Sagittale Gelenkinstabilität im kreuzbandinsuffizienten kaninen Kniegelenk

J. Rey; M. S. Fischer; P. Böttcher

doi:10.1055/s-0038-1623760

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Table of Contents

Tierarztl Prax Ausg K Kleintiere Heimtiere 2014; 42(03): 151-156
DOI: 10.1055/s-0038-1623760

Original Article

Schattauer GmbH

Sagittal joint instability in the cranial cruciate ligament insufficient canine stifle

Caudal slippage of the femur and not cranial tibial subluxationSagittale Gelenkinstabilität im kreuzbandinsuffizienten kaninen KniegelenkKaudale Rutschbewegung des Femurs, nicht kraniale Subluxation der Tibia

J. Rey

¹Klinik für Kleintiere, Universität Leipzig, Leipzig

,

M. S. Fischer

²Institut für Spezielle Zoologie und Evolutionsbiologie mit Phyletischem Museum, Friedrich-Schiller-Universität, Jena

,

P. Böttcher

¹Klinik für Kleintiere, Universität Leipzig, Leipzig

› Author Affiliations

Abstract

Summary

Objective: This in vivo study qualitatively describes the sagittal motion pattern of the cranial cruciate ligament (CrCL) insufficient canine stifle in operated and unoperated joints with cranio-caudal laxity on palpation. Material and methods: Sagittal stifle kinematics were recorded in vivo in dogs (> 15 kg BW) with unilateral (n = 7) or bilateral (n = 6) complete CrCL rupture and positive cranial drawer test as well as two sound control dogs using uniplanar fluoroscopic kinematography with the dogs walking on a treadmill. Stifle stability and sagittal motion pattern of the femur and the tibia were determined by visual inspection of the fluoroscopic video sequences. Results: Control dogs showed no cranio-caudal instability, identical to the contralateral stifles of the dogs with unilateral rupture. All unoperated stifles with CrCL rupture (n = 6) showed caudal slippage of the femur at the beginning of the stance phase. Of the 13 operated stifles (TightRope: n = 1, tibial tuberosity advancement, TTA: n = 6, tibial plateau leveling osteotomy, TPLO: n = 5, cranial closing wedge osteotomy, CCWO: n = 1) nine were unstable, showing the same motion pattern as the unoperated stifles. Conclusion: In the CrCL insufficient stifle with in vivo cranio-caudal instability caudal slippage of the distal femur at tow touch is the predominant motion pattern. Clinical significance: The discrepancy between in vivo motion pattern and in vitro simulation of CrCL insufficiency in which cranial tibial subluxation is the predominant sagittal motion pattern warrants further studies.

Zusammenfassung

Ziel: Diese In-vivo-Studie beschreibt qualitativ das sagittale Bewegungsmuster kreuzbandinsuffizienter Kniegelenke und solcher mit Schubladenphänomen nach operativer Stabilisierung. Material und Methoden: Die sagittale Kniegelenkskinematik wurde bei Hunden (> 15 kg KM) mit einseitigem (n = 7) und beidseitigem (n = 6) Riss des vorderen Kreuzbandes in vivo beurteilt, wobei die Probanden auf einem speziell für Hunde konstruierten Laufband liefen. Alle Gelenke waren zum Zeitpunkt der Ganganalyse palpatorisch instabil. Zwei gesunde Hunde dienten als Kontrolle. Die kraniokaudale Kniegelenkstabilität sowie das allgemeine sagittale Bewegungsmuster von Femur und Tibia wurden anhand uniplanarer fluoroskopischer Videosequenzen visuell beurteilt. Ergebnisse: Bei allen Kniegelenken der Kontrolltiere war ebenso wie bei den gesunden Kniegelenken unilateral betroffener Tiere keine kraniokaudale Instabilität erkennbar. Alle unoperierten Gelenke mit Riss des vorderen Kreuzbandes (n = 6) zeigten ein kaudal gerichtetes Abgleiten des distalen Femurs entlang des Tibiaplateaus zu Beginn der Standphase. Neun der 13 operierten Gelenke (TightRope: n = 1, TTA [tibial tuberosity advancement]: n = 6, TPLO [tibial plateau leveling osteotomy]: n = 5, Keilosteotomie [cranial closing wedge osteotomy, CCWO]: n = 1) wiesen eine Instabilität auf, identisch zum Bewegungsmuster der unoperierten instabilen Gelenke. Schlussfolgerung: Die sagittale Kniegelenkinstabilität im Zusammenhang mit einem Riss des vorderen Kreuzbandes ist durch eine kaudal gerichtete Rutschbewegung des Femurs beim Auffußen gekennzeichnet. Klinische Relevanz: Aufgrund der Diskrepanz zwischen dem Bewegungsmuster in vivo und der In-vitro-Simulation eines Kniegelenks mit rupturiertem vorderem Kreuzband, bei dem die kraniale Subluxation der Tibia die dominierende sagittale Bewegung darstellt, bedarf es weiterer Untersuchungen.

Key words Stifle - cranial cruciate ligament rupture - in vivo - kinematics - fluoroscopy

Schlüsselwörter

Kniegelenk - Riss des vorderen Kreuzbandes - in vivo - Kinematik - Fluoroskopie

Full Text

References

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