Risk factors for tibial damage associated with the modified Maquet technique in 174 stifles

Lefebvre, Michaël; Broux, Olivier; Barthélémy, Nicolas; Hamon, Martin; Moyse, Evelyne; Bouvy, Bernard; Balligand, Marc

doi:10.1111/vsu.12707

Cited by 11 publications

(11 citation statements)

References 12 publications

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“…We decided not to include the development of intra-operative fissure at the hinge cortex into the postoperative minor complication rate count, but if this is was to be considered, our minor complication rate could be as high as 65.7% [ 21 ]. One study reported that only 9.4% of these fissures subsequently led to postoperative fractures [ 22 ]. In our cases, we presume that the development of a fissure of the cranial hinge cortex had a relatively benign outcome because of the protective effect exerted by the cerclage wire tension band that was applied intra-operatively in almost all cases.…”

Section: Discussionmentioning

confidence: 99%

Outcome after Modified Maquet Procedure in dogs with unilateral cranial cruciate ligament rupture: Evaluation of recovery limb function by use of force plate gait analysis

et al. 2021

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Introduction Cranial cruciate ligament failure is one of the principal causes of canine lameness. Several surgical procedures were proposed to achieve joint stabilisation; among these, the Modified Maquet Procedure involves using a titanium foam wedge to achieve and maintain the tibial tuberosity advancement. The force-plate analysis provides to objectively assess normal and abnormal gait and the outcome of different surgical techniques. The study evaluates the outcome of limbs that underwent Modified Maquet Procedure using land-force plate analysis comparing the operated limb with its healthy contralateral one as a control. Materials and methods Thirty-five dogs with unilateral cranial cruciate ligament rupture were evaluated. Outcome after surgery was assessed by orthopaedic and radiographic evaluations and force plate gait analysis performed before surgery, at 15, 30 and 90 days after surgery. For objective comparison of ground reaction forces, data of operated limb were compared to contralateral limb on each time control and Symmetry Index at 90 days was determined. Healing radiographic signs, minor and major complication were reported. Results A significant improvement in ground reaction forces was reached in all the treated limbs between set time intervals. The median percentage increase in ground reaction forces was constant from 15 to 90 days, with a Symmetry Index >9 in 54.2% of patients suggesting a normal gait symmetry. A complete bone healing was noticed at 90 days follow-up radiographic assessment. We experienced three major (8.5%) and one minor (2.8%) complications. Conclusions To the Authors’ knowledge, this is the first study in the veterinary literature that assessed outcomes of dogs undergoing Modified Maquet Procedure for the treatment of cranial cruciate ligament rupture using force plate gait analysis and healthy contralateral limb as a control group. Our results confirm that Modified Maquet Procedure is an effective method to stabilise the stifle joint.

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Section: Discussionmentioning

confidence: 99%

Outcome after Modified Maquet Procedure in dogs with unilateral cranial cruciate ligament rupture: Evaluation of recovery limb function by use of force plate gait analysis

et al. 2021

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“…The implant we used was designed to advance the tibial tuberosity and to not exceed a distal angle of 11 degrees to approximate modified Maquet technique cut recommendations by Lefebvre and colleagues. 21 We also utilized a drill hole at the distal aspect of the osteotomy, as we have had good outcomes and minimal fissure/fracture complications with our previous experience performing a modified Maquet-tibial tuberosity advancement technique. 7 Despite these precautions, cortical hinge fractures occurred in 6/15 procedures.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of a Citrate-Based Biomaterial Wedge for a Modified Maquet Procedure in the Treatment of Cranial Cruciate Ligament Rupture in Dogs

