angle, inflammation, or septic reaction were observed. Conclusion The treatment of this case resulted in a satisfactory clinical outcome despite tunnel widening. This modified method using an interference screw could thus be considered as an alternative treatment of medial shoulder instability.

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Effect of the number of interference screws for the fixation of an intra-articular cranial cruciate ligament prosthesis in dogs: Biomechanical study

Cited by 8 publications

References 6 publications

Long-term outcome following synthetical reconstruction of the tarsal medial collateral ligament in a dog

Long-term outcome following synthetical reconstruction of the tarsal medial collateral ligament in a dog

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

Long-Term Clinical Outcome of Medial Shoulder Instability in a Dog Treated with Synthetic Implant, Cortical Button, and Interference Screw

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