Meniscal Load and Load Distribution in the Canine Stifle after Modified Tibial Tuberosity Advancement with 9 mm and 12 mm Cranialization of the Tibial Tuberosity in Different Standing Angles

Abstract Objectives  The aim of this study was to investigate the kinetic and kinematic changes in the stifle after a modified tibial tuberosity advancement (TTA) with 9 and 12 mm cranialization of the tibial tuberosity in different standing angles. Study Design  Biomechanical ex vivo study using seven unpaired canine cadaver hindlimbs. Sham TTA surgery was performed. Motion sensors were fixed to the tibia and the femur for kinematic data acquisition. Pressure mapping sensors were placed between femur and both menisci. Thirty percent body weight was applied to the limbs with the stifle in 135 or 145 degrees of extension. Each knee was tested in 135 degrees with intact cranial cruciate ligament (CCL) and deficient CCL with 12 mm cranialization of the tibial tuberosity in 135 and 145 degrees of extension. The last two tests were repeated with 9 mm. Results  Transection of the CCL altered kinematics and kinetics. Tibial tuberosity advancement with 12 mm cranialization sufficiently restored stifle kinematics in 135 and 145 degrees but 9 mm TTA failed to do so in 135 degrees. The same effects were seen for internal rotation of the tibia. After TTA, a significant reduction in the force acting on both menisci was detected. Conclusions  Tibial tuberosity advancement could restore stifle kinematics and meniscal kinetics after transection of the CCL ex vivo in the present study. Tibial tuberosity advancement reduced the contact force ratio on both menisci significantly. No changes of peak pressure and peak pressure location occurred following TTA under any of the tested experimental settings. Increased stifle extension (145 degrees) might lead to more stability, contradictory to biomechanical theory.

[1]  J. Milgram,et al.  The Effect of Increasing Tibial Tuberosity Advancement and Quadriceps Muscle Force on Cranial Translation of the Tibia in the Cranial Cruciate Deficient Stifle Joint in Dogs , 2022, Frontiers in Veterinary Science.

[2]  H. Richter,et al.  Comparison of four methods to -determine cage width in tibial tuberosity advancement. , 2022, Schweizer Archiv fur Tierheilkunde.

[3]  S. Reese,et al.  Outcome after Tibial Plateau Levelling Osteotomy and Modified Maquet Procedure in Dogs with Cranial Cruciate Ligament Rupture , 2020, Veterinary and Comparative Orthopaedics and Traumatology.

[4]  M. Conzemius,et al.  Long-term arthroscopic assessment of intra-articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog. , 2020, Veterinary surgery : VS.

[5]  B. MacDonald,et al.  Comparison of tension band wiring and other tibial tuberosity advancement techniques for cranial cruciate ligament repair: an experimental study , 2019, Acta Veterinaria Scandinavica.

[6]  E. Andrada,et al.  Three-dimensional kinematics of canine hind limbs: in vivo, biplanar, high-frequency fluoroscopic analysis of four breeds during walking and trotting , 2018, Scientific Reports.

[7]  P. Böttcher,et al.  In vivo fluoroscopic kinematography of cranio-caudal stifle stability after tibial tuberosity advancement (TTA): a retrospective case series of 10 stifles , 2018, Open veterinary journal.

[8]  B. Bockstahler,et al.  Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review , 2018, Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere.

[9]  S. Banks,et al.  Femorotibial kinematics in dogs with cranial cruciate ligament insufficiency: a three-dimensional in-vivo fluoroscopic analysis during walking , 2018, BMC Veterinary Research.

[10]  R. Palmer,et al.  The effect of polydioxanone hemicerclage suture on the occurrence of fracture during tibial tuberosity advancement with an elongated bi‐directional hinged osteotomy , 2017, Veterinary surgery : VS.

[11]  C. Frank,et al.  Relationship between increased in vivo meniscal loads and abnormal tibiofemoral surface alignment in ACL deficient sheep is varied. , 2016, Journal of biomechanics.

[12]  M. Ness.  The Modified Maquet Procedure (MMP) in Dogs: Technical Development and Initial Clinical Experience. , 2016, Journal of the American Animal Hospital Association.

[13]  R. Todhunter,et al.  Long Term Functional Outcome of Tibial Tuberosity Advancement vs. Tibial Plateau Leveling Osteotomy and Extracapsular Repair in a Heterogeneous Population of Dogs. , 2016, Veterinary surgery : VS.

[14]  D. Marcellin-Little,et al.  Canine Stifle Biomechanics Associated With Tibial Tuberosity Advancement Predicted Using a Computer Model. , 2015, Veterinary surgery : VS.

