Effect of center of rotation of angulation‐based leveling osteotomy on ex vivo stifle joint stability following cranial cruciate ligament transection and medial meniscal release with and without a hamstring load

Abstract

Objective To evaluate the effect of center of rotation of angulation (CORA)‐based leveling osteotomy (CBLO) and hamstring load on stifle stability following cranial cruciate ligament transection (CCLx) and medial meniscal release (MMR). Study design Ex vivo experimental study. Sample population Cadaver hind limb preparations (n = 7). Methods After instrumentation, constant quadriceps and gastrocnemius loads with an optional hamstring load in a 3:1:0.6 ratio were applied, and stifles were extended from fully flexed using an electrical motor during fluoroscopic recording. The recording process was repeated after each of CCLx, MMR and CBLO and the extracted landmark coordinates were used for calculation of cranial tibial translation (CTT) and patellar ligament angle (PTA). Results Mean initial tibial plateau angle was 28.1°: post‐CBLO the mean was 9.7°. Cranial tibial translation developed from 50° and 75° with CCLx and MMR respectively (p < .04, < .02) without hamstring loading. Hamstring loading mitigated CTT due to CCLx and delayed CTT until 120° for MMR (P < .02) in this model. CBLO prevented CTT, except at 140° without hamstring loading (P = .01). Similar results were seen for PTA, but CBLO curves were parallel to and lower than intact values at all tested angles (P < .04), consistent with induced effective joint flexion. Conclusion CBLO to a target tibial plateau angle of 10° largely eliminated CTT induced by CCLx and MMR. Hamstring loads of 20% quadriceps load improved stifle stability in this model. Impact Stifle stability following CBLO appears to be multifactorial and depends on meniscal integrity, joint angle, and hamstring strength.

Effect of center of rotation of angulation-based levelling osteotomy on instantaneous center of rotation ex vivo

“…Weight-bearing influences ICR path in humans (Hollman et al 2002 ), and variations in simulated muscle loading affect ex vivo canine joint stability before and after CBLO (Mazdarani et al 2022 ): in the latter study simulated quadriceps and gastrocnemius loads of 147 N and 49 N, respectively, were tested alone or in combination with a hamstring load of 29 N. Hamstring loading resulted in improved joint stability in this study. Given in vivo evidence of better medium- to long-term joint health following CBLO (Vasquez et al 2018 ) compared to tibial plateau leveling osteotomy (Hulse et al 2010 ), it seems valid to consider whether CBLO results in a distinct ICR path compared to other osteotomies.…”

“…Coordinate data were obtained from an ex vivo fluoroscopic study of canine stifle joint stability (Mazdarani et al 2022 ) and a similar analytical approach to that previously described was employed (Mazdarani et al 2023 ). Briefly, seven left hind limbs were instrumented, including placement of fiduciary markers at the origin and insertion of the CCL, and in the distal femoral and proximal tibial diaphysis (3 each) to indicate the bone axes.…”

“…Limbs were mounted on a custom frame with simulated quadriceps and gastrocnemius loads (147 N and 49 N, respectively) and an optional hamstring load of 29 N created using lines connected to the patella, calcaneus, and proximal tibial metaphysis, respectively, and passing around pulleys to align the loads with muscle lines of action. Simulated muscle loads were based on previous biomechanical studies and experimental results (Jensen et al 2020 ; Mazdarani et al 2022 ; Shahar and Banks-Sills 2004 ). No compressive load to simulate weight-bearing was applied.…”

“…Cranial cruciate ligament (CCL) rupture is a common cause of canine stifle disability (Engdahl et al 2021 ), and the choice of technique to stabilize affected joints remains controversial (von Pfeil et al 2018 ). The center of rotation of angulation (CORA)-based levelling osteotomy (CBLO) is a recent addition to stabilization surgeries which has shown promise clinically (Vasquez et al 2018 ) and in ex vivo and in silico studies (Mazdarani et al 2022 ; Putame et al 2019 ).…”

Stifle kinematics in 4 dogs with cranial cruciate ligament insufficiency treated by CORA-based leveling osteotomy

“…The CBLO aligns the proximal tibial anatomic and mechanical axes and has several purported advantages, such as minimizing caudal tibial subluxation (4)(5)(6). A cadaveric study reported that CBLO prevented cranial tibial translation after CCL transection throughout stifle range of motion, but no weight bearing force was applied (7). In addition, this study was ex-vivo; in-vivo kinematic outcomes have not been investigated after CBLO.…”