Inter- and intra-operator variability associated with extracapsular suture tensioning

Dunn, Amy L.; Buffa, E. A.; Marchevsky, A. M.; Heller, Jane; Moores, A. P.; Farrell, Michael

doi:10.3415/vcot-11-12-0189

Cited by 10 publications

(2 citation statements)

References 30 publications

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“…It is our belief that LSS tensioning should aim to apply a tension that is only sufficient to limit cranial drawer but not excessive in order to limit its impact on 3D kinematics in the other planes. Variability associated with LSS tensioning has been reported within and between surgeons and is suggested to lead to inconsistent clinical outcomes [ 24 ]. Further studies are needed to assess the impact of excessive LSS suture tensioning on 3D kinematics in order to provide clearer clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional kinematic evaluation of lateral suture stabilization in an in vitro canine cranial cruciate deficient stifle model

et al. 2021

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The impact of surgical correction of cranial cruciate ligament rupture (CCLR) on 3D kinematics has not been thoroughly evaluated in dogs. The success of current techniques remains limited, as illustrated by suboptimal weightbearing and progression of osteoarthritis. The inability to restore the stifle’s 3D kinematics might be a key element in understanding these suboptimal outcomes. The objective of this study was to evaluate the impact of lateral suture stabilization (LSS) on the 3D kinematics of the canine stifle joint. We hypothesized that LSS would not restore 3D kinematics in our model. Ten cadaveric pelvic limbs collected from large dogs (25–40 kg) were tested using a previously validated apparatus that simulates gait. Three experimental conditions were compared: (a) intact stifle; (b) unstable stifle following cranial cruciate ligament transection (CCLt) and (c) CCLt stabilized by LSS. Three-dimensional kinematics were collected through 5 loading cycles simulating the stance phase of gait and curves were analyzed using a Wilcoxon signed-rank test. LSS restored baseline kinematics for the entire stance phase for cranial and lateromedial translation, flexion, and abduction. It restored distraction over 90% of the stance phase. Internal rotation was limited, but not restored. This in vitro study had limitations, as it used a simplified model of stifle motion and weight-bearing. The results of this study report that LSS can restore physiologic 3D kinematics largely comparable to those of healthy stifles. Suboptimal outcome in patients following CCLR stabilization by LSS may therefore result from causes other than immediate postoperative abnormal 3D kinematics.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional kinematic evaluation of lateral suture stabilization in an in vitro canine cranial cruciate deficient stifle model

et al. 2021

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“…It thus appeared that with a similar surgical technique, inconsistent suture tensioning plays an important role in different postoperative stifle kinematics. A previous study also indicated that there is variability in the tension applied during ECS application, both within and between surgeons, which may lead to discrepancies in clinical outcomes [ 36 ]. Further studies are warranted to quantify the suture tension and assess the impact of different suture tensions.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo biomechanical evaluation of extracapsular stabilization with quasi-isometric points in canine cranial cruciate ligament-deficient stifles

Hsu¹,

Lin²,

Sun³

et al. 2023

BMC Vet Res

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Background Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs. The extracapsular stabilization (ECS) utilizing bone anchors and monofilament nylon leader was an alternative treatment for CCL-deficient (CCLD) dogs. However, the biomechanical response of the canine stifle to such a surgical repair strategy in conjunction with the use of recently reported quasi-isometric anchoring points remains unclear. The objectives of the study were to evaluate the mobility and stability of CCL-intact, CCLD, and CCLD stifles repaired with ECS at two different pairs of quasi-isometric points (quasi-IPs). Methods Twelve stifle specimens from 7 dogs underwent mobility and stability tests under 4 different conditions, namely, CCL-intact, CCLD, and ECS-repaired at 2 different pairs of quasi-IPs (referred to as ECS-IP1 and ECS-IP2). The mobility tests evaluated 6 degrees-of-freedom stifle kinematics during flexion and extension. The stability tests involved cranial drawer and tibial internal rotation (IR) tests at various stifle opening angles and quantifying the cranial tibial translation (CTT) and tibial IR angles under constantly applied loadings. Results The ECS repaired at quasi-IPs was shown to restore cranial instability of the stifles with averaged CTT magnitudes < 1.4 mm. During the tibial IR test, the ECS treatments resulted in significantly less tibial IR compared to those in intact CCL stifles. The mobility tests showed similar results. Conclusion The 2 chosen pairs of quasi-IPs were shown to effectively correct the excessive CTT caused by CCLD stifles, whereas the excessive tibial external rotation in comparison to those of intact stifles should be considered for its subsequent influence on joint alignment and the contact pressure applied to the stifle joint.

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Extracapsular Stabilization Using Synthetic Material

Holsworth¹

2021

Complications in Canine Cranial Cruciate Ligament Surgery

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Inter- and intra-operator variability associated with extracapsular suture tensioning

Cited by 10 publications

References 30 publications

Three-dimensional kinematic evaluation of lateral suture stabilization in an in vitro canine cranial cruciate deficient stifle model

Three-dimensional kinematic evaluation of lateral suture stabilization in an in vitro canine cranial cruciate deficient stifle model

Ex vivo biomechanical evaluation of extracapsular stabilization with quasi-isometric points in canine cranial cruciate ligament-deficient stifles

Extracapsular Stabilization Using Synthetic Material

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