Relationship between age and tibial plateau angle in dogs with cranial cruciate rupture

The pathogenesis of cranial cruciate ligament (CCL) rupture remains controversial, and its relationship to tibial plateau angle is unknown. In this study, the tibial plateau angle was measured in 200 large-breed dogs diagnosed with CCL rupture. Correlation analyses were performed to determine whether the age at the time of CCL rupture and the tibial plateau angle were related. While these two values were inversely correlated, the relationship was not strong enough to explain the frequency of CCL rupture in young, large-breed dogs. There was no statistically significant correlation between age at the time of CCL rupture and tibial plateau angle.     

Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling

Objectives : To evaluate a novel surgery aimed at managing concurrent medial patellar luxation (MPL) and cranial cruciate ligament (CCL) ruptures in dogs weighing more than 30 kg. Methods : Tibial plateau levelling osteotomy (TPLO) and femoral trochleopasty were performed. The principal tibial fragment was laterally translated by 3 to 6 mm and was externally and abaxially rotated to create a wedge measuring 1·5 to 2·5 mm at the medial and cranial aspect and 1 to 3 mm at the medial and distal aspect of the tibial plateau fragment. The fragments were stabilised with a narrow TPLO plate. Results : Thirteen surgeries were performed in 12 dogs with a mean weight of 39·8 kg. The mean postoperative tibial plateau slope was 8·1°. Additional surgery was required in two cases, one due to failure of fixation and another due to screw breakage. The mean lameness score was 3·5 (out of 5) before surgery, 0·7 after 8 to 12 weeks, and 0·3 at final follow-up. Median follow-up was 1115 days (range, 270 to 2040 days). No patella luxated after surgery. Clinical Significance : MPL and CCL ruptures may be successfully managed by performing a TPLO and simultaneously altering the relationship of the principal and tibial plateau fragments during surgery.     

Caudal cruciate ligament damage in dogs with cranial cruciate ligament rupture

Objective: To investigate the incidence of caudal cruciate ligament (CaCL) damage in dogs with cranial cruciate ligament rupture (CCLR). Study Design: Prospective clinical study. Animals: Dogs (n=24) admitted for surgical stabilization of the stifle after CCLR and 8 healthy dogs with intact cranial cruciate ligament (CCL) and CaCL studied as controls. Methods: Preoperative radiographs and stifle joint images (arthrotomy, 6; arthroscopy, 18) were collected from dogs with CCLR. Severity of arthritis, synovitis, CCL damage, and CaCL damage were assessed using numerical rating scales. The CaCL was probed to determine whether minor fraying or a full thickness defect in the ligament was present. Data collected from the study population were compared with the control population of dogs. Results: The CaCL was damaged in 21/24 (88%) of dogs with CCLR; 6/24 (25%) had a full thickness defect in the CaCL. Severity of stifle synovitis and severity of damage to the CaCL were positively correlated (P<.05). Conclusions: The CaCL is damaged in a high percentage of dogs with CCLR. A significant and positive correlation exists between the degree of synovitis present and the extent of CaCL damage. Clinical Relevance: In dogs with CCLR, cruciate ligament pathology typically involves both the CCL and CaCL. As the severity of synovitis and the extent of CaCL damage are related, this observation supports the hypothesis that stifle synovitis may contribute to CCL and CaCL degeneration and subsequent damage.     

Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries

OBJECTIVE: To measure and compare tibial plateau angles (TPA) of dogs with cranial cruciate ligament (CrCL) injuries and dogs without CrCL injuries. DESIGN: Prospective study. ANIMALS: 87 dogs. PROCEDURE: Stifle joints were measured from lateral radiographic views to determine TPA in 3 groups: group-1 dogs had CrCL injuries, group-1a dogs, a subgroup of group 1, had 1 unaffected stifle joint, and group-2 dogs had no CrCL injuries. Age, sex, breed, body weight, limb injured, and TPA were recorded for each dog. RESULTS: 56 stifle joints were measured in group-1 dogs; mean TPA was 23.76 degrees , and mean age and weight were 5.7 years and 37.91 kg (83.4 lb), respectively. Fourteen stifle joints were measured in group-1a dogs; mean TPA was 24.71 degrees , and mean age and weight were 5.6 years and 38.06 kg (83.8 lb), respectively. Sixty stifle joints were measured in group-2 dogs; mean TPA was 18.10 degrees , and mean age and weight of these dogs were 4.83 years and 35.85 kg (79 lb), respectively. The most common breeds included Labrador Retriever, Golden Retriever, and Rottweiler. The TPA of dogs in group 1 and group 1a were significantly greater than the TPA of dogs in group 2. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs with CrCL injuries have a significantly greater TPA than dogs without CrCL injury. With further investigation, a normal TPA can be determined. In the future, TPA measurements may be used to screen dogs suspected of being susceptible to CrCL injury.     

Feasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs

The patellar ligament angle (PLA) was assessed in 105 normal stifle joints of 79 dogs and 33 stifle joints of 26 dogs with a ruptured cranial cruciate ligament (CrCL). The PLA of stifles with complete CrCL rupture was significantly lower than that of normal stifles, particularly at a flexion angle of 60~80° in both plain and stress views. If the PLA was <90.55° on the stress view with a 60~80° flexion angle, the dog was diagnosed with a complete rupture of the CrCL with a sensitivity of 83.9% and specificity of 100%. In conclusion, measuring the PLA is a quantitative method for diagnosing complete CrCL rupture in canines.     

Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs

Eight dogs presented with chronic hindlimb lameness associated with cranial cruciate ligament rupture. Seven were small terriers. A caudal deformity of the proximal tibial shaft, originating at the proximal tibial physis, and an excessive caudal slope of the tibial plateau were present bilaterally in all dogs. The deformity was thought to be responsible for the cranial cruciate ligament failure and poor response to conservative management. Tibial plateau angles were in excess of 26 degrees in all dogs. The lameness was bilateral in three dogs. There was complete cranial cruciate ligament rupture in seven stifles and partial rupture in four. There were no meniscal injuries. Surgical correction resulted in a significant improvement (P<0.0001) in all dogs, with a mean follow-up of 12 months (range three to 24 months). There were no complications.     

The possible role of the tibial plateau angle for the severity of osteoarthritis in dogs with cranial cruciate ligament rupture

The purpose of this study was to determine factors correlated with the severity of radiographic osteoarthritis (OA) scoring in dogs with cranial cruciate ligament rupture (CrCLR). Three radiographs of stifle joints (craniocaudal, mediolateral, and mediolateral radiograph with 90 degree flexion of the stifle and tarsal joints) were obtained from 36 dogs with CrCLR (Clinical group) and from 22 dogs without stifle joint disease (Control group). Information about these dogs was collected from the owners and from medical records. Radiographic OA scores in each dog in the clinical group were determined from radiographs using a numeric grading system previously reported. The tibial plateau angle (TPA) in each dog in both groups was measured on mediolateral radiographs with 90 degree flexion of the stifle and tarsal joints. The Mann-Whitney's U test was used for comparing variables between the clinical group and the control group, and Spearman's rank correlation test was used for evaluating correlations between radiographic OA scores and variables in the clinical group. No significant differences were detected between the clinical group and the control group for any of the variables. There were two positive correlations; one between the radiographic OA score and TPA (r=0.395, p=0.014); and the other between body weight and OA score (r=0.399, p=0.013) in the clinical group. Our results indicate that body weight and TPA could affect the severity of the radiographic OA score in dogs with CrCLR.     

