Biomechanical evaluation of two extracapsular techniques for cranial cruciate ligament reconstruction in cadaver dogs

Abstract

Cranial cruciate ligament rupture (CCLR) is one of the most important orthopedic conditions in dogs, leading to joint instability, pain, osteoarthritis and eventually to meniscal injuries. Several surgical techniques have been described to reestablish joint stability following CCLR, including extracapsular procedures. This study compared the biomechanical effects of two extracapsular stabilization techniques (lateral fabello-tibial suture -LFTS, and modified retinacular imbrication technique -MRIT) using nylon leader line following experimental CCLR in cadaver dogs. Twenty canine cadaveric stifles were used. Joint stiffness, cranial and caudal tibial displacement were evaluated in 4 different experimental scenarios: intact stifle, stifle with CCLR, CCLR treated with lateral fabello-tibial suture (LFTS), and CCLR treated with modified retinacular imbrication technique (MRIT). Results: Mean cranial tibial displacement increased progressively from intact to MRIT, LFTS and CCRL stifles. MRIT resulted in less caudal drawer motion than LFTS. Joint stiffness did not differ significantly between LFTS and MRIT treated stifles. Conclusion: LFTS and MRIT increase joint stability but MRIT is more effective; however none of the techniques studied was able to restore original intact stifle stiffness. Clinical implications of the results presented remain to be determined but kinetic gait analysis studies are warranted to determine whether this biomechanical advantage translates into improved hind limb function in dogs. Key words: Biomechanics. Cranial cruciate ligament. Dogs. Fabellar suture. Stifle. ResumoA ruptura do ligamento cruzado cranial (RLCCr) é uma das principais afecções ortopédicas em cães e resulta na instabilidade do joelho, dor, desenvolvimento de osteoartrose, podendo também causar lesão de menisco. Com o intuito de restabelecer a estabilidade da articulação, muitas técnicas são utilizadas, dentre elas, as extracapsulares. O objetivo do presente trabalho foi realizar a avaliação biomecânica de duas dessas técnicas em 20 joelhos de cadáveres de cães utilizando-se fio de náilon leader line. Nestas peças foram avaliados a rigidez articular e o deslocamento tanto cranial quanto caudal da tíbia em quatro situações distintas: joelho íntegro; joelho com RLCCr e sutura fabelo-tibial lateral (SFTL); joelho com RLCCr e sutura fabelo-tibial lateral e medial (SFTLM); e por fim, o joelho com RLCCr sem as técnicas de estabilização. Houve diferença no deslocamento cranial entre todas as situações, sendo em ordem crescente, o joelho integro, com SFTLM, com SFTL e por fim, o joelho com RLCCr não estabilizado. Na comparação da presença de movimento de gaveta caudal a técnica de SFTLM apresentou menor deslocamento que a técnica de SFTL. Com relação à rigidez tanto cranial quanto caudal, as duas técnicas não apresentaram diferença. As duas técnicas testadas diminuem a instabilidade do joelho, sendo a SFTLM mais efetiva, e nenhuma delas restaurou a rigidez articular de um joelho íntegro. As implicações clínicas dos resultad...

Biomechanical cyclic loading test of a synthetic ligament fixation system used for intra-articular stabilization of deficient canine stifles

“…The literature review on ex-vivo biomechanical veterinary studies published on passive stabilization techniques for deficient stifles revealed limited research with very different testing protocols ( Sicard et al , 2002 ; Banwell et al , 2005 ; Burgess et al , 2010 ; Tonks et al , 2010 ; Cabano et al , 2011 ; Rose et al , 2011 ; Choate et al , 2013 ; Oda et al , 2016 ).…”

“…), their fixation technique (Knotted, Crimped, etc. ), or the effect of the sterilization method use for the suture material ( Sicard et al , 2002 ; Banwell et al , 2005 ; Burgess et al , 2010 ; Cabano et al , 2011 ; Rose et al , 2011 ); on the other hand, biomechanical studies on the various passive stabilization techniques for deficient stifles using different types of material and fixation systems on cadaveric canine hind limbs ( Tonks et al , 2010 ; Choate et al , 2013 ; Oda et al , 2016 ). Therefore, the study published by Choate et al (2013) is the only one that deals with a similar subject and allows a general comparison with our work.…”