Replacement of the Collateral Ligaments of the Canine Tarsocrural Joint: A Proposed Technique

Abstract

A technique for replacement of the medial and lateral collateral ligaments of the tarsocrural joint in dogs was developed based on studies of normal anatomy and function. The medial or lateral tarsocrural joint was made unstable by removal of the respective malleolus, ligaments, and joint capsule; the component parts of the collateral ligaments were replaced using suture material to function as ligament prostheses. The technique was found to be effective in maintaining near normal joint motion and adequate joint stability in cadavers immediately following surgery, and in dogs observed for up to 39 months postoperatively. No degenerative joint disease was noted upon gross or radiographic examination.

Tarsocrural Instability in Cats: Combined Internal Repair and Transarticular External Skeletal Fixation

“…An internal splint is created by placing bone anchors, screws with washers or bone tunnels at the attachment points of the ligament; these implants or tunnels serve as anchor points for suture materials. 2,6,8,[10][11][12] Clinical use of this technique in veterinary orthopaedics has only been documented in dogs in limited retrospective studies. 13,14 Anatomic specificities in the cat need to be carefully considered when applying these techniques as cats only have short collateral ligaments consisting of straight and oblique branches.…”

The Effect of Knotting Method on the Structural Properties of Large Diameter Nonabsorbable Monofilament Sutures

“…Extra‐articular stabilization of injured stifle or hock joints is a surgical procedure frequently performed in dogs. Large diameter nonabsorbable monofilament materials (USP size 2 or greater) are typically used 1–6 . Celiotomies in horses or ruminants also are often closed with similar suture materials 7,8 …”

Isometry of potential suture attachment sites for the medial aspect of the tibiotarsal joint

“…This can result in jointi nstability ranging from isolated ligament tearst oc ontaminated shearing injuries with lossofbonyattachment sitesa nd associated soft tissues. Treatment optionsinclude primaryrepairof the tornligament, placementofaprosthetic ligament, or arthrodesis (1)(2)(3)(4)(5). Due to the severe disruption of the ligament, primary repair of the ligamenti so ftenn ot possible (2,3,5).…”

“…When primaryr epairo ft he medialc ollaterall igamentc annot be achieved, the placemento faprostheticl igaments hould be anatomically positioned to maintain equall ength andt ension throughout the range of motion of the joint. Changesi n length, andtherefore tension, of the prosthesiscan decrease the stability of the joint, impinge on jointrange of motion, affect cartilage physiology,a nd increase the potential of implant failurethrough stretching or cyclical fatigue ( 1,3,4). Twop rosthetic ligament techniques have been describedf or stabilization of amedialcollateral ligament injury of the tarsus (1,2,4).…”

“…Changesi n length, andtherefore tension, of the prosthesiscan decrease the stability of the joint, impinge on jointrange of motion, affect cartilage physiology,a nd increase the potential of implant failurethrough stretching or cyclical fatigue ( 1,3,4). Twop rosthetic ligament techniques have been describedf or stabilization of amedialcollateral ligament injury of the tarsus (1,2,4). One technique is based on the implantation of ad ouble prostheticl igament, to mimic the dichotomousfunction of the shortand long portions of the ligament.…”