Evaluation of the accuracy and intra‐ and interobserver reliability of three manual laxity tests for canine cranial cruciate ligament rupture—An ex vivo kinetic and kinematic study

Abstract

Objectives To investigate the accuracy and intra‐ and interobserver reliability of the cranial drawer test (CD), tibial compression test (TCT), and the new tibial pivot compression test (TPCT) in an experimental setting resembling acute cranial cruciate ligament rupture (CCLR) and to elucidate the ability to subjectively estimate cranial tibial translation (CTT) during testing. Study design Experimental ex vivo study. Sample population Ten cadaveric hindlimbs of large dogs. Methods Kinetic and 3D‐kinematic data was collected while three observers performed the tests on each specimen with intact (INTACT) and transected cranial cruciate ligament (CCLD) and compared using three‐way repeated‐measures ANOVA. Subjectively estimated CTT (SCTT), obtained during a separate round of testing, was compared to kinematic data by Pearson correlation. Results CTT was significantly higher for CCLD than for INTACT for all tests, resulting in 100% sensitivity and specificity. TPCT induced the highest CTT and internal rotation. Intra‐ and interobserver agreement of translation was excellent. For rotation and kinetics, agreement was more variable. SCTT strongly correlated with the objectively measured values. Conclusion The CD, TCT and the new TPCT were all accurate and reliable. The high translations and rotations during TPCT are promising, encouraging further development of this test. SCTT was reliable in our experimental setting. Clinical significance Veterinary manual laxity tests are accurate and reliable in acute CCLR. The TPCT might have potential for the assessment of subtle and rotational canine stifle instabilities. The high reliability of SCTT implies that grading schemes for stifle laxity, similar to human medicine, could be developed.

Comparative kinetic and kinematic evaluation of TPLO and TPLO combined with extra‐articular lateral augmentation: A biomechanical study

“…The testing setup was recently described for testing laxity in dogs 11 and was developed based on a testing fixture used for knee testing in people. 14 The stifles were mounted to a 3D printed testing fixture that was secured to a table by clamps (Figure 1).…”

“…Intra-and interobserver agreement in specimens with intact and transected CCL has been reported to be excellent in a recent study using the same setup. 11 During all rounds of testing, the kinetic and 3D kinematic data were captured.…”

“…However, before initiating tibial compression, the tarsus was brought in external rotation until resistance was felt and a valgus stress was applied. Then tibial compression was established, and external rotation was released, allowing the tibia to internally rotate and eventually subluxate 11 For eTPT, rotation was subjective and not controlled by goniometer.…”

“…The TPT has been described and validated as a tool to assess craniocaudal and rotational instability in CCL-intact and -deficient stifle. 11 It combines tibial compression either with an internal (iTPT) or an external rotational moment (eTPT). These tests were performed in intact, CCL-deficient, TPLO-stabilized stifles, and after combined TPLO and extra-articular lateral augmentation.…”

“…These tests were performed in intact, CCL-deficient, TPLO-stabilized stifles, and after combined TPLO and extra-articular lateral augmentation. A testing set-up, previously described by Lampart et al 11 and used in several biomechanical studies in people for evaluating anterior cruciate ligament reconstruction techniques, was utilized. [12][13][14] We hypothesized that:…”