Evaluation of Fibular Head Transposition for Repair of Experimental Cranial Cruciate Ligament Injury in Dogs

Unilateral cranial cruciate ligament excision and fibular head transposition (FHT) were performed on 30 adult dogs. Vertical ground reaction forces were determined using force plate data before and after surgery. Cranial drawer motion, tibial rotation, and varus-valgus motion were measured at monthly intervals. Radiographic, gross, and histological examinations of the stifle joints that had been operated on were performed 3 weeks, 4 months, and 10 months after surgery. A scoring system was used to evaluate lameness, osteophyte formation, and meniscal damage. Rank correlation coefficients were calculated between variables tested in pairs. Cranial drawer motion and abnormal tibial rotation were present in all of the joints that had been operated on. Peak vertical force and associated impulse were not restored during the study time period. Meniscal damage was noted in 25% of the dogs at month 4 and in 50% of the dogs at month 10. Progressive gross and histological deterioration of the articular cartilage was observed in all joints. Positive correlations were noted between the degree of stifle joint instability and meniscal injury or radiographic changes. FHT did not control cranial drawer motion and rotational instability, was not successful in restoring limb function, and did not prevent joint degeneration, especially meniscal damage.     

Biomechanical Stability of Four Cranial Cruciate Ligament Repair Techniques in the Dog

Four commonly used cranial cruciate ligament (CCL) repair techniques were compared biomechanically in canine cadaver stifles by assessment of immediate postoperative laxity (cranial drawer) and stiffness. Each joint was tested nondestructively before repair, with the CCL intact and with the CCL excised. The cranio-caudal laxity after each repair was expressed as a percentage of the laxity in the same stifle after CCL excision. The stiffness of a repair was expressed as a percentage of the same intact joint's stiffness at an equivalent displacement. Repaired stifles were tested three consecutive times to the same maximum load (180 N) and the comparative laxity and stiffness in each test were determined. Fibular head transposition resulted in significantly increased stiffness, less laxity, and less decay per test than the other repairs. Lateral imbrication resulted in significantly less laxity on all tests, and significantly greater stiffness than the fascial strip or patellar tendon on the second and third tests to maximum load. The fascial strip resulted in significantly less laxity on all tests than the patellar tendon, but it was not significantly greater in stiffness. These data suggest that, of the reconstructive methods tested, fibular head transposition has biomechanically superior properties in the immediate postoperative period.     

Clinical Results Following Nonoperative Management for Rupture of the Cranial Cruciate Ligament in Dogs

Eighty-five dogs were diagnosed as having rupture of the cranial cruciate ligament. They were managed by restriction of activity to leash walks for 3 to 6 weeks, weight loss if indicated, and analgesic medication as needed. Twenty-four of 28 dogs that had a body weight of 15 kg or less (85.7%) were considered to be clinically normal (no lameness and normal range of motion in stifle, 21 dogs) or improved (3 dogs) after an average follow-up period of 36.6 months. Lameness in the remaining four dogs persisted or worsened over an average period of 8.2 months (minimum 6 months), and surgical replacement of the cruciate ligament was performed. Eleven of 57 dogs that had a body weight of 15 kg or greater (19.3%) were classified as normal (4 dogs) or improved (7 dogs) after an average follow-up period of 49.1 months. Lameness in the remaining 46 dogs persisted or worsened over an average period of 10.2 months (minimum 6 months), and surgical replacement of the cruciate ligament was performed.     

前十字韧带断裂犬胫骨平台角的X线和CT测量

为探究胫骨平台角（tibial plateau angle,TPA）在犬前十字韧带断裂（cranial cruciate ligament rupture,CCLR）中的临床意义及为犬CCLR的整体发病规律与风险、诊断和治疗方案提供参考,本研究选用2018年6月至2019年1月在中国农业大学动物医院确诊为CCLR的共15只患犬的30个膝关节,使用X线和CT测量TPA （R-TPA和CT-TPA）并比较X线和CT测量TPA的一致性及优缺点。结果显示,R-TPA大小与年龄、体重、胖瘦、性别及绝育/去势与否均无关（P>0.05）,前十字韧带是否断裂亦与TPA大小无关（P>0.05）。经CT测量所得30个CT-TPA的平均值为26.93°（范围：19.03°~32.67°）;左侧膝关节的CT-TPA的平均值为26.82°,右侧为27.04°。R-TPA与CT-TPA值具高度相关性（r>0.75,P>0.05）;21个膝关节（70%）可在CT图像中观察到骨赘生成,其CT图像比X线图像能更清楚地辨识出骨赘与骨皮质的分界。结果表明,TPA与CCLR患犬的临床病理因素无关,X线与CT在测量犬TPA方面具有一致性,CT测量在测量图像的采集上较X线拍摄更方便、快捷与全面,并在骨关节炎病例中的测量精度更高。     

In vitro evaluation of the 18 and 36 kg Securos Cranial Cruciate Ligament Repair System

