Effect of Tibial Tuberosity Advancement on the Contact Mechanics and the Alignment of the Patellofemoral and Femorotibial Joints

Guerrero, Tomás; Pozzi, Antonio; Dunbar, Nicholas J.; Kipfer, Nicolas; Haessig, Michael; Horodyski, Mary Beth; Montavon, P. M.

doi:10.1111/j.1532-950x.2011.00866.x

Cited by 32 publications

(53 citation statements)

References 49 publications

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“…Tibial tuberosity advancement (TTA) is designed to align the patellar tendon perpendicularly relative to the tibial plateau, by displacing the tibial tuberosity cranially. This advancement neutralizes tibiofemoral shear forces and allows return to function despite deterioration of the cranial cruciate ligament (CrCL) in the dog stifle . TTA is an accepted surgical procedure to manage lameness associated with cruciate ligament disease in dogs .…”

Section: Introductionmentioning

confidence: 99%

Major complications of tibial tuberosity advancement in 1613 dogs

Costa

Craig²,

Cambridge³

et al. 2017

Veterinary Surgery

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Section: Introductionmentioning

confidence: 99%

Major complications of tibial tuberosity advancement in 1613 dogs

Costa

Craig²,

Cambridge³

et al. 2017

Veterinary Surgery

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“…In our study, the quadriceps muscle group was transected. Other studies evaluating cranial cruciate ligament disease have utilized a spring to simulate the function of the quadriceps mechanism [22, 23]. This was not performed in our study.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo preliminary investigation of radiographic quantitative assessment of cranial tibial displacement at varying degrees of canine stifle flexion with or without an intact cranial cruciate ligament

Castaneda¹,

Hudson²,

Beale³

2018

BMC Vet Res

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BackgroundThe presence of cranial tibial subluxation can aid in the detection of joint instability as a result of CrCL injury. Detection of cranial tibial subluxation has been described using the tibial compression test (TCT) and cranial drawer test (CDT); however, diagnosis of CrCL insufficiency by assessing cranial subluxation motion of the tibia is subjective and difficult to quantify accurately. The aim of this study was to investigate a measurement technique to assess the degree of cranial tibial displacement relative to the femoral condyles on mediolateral projection stifle radiographs at varying degrees of stifle flexion (90°, 110°, and 135°) in CrCL intact, partially, and completely transected conditions. Radiographic measurements included: CrCL length and intercondylar distance (ICD), defined as the distance between the tibial mechanical axis (TMA) and the femoral condylar axis (FCA). The influence of CrCL status, stifle flexion angle, and measurement type on measured distance was evaluated. The relationship between CrCL length and ICD measurement was also assessed.ResultsComplete transection of the CrCL resulted in significant cranial tibial displacement. Stifle flexion angle affected ICD, but not CrCL length. Normalized measured CrCL length and ICD were significantly different; however, no differences existed between the change in distance detected by CrCL length and ICD measurements as CrCL transection status changed. Correlation coefficients detected a significant positive correlation between measured CrCL and ICD.ConclusionThe ICD measurement technique was able to quantify tibial displacement at various stifle flexion angles in the intact and completely transected CrCL conditions. The ICD measurement was more affected by stifle flexion angle than was the CrCL length.Electronic supplementary materialThe online version of this article (10.1186/s12917-018-1599-5) contains supplementary material, which is available to authorized users.

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“…Because the most profound femorotibial kinematic abnormalities with cranial cruciate ligament rupture occur in the sagittal plane, it is logical to expect that the patellofemoral kinematics we reported, including patellar flexion, proximodistal translation, and craniocaudal translation, may be disrupted by the condition. Indeed, cadaveric studies have found the cranial cruciate ligament rupture can alter patella alignment and patellofemoral contact mechanics [4]. Patellofemoral mechanics are also of particular interest with the surgical treatment of cranial cruciate ligament rupture as stifle extensor mechanism abnormalities frequently occur following various procedures used to address the disease [26].…”

Section: Discussionmentioning

confidence: 99%

“…Patellar luxation is a highly prevalent disorder affecting the stifles of dogs and alters stifle mechanics [2]. Cranial cruciate ligament insufficiency is also common in dogs and has been shown to disrupt normal patellofemoral joint motion [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

Normal patellofemoral kinematic patterns during daily activities in dogs

et al. 2016

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BackgroundPatellar abnormalities are a common cause of pain and lameness in dogs; however, in vivo the relative motion between the femur and patella in dogs is not well described. The objective of this study was to define normal in vivo sagittal plane patellofemoral kinematics in three axes of motion using non-invasive methods. We hypothesized patellofemoral alignment in the sagittal plane would tightly correlate with the femorotibial flexion angle. Six healthy dogs without orthopedic disease underwent computed tomography (CT) of their hind limbs to create 3-D models of the patella and femur. Normal stifle joint motion was captured via flat-panel imaging while each dog performed a series of routine activities, including sitting, walking, and trotting. The 3-D models of the patella and femur were digitally superimposed over the radiographic images with shape-matching software and the precise movement of the patella relative to the femur was calculated.ResultsAs the femorotibial joint flexed, the patellofemoral joint also flexed and the patella moved caudally and distally within the femoral trochlea during each activity. Patellar flexion and distal translation during walk and sit were linearly coupled with the femorotibial flexion angle. Offset was evident while trotting, where patella poses were significantly different between early and late swing phase (p ≤ 0.003). Patellar flexion ranged from 51 to 6° while trotting. The largest flexion angle (92°) occurred during sit. The patella traversed the entire proximodistal length of the femoral trochlea during these daily activities.ConclusionsUsing single-plane flat-panel imaging, we demonstrated normal in vivo patellofemoral kinematics is tightly coupled with femorotibial kinematics; however, trot kinematic patterns did not follow the path defined by walking and stand-to-sit motions. Our normal data can be used in future studies to help define patellofemoral joint kinematics in dogs with stifle abnormalities.

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Effect of Tibial Tuberosity Advancement on the Contact Mechanics and the Alignment of the Patellofemoral and Femorotibial Joints

Abstract: TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%.

Cited by 32 publications

References 49 publications

Major complications of tibial tuberosity advancement in 1613 dogs

Major complications of tibial tuberosity advancement in 1613 dogs

Ex vivo preliminary investigation of radiographic quantitative assessment of cranial tibial displacement at varying degrees of canine stifle flexion with or without an intact cranial cruciate ligament

Normal patellofemoral kinematic patterns during daily activities in dogs

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