Terreros¹,

Daye²

2020

Vet Comp Orthop Traumatol

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Objective The aim of this study was to describe short- and mid-term outcomes, complications, implant bioabsorption and owner satisfaction for a modified Maquet procedure (MMP) in which a novel bioabsorbable citrate-based implant is used as the wedge component to treat cranial cruciate ligament rupture in client-owned dogs. Study Design Prospective clinical study of dogs (n = 13) undergoing MMP (n = 15). Intraoperative complications, postoperative complications, clinical follow-up using a 5-point lameness score and radiographs at 8 weeks and 6 months postoperatively were obtained. Mid-term outcome was assessed via physical examination, radiographs, canine orthopaedic index and owner satisfaction questionnaires. Results No catastrophic complications occurred. Major complications occurred in 3/15 stifles. All were surgical site infections and one case required implant removal. Minor complications occurred in 9/15 stifles. Non-displaced cortical hinge fractures were the most common minor complication, and these occurred intraoperatively (4/15) or postoperatively (2/15). Three dogs achieved full function, eight dogs acceptable function and the outcome was unacceptable in two dogs. Most owners were satisfied with the procedure (11/13). Complete implant bioabsorption was not confirmed on mid-term radiographs. Conclusion The described MMP with a citrate-based implant can produce satisfactory mid-term results. However, the long-term outcome of this procedure must be evaluated and technical modifications need to be implemented prior to larger-scale use of this implant.

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“…Many studies suggested that reduced thickness of the osteotomized tibial tuberosity, incorrect plaque positioning, reduced contact of the osteotomy, wide angle of the preoperative patellar ligament, and iatrogenic region wounds during surgical dissection contribute to the development of this complication [8,17,18]. Lefebvre et al [24] stated that intraoperative fissures occurred more frequently than intraoperative fractures and were located most commonly at the distal aspect of the osteotomy line. They also considered the angle of opening of the osteotomy line and the thickness of the cortical hinge as the main factors increasing the risk of perioperative tibial damage during Maquet modified technique (MMT) in dogs [24].…”

Section: Discussionmentioning

confidence: 99%

“…Lefebvre et al [24] stated that intraoperative fissures occurred more frequently than intraoperative fractures and were located most commonly at the distal aspect of the osteotomy line. They also considered the angle of opening of the osteotomy line and the thickness of the cortical hinge as the main factors increasing the risk of perioperative tibial damage during Maquet modified technique (MMT) in dogs [24].…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence ranged from 1-4% [7,8,25] to 20% [5]. In Lefebvre's study [24], intraoperative fissures were detected in 37% of MMT cases, but only 9.4% subsequently led to postoperative tibial fracture. Based on published data reporting complication rates, an acceptable failure rate should be set at 15% and an unacceptable failure rate at 25% during the initial learning curve [17,26].…”

Section: Discussionmentioning

confidence: 99%

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Role of Tibial Tuberosity Fracture/Fissure through the Maquet Hole in Stifle Osteoarthritis after Porous Tibial Tuberosity Advancement in Dogs at Mid-Term Follow-Up

Crovace

Staffieri

Monopoli

et al. 2019

Veterinary Sciences

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Tibial tuberosity advancement (TTA) is used to treat cranial cruciate ligament rupture of the stifle joint in dogs. Tibial tuberosity fracture/fissure is a complication of TTA that may have a favorable prognosis. The aim of this study was to detect how tibial tuberosity fracture/fissure through the Maquet hole worsens the progression of osteoarthritis (OA) in the stifle joint of dogs treated with porous TTA. Seventeen cases were included in the study, divided into two groups. The first group (n = 10) included subjects that had tibial tuberosity fracture/fissure through the Maquet, and the second group included subjects that had no complications (n = 7). Both groups showed significant progression compared to OA at 3 months after surgery. We observed that at T0, the control group showed a higher level of OA. For this reason, we normalized the OA scores, evaluating the percentage difference from T0 and T1. We verified that there were no statistically significant differences between the two groups. The results confirm that OA progression in subjects undergoing TTA was not significantly influenced by fracture/fissure of the tibial tuberosity through the Maquet hole. Therefore, fracture fissure through the Maquet hole should be considered as a common minor complication during TTA.

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Risk factors for tibial damage associated with the modified Maquet technique in 174 stifles

Cited by 11 publications

References 12 publications

Outcome after Modified Maquet Procedure in dogs with unilateral cranial cruciate ligament rupture: Evaluation of recovery limb function by use of force plate gait analysis

Outcome after Modified Maquet Procedure in dogs with unilateral cranial cruciate ligament rupture: Evaluation of recovery limb function by use of force plate gait analysis

Prospective Evaluation of a Citrate-Based Biomaterial Wedge for a Modified Maquet Procedure in the Treatment of Cranial Cruciate Ligament Rupture in Dogs

Role of Tibial Tuberosity Fracture/Fissure through the Maquet Hole in Stifle Osteoarthritis after Porous Tibial Tuberosity Advancement in Dogs at Mid-Term Follow-Up

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