Arthroscopic assisted femoral tunnel drilling for the intra-articular anatomic cranial cruciate ligament reconstruction in dogs

A. Bolia; P. Böttcher

doi:10.15654/TPK-141128

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Inhaltsverzeichnis

Tierarztl Prax Ausg K Kleintiere Heimtiere 2015; 43(05): 299-308
DOI: 10.15654/TPK-141128

Original Article

Schattauer GmbH

Arthroscopic assisted femoral tunnel drilling for the intra-articular anatomic cranial cruciate ligament reconstruction in dogs

Arthroskopisch assistierte femorale Bohrkanalplatzierung für die anatomische Rekonstruktion des vorderen Kreuzbands beim Hund

Autor*innen

A. Bolia

¹Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
P. Böttcher

¹Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany

Abstract

Summary

Objective: To develop and test an arthroscopic aiming device for extrato intra-articular femoral tunnel drilling emerging at the center of the femoral insertion of the cranial cruciate ligament (CrCL) in medium to large breed dogs. Material and methods: Hindlimbs (n = 12) of six cadaveric dogs (≥ 20 kg bodyweight). One hindlimb from each cadaver was randomly chosen. On a standard medio-lateral stifle radiograph the caudo-cranial position of the CrCL center was measured and transferred onto an adjustable aiming device. After arthroscopic debridement of the CrCL the aiming device was hooked behind the lateral condyle and a 2.4 mm guide pin was placed from extrato intra-articular. The intra-articular position of the resulting bone tunnel was evaluated radiographically as well as compared to the anatomic CrCl center of the contralateral hindlimb using 3D renderings. Results: According to the postoperative radiographs all six drill tunnels were located at or near the CrCL center. The median absolute 3D error from the anatomical center of the CrCL was 0.6 mm (range: 0.2–0.9 mm). Conclusion: Precise anatomic placement of the femoral tunnel for intra-articular repair of the CrCL was achieved using an adjustable aiming device. Clinical relevance: The proposed technique will reduce femoral tunnel misplacement when performing intra-articular CrCL repair in dogs. In combination with the published technique for arthroscopic tibial tunnel drilling using a similar aiming device, the technical requirements for arthroscopic assisted tunnel positioning for anatomical graft replacement are available.

Zusammenfassung

Ziel: Entwicklung und Erprobung eines Zielgeräts für die arthroskopisch assistierte, anatomische Rekonstruktion des vorderen Kreuzbands beim Hund. Material und Methoden: Hintergliedmaßen (n = 12) von sechs Hundekadavern (≥ 20 kg Körpermasse) wurden verwendet. Bei einer zufällig ausgewählten Gliedmaße jedes Kadavers wurde die kaudokraniale Lage des Zentrums vom Ansatz des vorderen Kreuzbands (vKBA) in mediolateralen Röntgenbildern berechnet und anschließend auf ein justierbares Zielgerät übertragen. Nach arthroskopischer Resektion des vorderen Kreuzbands wurde das Zielgerät hinter der lateralen Kondyle eingehakt und ein 2,4 mm starker Steinmann-Pin von extranach intraartikulär platziert. Die Position der resultierenden Bohrkanäle wurde röntgenologisch bestimmt und zudem anhand dreidimensionaler Modelle mit dem anatomischen Zentrum des vKBA der kontralateralen Hintergliedmaßen verglichen. Ergebnisse: In allen postoperativen Röntgenaufnahmen lagen die sechs Bohrkanäle im bzw. nahe dem Zentrum des vKBA. Die 3D-Messungen ergaben eine mediane Abweichung der Bohrkanalposition im Vergleich zum anatomischen Zentrum der kontralateralen Seite von 0,6 mm (Bereich: 0,2–0,9 mm). Schlussfolgerung: Die präzise anatomische Platzierung des femoralen Bohrkanals für die intraartikuläre Rekonstruktion des vorderen Kreuzbands ist bei Verwendung eines justierbaren Zielgeräts möglich. Klinische Relevanz: Die beschriebene Methode wird helfen, eine Fehlplatzierung des femoralen Bohrkanals im Zuge der intraartikulären Plastik des vorderen Kreuzbands zu reduzieren. In Kombination mit dem bereits beschriebenen tibialen Zielgerät sind nun die technischen Voraussetzungen für die arthroskopisch assistierte anatomische Rekonstruktion des vorderen Kreuzbands in der Tiermedizin gegeben.

Keywords

Cranial cruciate ligament - intra-articular reconstruction - aiming device - dog - stifle

Schlüsselwörter

Vorderes Kreuzband - intraartikuläre Rekonstruktion - Zielgerät - Hund - Kniegelenk

Volltext

Referenzen

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