Apoptosis of ligamentous cells of the cranial cruciate ligament from stable stifle joints of dogs with partial cranial cruciate ligament rupture

OBJECTIVE: To describe the presence and amount of apoptotic ligamentous cells in different areas of partially ruptured canine cranial cruciate ligaments (prCCLs) and to compare these findings with apoptosis of ligamentous cells in totally ruptured cranial cruciate ligaments (trCCLs). ANIMALS: 20 dogs with prCCLs and 14 dogs with trCCLs. PROCEDURES: Dogs with prCCLs or trCCLs were admitted to the veterinary hospital for stifle joint treatment. Biopsy specimens of the intact area of prCCLs (group A) and the ruptured area of prCCLs (group B) as well as specimens from trCCLs (group C) were harvested during arthroscopy. Caspase-3 and poly (ADP-ribose) polymerase (PARP) detection were used to detect apoptotic ligamentous cells by immunohistochemistry. RESULTS: No difference was found in the degree of synovitis or osteophytosis between prCCLs and trCCLs. No difference was found in degenerative changes in ligaments between groups A and B. A substantial amount of apoptotic cells could be found in > 90% of all stained slides. A correlation (r(s) = 0.71) was found between the number of caspase-3-and PARP-positive cells. No significant difference was found in the amount of apoptotic cells among the 3 groups. No significant correlation could be detected between the degree of synovitis and apoptotic cells or osteophyte production and apoptotic cells. CONCLUSIONS AND CLINICAL RELEVANCE: The lack of difference between the 3 groups indicates that apoptosis could be a factor in the internal disease process leading to CCL rupture and is not primarily a consequence of the acute rupture of the ligament.     

Comparison of the tibial mechanical joint orientation angles in dogs with cranial cruciate ligament rupture

Use of the tibial mechanical joint orientation angles is now the standard of care for evaluating tibial deformities, although they have not been used to evaluate dogs with cranial cruciate ligament (CrCL) rupture. The objective of this study was to compare the tibial mechanical joint orientation angles and tibial plateau angle (TPA) between dogs with bilateral CrCL rupture (BR) and unilateral CrCL rupture with (UR-SR) and without subsequent contralateral CrCL rupture (UR-w/o-SR) as risk factors for subsequent contralateral CrCL rupture. Twenty dogs (21.7%) were classified as BR, 38 (41.3%) were classified as UR-SR, and 34 (37.0%) were classified as UR-w/o-SR. The tibial mechanical joint orientation angles and TPA, in the range studied (< 35°), were not statistically different for dogs with BR, UR-SR, and UR-w/o-SR, and were not significant risk factors for subsequent contralateral CrCL rupture.     

Proximal tibial epiphysiodesis to reduce tibial plateau slope in young dogs with cranial cruciate ligament deficient stifle

The purpose of this study was to evaluate the ability of proximal tibial epiphysiodesis to reduce the tibial plateau slope in young dogs with cranial cruciate ligament (CCL) deficient stifles. Of the 14 treated dogs, eight had a bilateral injury, for a total of 22 joints. After physical and radiographical examination and measurement of tibial plateau slope, all of the dogs underwent surgery. Insertion of the screw was placed in the most proximal part of the tibial plateau, in its medio-lateral centre, aiming to the tibial shaft and using a K wire predriven as a guide; correct position of the screw was confirmed with intraoperative fluoroscopy or radiography. In all of the dogs the tibial slope was decreased at the time of physis fusion and the degree of change depended on the age and the breed of the dog at the time of surgery. The minimum change was 4 degrees and the maximum was 24 degrees. There was a statistically significant difference between tibial slope measured before surgery compared to tibial slope measured at the last follow-up visit after surgery. This study shows that the partial proximal tibial fusion in dogs with ACL injuries was effective in reducing the tibial slope during the residual growing time to such an extent to stabilize the joint, provided that the surgery had been carried out when there was still residual growing potential. The technique appeared to be mini-invasive and malalignment complications could be avoided by correct and precise insertion of the screw.     

