Vet Comp Orthop Traumatol 2022; 35(02): 096-104
DOI: 10.1055/s-0041-1736217
Original Research

Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study

Esa V. Eskelinen
1   Tammisto Animal Hospital, Evidensia Eläinlääkäripalvelut Oy, Finland
,
Ari P. Suhonen
2   Aisti Animal Hospital, Finland
,
Juha V. Virolainen
3   Vethaus Animal Hospital, Evidensia Eläinlääkäripalvelut Oy, Finland
,
William D. Liska
4   Global Veterinary Specialists PLLC, Houston, Texas, United States
› Institutsangaben
Funding None.

Abstract

Objectives The purpose of this study was to compare the load at failure, stiffness and mode of failure between three types of tibial tuberosity transposition fixation techniques: (a) pin and figure-8 tension band wire (Pin-TBW), (b) locking plate with pin and a tension band wire (Plate-Pin-TBW) and (c) locking plate with a pin (Plate-Pin).

Methods Six pairs of raccoon dog cadaveric tibiae were tested in Phase I Pin-TBW versus Plate-Pin-TBW and seven pairs in Phase II Plate-Pin-TBW versus Plate-Pin. One limb of each pair was randomly assigned to one of two groups for each phase. A tensile force was applied to the patellar ligament until construct failure.

Results Pin-TBW (342N ± 54.7N) failed at a lower load than Plate-Pin-TBW (469N ± 77.3N), p = 0.00748, with all Pin-TBW failing by fracture and the majority of Plate-Pin-TBW failing by rupture of patellar ligament. Pin-TBW group Phase I, normalized with Plate-Pin-TBW Phase I, failed at a lower load than Plate-Pin group Phase II, normalized with Plate-Pin-TBW Phase II, p = 0.00467. There was no significant difference in mean load at failure, stiffness or mode at failure between the groups in the Phase II study.

Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative live dog or cat, these results demonstrate lower construct strength of the Pin-TBW construct compared with the Plate-Pin construct in the raccoon dog cadaver model.

Authors' Contributions

E.V.E. together with Gillian Butterwick (Product Development Engineer, Veterinary Instrumentation) designed the locking plates. All authors contributed to the study conception, the study design, the acquisition of data, data analysis and interpretation, drafting or revising of the manuscript and approved the submitted manuscript.




Publikationsverlauf

Eingereicht: 20. März 2021

Angenommen: 21. August 2021

Artikel online veröffentlicht:
11. Oktober 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Perry KL, Déjardin LM. Canine medial patellar luxation. J Small Anim Pract 2021; 62 (05) 315-335
  • 2 Bosio F, Bufalari A, Peirone B, Petazzoni M, Vezzoni A. Prevalence, treatment and outcome of patellar luxation in dogs in Italy. A retrospective multicentric study (2009-2014). Vet Comp Orthop Traumatol 2017; 30 (05) 364-370
  • 3 Alam MR, Lee JI, Kang HS. et al. Frequency and distribution of patellar luxation in dogs. 134 cases (2000 to 2005). Vet Comp Orthop Traumatol 2007; 20 (01) 59-64
  • 4 Rutherford L, Langley-Hobbs SJ, Whitelock RJ, Arthurs GI. Complications associated with corrective surgery for patellar luxation in 85 feline surgical cases. J Feline Med Surg 2015; 17 (04) 312-317
  • 5 Smith GK, Langenbach A, Green PA, Rhodes WH, Gregor TP, Giger U. Evaluation of the association between medial patellar luxation and hip dysplasia in cats. J Am Vet Med Assoc 1999; 215 (01) 40-45
  • 6 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35 (06) 559-566
  • 7 Cashmore RG, Havlicek M, Perkins NR. et al. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs. Vet Comp Orthop Traumatol 2014; 27 (04) 263-270
  • 8 Gallegos J, Unis M, Roush JK, Agulian L. Postoperative complications and short-term outcome following single-session bilateral corrective surgery for medial patellar luxation in dogs weighing <15 kg: 50 cases (2009–2014). Vet Surg 2016; 45 (07) 887-892
  • 9 Rossanese M, German AJ, Comerford E, Pettitt R, Tomlinson A, de Vicente F. Complications following surgical correction of medial patellar luxation in small-to-medium-size dogs. Vet Comp Orthop Traumatol 2019; 32 (04) 332-340
  • 10 Stanke NJ, Stephenson N, Hayashi K. Retrospective risk factor assessment for complication following tibial tuberosity transposition in 137 canine stifles with medial patellar luxation. Can Vet J 2014; 55 (04) 349-356
  • 11 Loughin CA, Kerwin SC, Hosgood G. et al. Clinical signs and results of treatment in cats with patellar luxation: 42 cases (1992-2002). J Am Vet Med Assoc 2006; 228 (09) 1370-1375
  • 12 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
  • 13 Augat P, von Rüden C. Evolution of fracture treatment with bone plates. Injury 2018; 49 (Suppl. 01) S2-S7
  • 14 Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002; 84 (08) 1093-1110
  • 15 Birks RR, Kowaleski MP. Combined tibial plateau levelling osteotomy and tibial tuberosity transposition: an ex vivo mechanical study. Vet Comp Orthop Traumatol 2018; 31 (02) 124-130
  • 16 Newman M, Bertollo N, Walsh W, Voss K. Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: an ex vivo canine study. Vet Comp Orthop Traumatol 2014; 27 (04) 271-276
  • 17 Zide AN, Jones SC, Litsky AS, Kieves NR. A cadaveric evaluation of pin and tension band configuration strength for tibial tuberosity osteotomy fixation. Vet Comp Orthop Traumatol 2020; 33 (01) 9-14
  • 18 Shahar R, Banks-Sills L. Biomechanical analysis of the canine hind limb: calculation of forces during three-legged stance. Vet J 2002; 163 (03) 240-250
  • 19 Alexander R. The mechanics of jumping by a dog (Canis Familiaris). J Zool 1974; 173: 549-573
  • 20 Shaver SL, Mayhew KN, Sutton JS. et al. Complications after corrective surgery for lateral patellar luxation in dogs: 36 cases (2000-2011). J Am Vet Med Assoc 2014; 244 (04) 444-448
  • 21 Filliquist B, Viskjer S, Stover SM. Tibial tuberosity transposition stabilization using a cortical screw placed adjacent to the tuberosity in dogs with patellar luxation. Vet Comp Orthop Traumatol Open 2019; 2: e43-e49
  • 22 Yeadon R, Fitzpatrick N, Kowaleski MP. Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Surgical technique, radiographic and clinical outcomes. Vet Comp Orthop Traumatol 2011; 24 (01) 18-26
  • 23 Mehrkens LR, Hudson CC, Cole GL. Factors associated with early tibial tuberosity fracture after tibial plateau leveling osteotomy. Vet Surg 2018; 47 (05) 634-639
  • 24 Aerssens J, Boonen S, Lowet G, Dequeker J. Interspecies differences in bone composition, density, and quality: potential implications for in vivo bone research. Endocrinology 1998; 139 (02) 663-670