[15]  B. van Ryssen,et al.  TTA Rapid: Description of the Technique and Short Term Clinical Trial Results of the First 50 Cases. , 2015, Veterinary surgery : VS.

[16]  S. Budsberg,et al.  Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. , 2014, Journal of the American Animal Hospital Association.

[17]  R. Evans,et al.  Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. , 2013, Journal of the American Veterinary Medical Association.

[18]  A. Pozzi,et al.  In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. , 2013, Veterinary journal.

[19]  M. Balligand,et al.  Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique , 2012, Veterinary and Comparative Orthopaedics and Traumatology.

[20]  Y. Harada,et al.  In vitro evaluation of the relationship between the semitendinosus muscle and cranial cruciate ligament in canine cadavers. , 2012, American journal of veterinary research.

[21]  R. Evans,et al.  Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement. , 2011, Veterinary surgery : VS.

[22]  R. Palmer,et al.  Meniscal injury in dogs with cranial cruciate ligament rupture. , 2010, Compendium.

[23]  R. Boudrieau,et al.  Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study. , 2007, Veterinary surgery : VS.

[24]  P. Montavon,et al.  Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease. , 2006, American journal of veterinary research.

[25]  P. Shires,et al.  Tibial tuberosity advancement in 65 canine stifles , 2006, Veterinary and Comparative Orthopaedics and Traumatology.

[26]  J. Mattoon,et al.  The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study. , 2005, Veterinary surgery : VS.

[27]  C. Berry,et al.  Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. , 2005, Veterinary surgery : VS.

[28]  C. Horstman,et al.  Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. , 2005, Journal of the American Veterinary Medical Association.

[29]  Mandi J. Lopez,et al.  A comparison of joint stability between anterior cruciate intact and deficient knees: A new canine model of anterior cruciate ligament disruption , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[30]  S. Arnoczky,et al.  Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. , 2001, Veterinary surgery : VS.

[31]  W. Herzog,et al.  Effects of inserting a pressensor film into articular joints on the actual contact mechanics. , 1998, Journal of biomechanical engineering.

[32]  K. Marshall,et al.  Bilateral canine model of osteoarthritis. , 1996, The Journal of rheumatology.

[33]  D. Bennett,et al.  Meniscal damage associated with cruciate disease in the dog , 1991 .

[34]  M. Verstraete,et al.  Force plate analysis of the walking gait in healthy dogs. , 1987, American journal of veterinary research.

[35]  J. L. Marshall,et al.  The cruciate ligaments of the canine stifle: an anatomical and functional analysis. , 1977, American journal of veterinary research.

[36]  G. Nuki,et al.  Experimentally-induced osteoarthritis in the dog. , 1973, Annals of the rheumatic diseases.

[37]  J. L. Marshall,et al.  5 Periarticular Osteophytes: Initiation and Formation in the Knee of the Dog , 1969, Clinical orthopaedics and related research.

[38]  Don King,et al.  The function of semilunar cartilages , 1936 .

[39]  S. Reese,et al.  Long-term outcome after surgical treatment of cranial cruciate ligament rupture in small breed dogs. Comparison of tibial plateau leveling osteotomy and extra-articular stifle stabilization. , 2015, Tierarztliche Praxis. Ausgabe K, Kleintiere/Heimtiere.

[40]  P. Böttcher,et al.  Sagittal joint instability in the cranial cruciate ligament insufficient canine stifle , 2014, Tierärztliche Praxis K: Kleintiere/Heimtiere.

[41]  M. Rishniw,et al.  Treatment of canine cranial cruciate ligament disease , 2014, Veterinary and Comparative Orthopaedics and Traumatology.

[42]  H. Ochi,et al.  Tibial displacement with stifle joint flexion and cranial cruciate ligament transection in the dog , 2014, Veterinary and Comparative Orthopaedics and Traumatology.

[43]  J. Rawlinson,et al.  Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. , 2013, Veterinary surgery : VS.

[44]  S. Banks,et al.  Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. , 2009, Veterinary surgery : VS.

[45]  S. Banks,et al.  Effect of tibial plateau leveling osteotomy on femorotibial contact mechanics and stifle kinematics. , 2009, Veterinary surgery : VS.

[46]  R. Boudrieau.  Tibial plateau leveling osteotomy or tibial tuberosity advancement? , 2009, Veterinary surgery : VS.

[47]  G. Breur,et al.  Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989 , 1994, Veterinary and Comparative Orthopaedics and Traumatology.