Risk factors for excessive tibial plateau angle in large-breed dogs with cranial cruciate ligament disease

OBJECTIVE: To identify risk factors for development of excessive tibial plateau angle (TPA) in large-breed dogs with cranial cruciate ligament disease (CCLD). DESIGN: Case-control study. ANIMALS: 58 dogs with excessive TPAs (ie, TPA >or= 35 degrees ; case dogs) and 58 dogs with normal TPAs (ie, TPA or= 35 degrees in both limbs were 13.6 times (95% confidence interval, 2.72 to 68.1) as likely to have been neutered before 6 months of age as were control dogs with TPA 相似文献   

Partial rupture of the cranial cruciate ligament in dogs

Four cases of partial rupture of the craniomedial part of the cranial cruciate ligament (CCL) are presented. Clinical examination revealed only subtle signs of CCL injury. The cranial drawer sign was present in two dogs and in flexion only. As the cranial drawer sign is not always evident a tentative diagnosis of partial CCL rupture should be based on history, joint tenderness and joint effusion. Arthrotomy and careful probing of the ligament is indicated. In these cases the lesion was treated immediately after diagnosis to prevent further degeneration and possible total rupture of the ligament. A fascial graft using the ‘over the top’ reconstruction technique was performed leaving the intact portion of the ligament in situ. Follow-up examination after four to six months revealed normal limb function in three dogs whereas slight and periodic lameness persisted in one dog.     

Immunopathological mechanisms in dogs with rupture of the cranial cruciate ligament

The majority of studies on cranial cruciate ligament (CrCL) disease to date have been carried out on dogs that already sustained a CrCL rupture, which is the end-stage of the disease. Investigations have recently been carried out to study humoral and cellular immunopathological mechanisms in predisposed dogs before clinical rupture of the contralateral CrCL. The cruciate ligaments are mainly composed of collagen type I, and immune responses to collagen have been suggested as a cause of CrCL degradation in dogs. None of these investigations showed evidence that anticollagen type I antibodies alone initiate CrCL damage. However, in predisposed dogs a distinct anticollagen type I antibody gradient was found towards the contralateral stifle joint that eventually sustained a CrCL rupture, suggesting that there was an inflammatory process present in these joints before detectable joint instability occurred. The importance of cellular reactivity to collagen type I in cruciate disease also remains unclear. Peripheral blood mononuclear cell proliferation to collagen type I was very diverse in dogs with cruciate disease whereas some sham operated dogs and healthy dogs tested positive as well. It is not yet determined whether cellular reactivity to collagen type I exists locally in the stifle joints nor whether this could initiate CrCL degradation. Inflammatory processes within the stifle joint can alter the composition of the cruciate ligaments. In animal models of immune-mediated synovitis, the mechanical strength of the CrCL is significantly reduced. Immunohistochemical studies on synovial tissues from dogs with rheumatoid arthritis and dogs with cruciate disease revealed that the pathologic features are similar in both joint pathologies and that the differences are mainly quantitative. Joint inflammation induced by biochemical factors such as cytokines has been implied in CrCL degeneration. In several studies, the levels of pro-inflammatory and T helper cytokines were measured in dogs that sustained a CrCL rupture, but the exact role of the various cytokines in the pathogenesis of CrCL disease remains inconclusive. More recently, the levels of the cytokines have been investigated over time in predisposed dogs before and after CrCL rupture. IL-8 expression tended to be higher in stifle joints that will rupture their CrCL during the next 6 months than in those that will not, indicating an inflammatory process in these joints before clinical rupture. This review provides a comprehensive overview of all possible implications of humoral and cell-mediated immune responses published in dogs with cruciate disease together with publications from human joint diseases. Furthermore, this review highlights recent findings on cytokines and proteinases in the accompanying joint inflammation.     

