Biomechanical comparison of knotted and knotless stabilization techniques of the tarsal medial collateral ligament in cats: A cadaveric study

Abstract

ObjectiveTo compare mechanical properties of intact feline medial collateral ligaments and three techniques for treatment of feline medial tarsal instability.Study designControlled laboratory study.Sample populationForty‐eight normal, adult feline tarsi.MethodsThree repairs were tested: a bone tunnel with polypropylene (PP) suture, a bone tunnel with polyethylene (PE) cord, and a knotless anchor technique with PE cord. A cyclic (6‐N preload; 5‐N amplitude; 2‐Hz frequency) tensile test (600 cycles) was performed on feline tarsi with either the long or the short medial tarsal ligament intact, with each reconstruction technique followed by a single‐cycle load‐to‐failure test (0.5 mm/s) with a failure point at 2 mm of displacement. Total elongation, peak‐to‐peak elongation, stiffness, and maximum load to failure point were compared with the intact condition.ResultsNo differences in stiffness, total elongation, or peak‐to‐peak elongation were found between specimens repaired with the knotless technique and intact controls (P > .04), whereas tarsi repaired with the tunnel technique and PP were weaker (P < .008). Total and conditioning elongation were greater after tunnel reconstruction with PP than after knotless reconstruction (P = .005). Mean load to 2 mm of displacement tended (P = .03) to be higher after knotless than after knotted PP repairs and did not differ (P = .47) between tarsi repaired with the tunnel or anchor repairs with PE.ConclusionThe mechanical properties of intact tarsi were superior to those of tarsi repaired with tunnel techniques and PP but were similar to those of tarsi repaired with knotless techniques with PE.Clinical significanceFeline tarsal stabilization with the knotless technique for tarsal medial collateral ligament insufficiency may reduce the requirement for or duration of postoperative coaptation.

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

“…In this study, a distal tibial insertion, a talar insertion and an insertion at the level of the central tarsal bone were performed, thus respecting the anatomical insertions of the physiological ligament to maintain joint function. While some research teams chose to create one tibial and two talar insertions ( Aron and Purinton, 1985 ; Harasen, 2000 ; Martin et al ., 2019 ), others suggested recreating three insertions: a tibial one, one at the level of the calcaneus, and one at the level of the central tarsal bone or the talus ( Luescher et al ., 2020 ). However, none of the MCTL heads inserts at calcaneal level ( Johnston and Tobias, 2017 ).…”

“…Suspicion of MCTL injury may be confirmed by orthopedic examination combined with stress radiographs ( Vaughan, 1987 ; Fossum, 2013 ; Bogisch and Schuenemann, 2019 ; Linn and Duerr, 2020 ). Following diagnosis, two surgical management options are most commonly performed: the placement of a joint osteosynthesis plate ( Muir and Norris, 1999 ; Benson and Boudrieau, 2002 ; Mckee et al ., 2004 ; Scrimgeour et al ., 2012 ) or less frequently, the placement of a synthetic implant ( Aron and Purinton, 1985 ; Diamond et al ., 1999 ; Harasen, 2000 ; Martin et al ., 2019 ; Luescher et al ., 2020 ). These synthetic implants may be diverse, such as nylon monofilament, braided polyester wire or orthopedic wire that can be tied in a figure 8 around previously implanted screws in the tibia and the talus ( Aron and Purinton, 1985 ; Diamond et al ., 1999 ; Harasen, 2000 ).…”

“…In addition, TEFs may cause joint ankylosis associated with amyotrophy of the affected limb, thus increasing the animal’s functional recovery period ( Lieber and Danzig, 1988 ; Seibert et al ., 2011 ). In recent years, there has been renewed interest in MCTL reconstruction techniques using synthetic implants in cats ( Luescher et al ., 2020 ) and dogs ( Martin et al ., 2019 ). To our knowledge, these techniques have not yet been applied to patients in vivo.…”

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

“…4,5 Treatment modalities for collateral ligament ruptures include open reduction and internal stabilization using primary ligament suture and/or prosthetic ligament reconstruction, external coaptation, transarticular external skeletal fixation (TESF) or a combination of these. [1][2][3][6][7][8] Primary ligament suture should be attempted whenever possible. 9 Unfortunately, primary repair is not always feasible particularly when there is significant soft tissue damage.…”

“…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.…”