OBJECTIVE: To evaluate the mechanical properties of the 18 and 36 kg Securos Cranial Cruciate Ligament Repair System. STUDY DESIGN: In vitro mechanical evaluation. SAMPLE POPULATION: Loop constructs of 18, 27, and 36 kilogram test (kgt) nylon leader line (NLL) secured with Securos crimp-clamps (SCC, n=40 per NLL test weight) or by a clamped square knot (CSK; n=40/NLL test weight). METHODS: The 36 kg SCC were used for the 27 and 36 kgt NLL, and 18 kg SCC were used for the 18 kgt NLL. Loop constructs were mounted on a material testing machine, and distracted at 500 mm/min for static tests, and for cyclic tests at 500 mm/min to a distraction limit of 6 mm (18 kgt) or 7.5 mm (27 and 36 kgt) for 49 cycles, until failure. Constructs were tested at 20 degrees C except for 1 group of 27 kgt CSK loops tested at 40 degrees C. Load at failure, elongation, and stiffness was recorded and compared between groups under static or cyclic testing conditions. RESULTS: All 27 and 36 kgt loops failed by disruption of NLL contained within the knot or crimp-clamp, whereas 18 kgt SCC loops failed by the NLL pulling through the crimp-clamp. The 18 kg SCC loops had considerable variability in ultimate load and elongation (coefficient of variation 29.6% and 18.3%, respectively). There was no significant difference in elongation between 27.3 kgt CSK loops tested at 20 degrees C and 40 degrees C. Generally, in both static and cyclic testing, SCC constructs formed with 27.3 or 36.4 kgt NLL performed as well or better than CSK constructs, resulting in loops that were strong, underwent minimal elongation, and had high stiffness. CONCLUSION: The results support use of the 36 kg Securos system but not the 18 kg Securos system (with the clamp and crimping device used). The significantly lower load required for failure, slippage through the clamp, and substantial variability suggested that the crimp tube diameter or the crimping device tested may be inappropriate for use with 18 kgt NLL. CLINICAL RELEVANCE: Surgeons should be aware that crimp-clamp design is important in controlling suture slippage or breakage within the clamp, and that novel systems should undergo mechanical testing with the size suture material they are intended to secure before clinical use.     

Lymphocyte Populations in Joint Tissues from Dogs with Inflammatory Stifle Arthritis and Associated Degenerative Cranial Cruciate Ligament Rupture

Objective: To evaluate lymphocyte populations in stifle synovium and synovial fluid of dogs with degenerative cranial cruciate ligament rupture (CCLR). Study Design: Prospective clinical study. Animals: Dogs (n=25) with stifle arthritis and CCLR, 7 dogs with arthritis associated with cartilage degeneration (osteoarthritis [OA]), and 12 healthy Beagle dogs with intact CCL. Methods: Arthritis was graded radiographically in CCLR dogs. After collection of joint tissues, mononuclear cells were isolated and subsequently analyzed using flow cytometry for expression of CD3, CD4, CD8, and CD21. Results: The proportions of CD4⁺ T helper lymphocytes, CD8⁺ cytotoxic T lymphocytes, and CD3⁺CD4^?CD8^? T lymphocytes were increased in synovium from dogs with CCLR compared with synovium from healthy Beagle dogs (P<.05). The proportion of CD3⁺CD4^?CD8^? T lymphocytes in synovial fluid was increased in dogs with CCLR compared with dogs with OA (P<.05). In dogs with CCLR, the proportion of CD3⁺CD4^?CD8^? T lymphocytes in synovial fluid was inversely correlated with radiographic arthritis (S_R=?0.68, P<.005). Conclusion: Lymphocytic inflammation of stifle synovium and synovial fluid is an important feature of the CCLR arthropathy. Lymphocyte populations include T lymphocytes expressing CD4 and CD8, and CD3⁺CD4^?CD8^? T lymphocytes. Presence of CD3⁺CD4^?CD8^? T lymphocytes was associated with development of stifle synovitis. Further work is needed to fully identify the phenotype of these cells.     

Popliteal Tendon Transposition for Stabilization of the Cranial Cruciate Ligament Deficient Stifle Joint in Dogs: An Experimental Study

Popliteal tendon transposition was performed in five dogs with surgically induced cranial cruciate ligament rupture. After a lateral approach to the stifle joint, the popliteal tendon was severed distal to the sesamoid bone and transposed cranially onto the tibial crest to mimic the sagittal orientation of the cranial cruciate ligament. The origin of the popliteal tendon on the lateral femoral condyle was preserved. Lameness was not clinically detectable 2 months after surgery. At 6 months postoperatively, there was minimal radiographic and histopathologic evidence of degenerative joint disease in the stifle joints that had underwent surgery. There was no gross or microscopic evidence of meniscal damage found at necropsy 6 months after surgery. Biome-chanical studies are warranted before recommending the procedure.     

Arthroscopic Study of Cranial Cruciate Ligament and Medial Meniscal Lesions in the Dog

Twenty stifles (10 dogs) were studied for a period of 1 year after various lesions of the cranial cruciate ligament and medial meniscus were produced surgicaoy. Through serial arthroscopic evaluations, degenerative processes In stifles with a "torn" cranial cruciate ligament were documented. Intra-articular changes were minimal after partial meniscectomy and were severe after total meniscectomy. Multiple arthroscopies caused no demonstrable changes.