Comparison of tibial plateau angle between clinically normal Greyhounds and Labrador Retrievers with and without rupture of the cranial cruciate ligament

OBJECTIVE: To compare tibial plateau angle (TPA) between Greyhounds without damage to the cranial cruciate ligaments and Labrador Retrievers with and without damage to the cranial cruciate ligaments. DESIGN: Clinical study. ANIMALS: 87 client-owned dogs and 15 research colony Greyhounds. PROCEDURE: Standing position, horizontal-beam radiography was performed on Greyhounds and unaffected Labrador Retrievers to determine standing TPA. Lateral radiography of the stifle joint was performed on all dogs to determine traditional TPA. Age and body weight were recorded for unaffected and affected Labrador Retrievers. RESULTS: Greyhounds had mean standing TPA of 1.56 degrees and mean traditional TPA of 22.50 degrees. Unaffected Labrador Retrievers had mean standing TPA of 3.52 degrees and traditional TPA of 27.97 degrees. Affected Labrador Retrievers had mean traditional TPA of 25.55 degrees. No significant difference was found in mean standing TPA between Greyhounds and unaffected Labrador Retrievers. Standing TPAs in Greyhounds and unaffected Labrador Retrievers were not significantly different from a plane drawn parallel to the ground. Significant differences in traditional TPAs were detected among all 3 groups. CONCLUSIONS AND CLINICAL RELEVANCE: Greyhounds had mean traditional TPA of 22.50 degrees; similar angles should be considered normal for dogs. Although affected Labrador Retrievers had mean traditional TPA that was significantly greater than that of Greyhounds, the steepest TPA was found in unaffected Labrador Retrievers. Because Greyhounds and unaffected Labrador Retrievers had similar standing TPAs, we conclude that although TPA may be associated with damage to the cruciate ligaments, many dogs with a steep TPA do not develop cruciate ligament disease.     

Evaluation of partial cranial cruciate ligament rupture with positive contrast computed tomographic arthrography in dogs

Computed tomographic arthrography (CTA) of four cadaveric canine stifles was performed before and after partial cranial cruciate ligament rupture in order to verify the usefulness of CTA examination for the diagnosis of partial cranial cruciate ligament rupture. To obtain the sequential true transverse image of a cranial cruciate ligament, the computed tomography gantry was angled such that the scanning plane was parallel to the fibula. True transverse images of cranial cruciate ligaments were identified on every sequential image, beginning just proximal to the origin of the cranial cruciate ligament distal to the tibial attachment, after the administration of iodinated contrast medium. A significant decrease in the area of the cranial cruciate ligament was identified on CTA imaging after partial surgical rupture of the cranial cruciate ligament. This finding implies that CTA can be used for assessing partial cranial cruciate ligament ruptures in dogs.     

Comparison of tibial plateau angles in dogs with unilateral versus bilateral cranial cruciate ligament rupture: 150 cases (2000-2006)

OBJECTIVE: To compare tibial plateau angle (TPA) in dogs with unilateral versus bilateral cranial cruciate ligament (CCL) rupture, to compare right versus left TPA in dogs with bilateral CCL rupture, and to determine whether TPA can be used to predict whether a dog with unilateral CCL rupture would subsequently rupture the contralateral CCL. DESIGN: Retrospective case series. ANIMALS: 150 dogs with unilateral (n=58) or bilateral (92) CCL rupture. PROCEDURES: Medical records were reviewed and TPA was recorded. Dogs with unilateral CCL rupture that were not known to have ruptured the contralateral ligament were followed up for a minimum of 2 years. RESULTS: Dogs with unilateral CCL rupture were significantly older (median, 7.0 years) than dogs with bilateral CCL rupture (median, 4.5 years). Median TPA for dogs with unilateral CCL rupture (26 degrees) was not significantly different from median TPA for dogs with bilateral rupture (27 degrees in both the right and left limbs), and right and left TPAs were not significantly different in dogs with bilateral CCL rupture. There was no correlation between TPA and the time interval between diagnosis of the initial and subsequent CCL ruptures in dogs with bilateral CCL rupture. CONCLUSION AND CLINICAL RELEVANCE: Results suggested that TPA in the range studied (mostly<35 degrees) was not a useful predictor of contralateral CCL rupture among dogs with unilateral CCL rupture, although age may be a risk factor for development of bilateral CCL rupture. The incidence of bilateral CCL rupture may be higher than previously reported.