Extra-articular stabilization of the cranial cruciate deficient stifle with anchor systems^[*]

Summary

Complete or partial rupture of the cranial cruciate ligament (CCL) is a common injury of the canine stifle. Most practicing veterinarians would agree that optimal outcome is best achieved with surgical intervention. A popular method of stabilization is an extra-articular suture stabilization. The objective of this manuscript is to describe suture placement in a more isometric position as compared to traditional suture placement. A second objective is to introduce the veterinary surgeon to novel anchor products used for stabilization.

Zusammenfassung

Die komplette oder partielle Ruptur des kranialen Kreuzbandes ist beim Hund eine häufige Erkrankung des Kniegelenks. Die meisten Tierärzte vertreten die Ansicht, dass mit einer chirurgischen Behandlung die besten Resultate zu erhalten sind. Die extraartikuläre Stabilisierung des Kniegelenks mittels Nahtmaterial ist dabei eine sehr verbreitete chirurgische Methode. Ziel dieses Berichts ist die Beschreibung eines Verfahrens, bei dem der Faden in einer mehr isometrischen Position verläuft als bei der traditionell angewendeten Fadenzügelung. Ferner sollen neuartige Verankerungssysteme zur Stabilisierung des Kniegelenks vorgestellt werden.

Key words

Canine - cranial cruciate ligament - isometric extra-articular reconstruction; novel stabilization system

Schlüsselwörter

Hund - kraniales Kreuzband - isometrische extraartikuläre Rekonstruktion - neuartiges Stabilisierungssystem

^* Dedicated to Prof. Dr. Ulrike Matis with best wishes.

• References

• 1 Arnoczky SP. Pathomechanics of ligament and meniscal injuries. In: Disease Mechanisms in Small Animal Surgery. 2nd ed.. Bojrab MJ. ed. Philadelphia: Lea & Febiger; 1993: 764-770.
• 2 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
• 3 Brinker WO, Piermattei DL, Flo GL. Diagnosis and treatment of Orthopedic Conditions of the Hindlimb. In Handbook of Small Animal Orthopedics and Fracture Management. 2nd ed.. Brinker WO, Piermattei DL, Flo GL. eds. Philadelphia: Saunders; 1990: 341-470.
• 4 Choate CJ, Pozzi A. et al. Mechanical Comparison of Lateral Circumfabellar Suture, Tightrope CCL, and SwiveLock Bone Anchor for Extracapsular Stabilization of the cranial Cruciate Ligament-Deficient Stifle in Dogs. Proc. Veterinary Orthopedic Society. 2011
• 5 Cook JL, Luther JK, Beetem J. et al. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39: 315-323.
• 6 Elkins AD, Pechman K, Herron M. A retrospective study evaluating the degree of degenerative joint disease in the stifle joint of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533-540.
• 7 Fischer C, Cherres M, Grevel V. et al. Effects of attachment sites and joint angle at the time of lateral suture fixation on tension in the suture for stabilization of the cranial cruciate ligament deficient stifle in dogs. Vet Surg 2010; 39: 334-342.
• 8 Gambardella PC, Wallace LJ, Cassidy F. Lateral suture technique for management of anterior cruciate ligament rupture in dogs: A retrospective study. J Am Anim Hosp Assoc 1981; 17: 33-38.
• 9 Guenego L, Zahra A, Madelenat A. et al. Cranial cruciate ligament rupture in large and giant dogs. A retrospective evaluation of a modified lateral extracapsular stabilization. Vet Comp OrthopTraumatol 2007; 20: 43-50.
• 10 Hudson JT, Slater MR, Taylor L. et al. Assessing repeatability and validity of a visual analogue scale questionnaire for use in assessing pain and lameness in dogs. AVJR. 2004 65. 12.
• 11 Hulse DA. Cruciate ligament rupture. In: Small Animal Surgery, 2nd ed.. Fossum T. ed. St. Louis: Mosby; 2002: 1110-1143.
• 12 Hulse D, Beale B. Outcome with Corkscrew/FasTac anchor. Proc VA3. 2008
• 13 Hulse D, Hyman W, Beale B. et al. Determination of isometric points for placement of a lateral suture in treatment of the cranial cruciate ligament deficient stifle. Vet Comp Orthop Traumatol 2010; 23: 163-167.
• 14 Korvick DL, Pijanowski GJ, Schaeffer DJ. Three dimensional kinematics of the intact and cranial cruciate deficient stifle of dogs. J Biomech 1994; 27 (01) 77-87.
• 15 Korvick DL, Johnson AL, Schaeffer DJ. Surgeons preferences in treating cranial cruciate ligament ruptures in dogs. J Am Vet Med Assoc 1994; 205: 1318-1324.
• 16 Lewis DD, Milthorpe BK, Bellenger CR. Mechanical comparison of materials used for extra-capsular stabilization of the stifle joint in dogs. Aust Vet J 1997; 75: 890-896.
• 17 Perry B, Tige H, Witsberger T, Hulse DA. Novel Knotless Extracapsular Stifle Stabilization Technique Utilizing Two Bone Anchor Systems and Braided Multifilament Suture. Proc. Veterinary Orthopedic Society. 2011
• 18 Roe SC. Limitations of cranial cruciate ligament repairs: prosthetic ligament substitutions. Proc. American College of Veterinary Surgeons. 1996
• 19 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-568.
• 20 Vasseur PB. Stifle joint. In: Textbook of Small Animal Surgery. 2nd ed.. Slatter D. ed. Philadelphia: Saunders; 1993: 1817-1865.
• 21 Vasseur PB. Clinical results following conservative management for rupture of the crainial cruciate ligament in dogs. Vet Surg. 1984 13. 243.