Comparison of bone healing, as assessed by computed tomography, following tibial tuberosity advancement in dogs with and without autogenous cancellous bone grafts

Abstract AIMS: To objectively compare measures of bone healing, using computed tomography (CT) in dogs following bilateral tibial tuberosity advancement (TTA), between tibiae treated with and without autogenous cancellous bone grafts. METHODS: Ten dogs with bilateral cranial cruciate ligament disease requiring surgical stabilisation were prospectively recruited to undergo single-session bilateral TTA, with only one, randomly assigned, tibia receiving bone graft in the osteotomy deficit. Bone healing at the osteotomy site was assessed using CT performed 38–70 days post-operatively. CT images were evaluated using both objective measurements of osseous bridging and subjective evaluation by six radiologists. Repeated measures ANOVA was used to compare the objective outcomes between the grafted and non-grafted tibiae. RESULTS: The mean percentage of the osteotomy deficit bridged at the lateral cortex was greater in grafted (77.6, SD 35.2%) compared to non-grafted (63.0, SD 36.5%) tibiae (p=0.001), but did not differ at the medial cortex (p=0.1). The mean minimum callus width was greater in grafted (7.2, SD 3.3 mm) compared to non-grafted (3.6, SD 2.9 mm) tibiae (p<0.001). There was no difference in mean attenuation (measured in Hounsfield units) of the callus between grafted and non-grafted tibiae (p=0.5). The grafted tibia was deemed to have superior bone healing in 50/60 subjective assessments made by radiologists. CONCLUSIONS: Superior osseous bridging was detected by CT analysis following TTA using autogenous cancellous bone grafts compared with no graft. This was shown by greater bridging percentage at the lateral cortex and formation of a broader callus. Qualitative assessments made by six radiologists also supported the conclusion that bone healing was improved by use of autogenous cancellous bone graft. CT was a useful method for assessing evidence of bone healing following TTA. CLINICAL RELEVANCE: These findings justify the application of autogenous cancellous bone graft to augment healing following TTA in dogs.

[1]  D. Marcellin-Little,et al.  Single-stage bilateral tibial tuberosity advancement for treatment of bilateral canine cranial cruciate ligament deficiency , 2015, Veterinary and Comparative Orthopaedics and Traumatology.

[2]  O. Lanz,et al.  Comparison of autogenous cancellous bone grafting and extra-corporeal shock wave therapy on osteotomy healing in the tibial tuberosity advancement procedure in dogs , 2015, Veterinary and Comparative Orthopaedics and Traumatology.

[3]  R. Haut,et al.  In vivo biomechanical evaluation of a novel angle-stable interlocking nail design in a canine tibial fracture model. , 2014, Veterinary surgery : VS.

[4]  A. Worth,et al.  Comparison between a novel bovine xenoimplant and autogenous cancellous bone graft in tibial tuberosity advancement. , 2012, Veterinary surgery : VS.

[5]  R. Todhunter,et al.  Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs , 2012, Veterinary and Comparative Orthopaedics and Traumatology.

[6]  S. Johnston,et al.  Veterinary Surgery: Small Animal , 2012 .

[7]  M. Haessig,et al.  Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints. , 2011, Veterinary surgery : VS.

[8]  Sarah K. Bisgard,et al.  The effect of cancellous autograft and novel plate design on radiographic healing and postoperative complications in tibial tuberosity advancement for cranial cruciate-deficient canine stifles. , 2011, Veterinary surgery : VS.

[9]  D. A. A. S. K. Dvm,et al.  The Effect of Cancellous Autograft and Novel Plate Design on Radiographic Healing and Postoperative Complications in Tibial Tuberosity Advancement for Cranial Cruciate-Deficient Canine Stifles , 2011 .

[10]  J. Morgan,et al.  Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft. , 2011, Veterinary surgery : VS.

[11]  A. Crawford-Sykes,et al.  Donor site morbidity following iliac crest bone graft. , 2008, The West Indian medical journal.

[12]  H. Schmoekel,et al.  Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. , 2008, The Journal of small animal practice.

[13]  M. Hässig,et al.  Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles , 2008, Veterinary and Comparative Orthopaedics and Traumatology.

[14]  C. Doria,et al.  Lumbar interbody expanding cage , 2008, Veterinary and Comparative Orthopaedics and Traumatology.

[15]  M. Haessig,et al.  Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease , 2008, Veterinary and Comparative Orthopaedics and Traumatology.

[16]  R. Boudrieau,et al.  Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. , 2007, Veterinary surgery : VS.

[17]  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.

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

[19]  C Suzanne Cutter,et al.  Bone grafts and substitutes. , 2006, Journal of long-term effects of medical implants.

[20]  J. Roush,et al.  Evaluation of healing in feline femoral defects filled with cancellous autograft, cancellous allograft or Bioglass , 2005, Veterinary and Comparative Orthopaedics and Traumatology.

[21]  P. Morberg,et al.  Response of a Calcium Sulfate Bone Graft Substitute in a Confined Cancellous Defect , 2003, Clinical orthopaedics and related research.

[22]  P. Mantyh,et al.  Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur , 2002, Neuroscience.

[23]  J. F. Ferguson.  Fracture of the humerus after cancellous bone graft harvesting in a dog. , 1996, The Journal of small animal practice.

[24]  D. M. Clark,et al.  Healing of canine autogenous cancellous bone graft donor sites. , 1991, Veterinary surgery : VS.

[25]  A. D. Elkins,et al.  The effects of plaster of Paris and autogenous cancellous bone on the healing of cortical defects in the femurs of dogs. , 1988, Veterinary surgery : VS.

[26]  K. Johnson.  Cancellous Bone Graft Collection from the Tibia in Dogs , 1986 .

[27]  K. A. Jhonnson.  ANGIOGRAPHY OF THE CAPRINE DIGIT , 1981 .

[28]  K. A. Johnson,et al.  The effects of autologous bone grafting on bone healing after carpal arthrodesis in the dog , 1980, Veterinary Record.

[29]  R. D. Ray,et al.  Experimental comparison of living and dead bone in rats , 1965 .

[30]  R. D. Ray,et al.  An experimental comparison of living and dead bone in rats. I. Physical properties. , 1962, The Journal of bone and joint surgery. British volume.