Tibial Tuberosity Advancement for Partial Rupture of Cranial Cruciate Ligament in Two Dogs

경골조면 전이동술을 이용한 개에서의 부분 전십자인대 단열치료 2례

  • Heo, Su-Young (College of Veterinary Medicine, Chonbuk National University) ;
  • Lee, Hae-Beom (College of Veterinary Medicine, Chonbuk National University)
  • Accepted : 2014.03.27
  • Published : 2014.04.30

Abstract

Two dogs (Case 1 weighing 27 kg, Case 2 weighing 42 kg) were referred with hindlimb lameness. On physical examination, there was moderate pain on stifle joint testing and mild cranial translation on cranial drawer testing in Case 1. This translation was obvious when the patient was under general anesthesia. Case 2 showed discomfort during hyperextension of the stifle joint, but no significant cranial translation under general anesthesia. Joint effusion was detected on radiography in both cases. Based on physiologic and radiographic examinations, cranial cruciate deficiency was suspected, so exploratory arthroscopy was performed. Arthroscopy revealed partial rupture of the cranial cruciate ligament (CrCL) in both cases. Case 1 showed unstable partial CrCL rupture, while Case 2 had stable CrCL rupture. Tibial tuberosity advancement (TTA) was carried out as planned. Seroma occurred one week postoperatively in Case 2, and was removed surgically. The patients returned to satisfactory weight-bearing ambulation 5 months after initial surgery. Based on the results of these cases, TTA appears to be a useful procedure in the treatment of CrCL partial rupture.

두 마리 개가 (증례 1: 27 kg, 증례 2: 42 kg) 뒷다리 파행을 주증으로 내원하였다. 신체검사상, 증례 1은 무릎 검사 시 중증도 통증과 마취 상태에만 경골의 전위 증후을 보였고 증례 2는 과신전시 불편함을 호소하였으나 마취 전후 모두 전위 증후는 관찰되지 않았다. 방사선검사에서 두 증례 모두 관절 내 종창을 확인할 수 있었다. 위의 검사를 바탕으로 전십자인대 단열을 의심하고 관절경을 실시하였다. 관절상에서 증례 1은 불안정한 부분 전십자인대 단열을 증례 2는 안정화된 부분 전십자인대 단열로 진단하였다. 두증례 모두 경골조면 전이동술을 이용하여 치료 하였다. 증례 2에서 술 후 수술 부위에 장액종이 발생하여 수술적으로 제거하였다. 수술 5개월 후 두 증례 모두 임상증상이 개선되었다. 이 증례들을 바탕으로 경골조면 전이동술은 부분 전십자인대 단열에서 유용한 치료법으로 사료된다.

Keywords

References

  1. Arnoczky SP, Tarvin GB, Marshall JL, Saltzman B. The overthe- top procedure: A technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-290.
  2. Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement? Vet Surg 2009; 38: 1-22. https://doi.org/10.1111/j.1532-950X.2008.00439.x
  3. Cho TJ, Lee KS. Bone graft substitute. J Korean Fract Soc 2006; 19: 109-116. https://doi.org/10.12671/jkfs.2006.19.1.109
  4. Dennler R, Kipfer NM, Tepic S, Hassig M, Montavon PM. Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease. Am J Vet Res 2006; 67: 1849-1854. https://doi.org/10.2460/ajvr.67.11.1849
  5. 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.
  6. Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg 2010; 39: 399-409. https://doi.org/10.1111/j.1532-950X.2010.00654.x
  7. Johnson AL, Probst CW, DeCamp CE, Rosenstein DS, Hauptman JG, Kern TL. Vertical position of the patella in the stifle joint of clinically normal large-breed dogs. Am J Vet Res 2002; 63: 42-46. https://doi.org/10.2460/AJVR.2002.63.42
  8. Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial plateau leveling osteotomy on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38: 23-32. https://doi.org/10.1111/j.1532-950X.2008.00470.x
  9. Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38: 33-39. https://doi.org/10.1111/j.1532-950X.2008.00471.x
  10. Kim SE, Pozzi A, Kowaleski MP, Lewis DD. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125. https://doi.org/10.1111/j.1532-950X.2007.00361.x
  11. Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: Surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586. https://doi.org/10.1111/j.1532-950X.2007.00307.x
  12. Marino DJ, Loughin CA. Diagnostic imaging of the canine stifle: A review. Vet Surg 2010; 39: 284-295. https://doi.org/10.1111/j.1532-950X.2010.00678.x
  13. Might KR, Bachelez A, Martinez SA, Gay JM. Evaluation of the drawer test and the tibial compression test for differentiating between cranial and caudal stifle subluxation associated with cruciate ligament instability. Vet Surg 2013; 42: 392-397. https://doi.org/10.1111/j.1532-950X.2012.01064.x
  14. Nisell R, Németh G, Ohlsén H. Joint forces in extension of the knee: Analysis of a mechanical model. Acta Orthop 1986; 57: 41-46. https://doi.org/10.3109/17453678608993213
  15. Plesman R, Gilbert P, Campbell J. Detection of meniscal tears by arthroscopy and arthrotomy in dogs with cranial cruciate ligament rupture: A retrospective, cohort study. Vet Comp Orthop Traumatol 2013; 26: 42-46.
  16. Kowaleski MP, Pozzi A, Boudrieau RJ. Stifle joint. In: Veterinary surgery : Small animal. St. Louis: Mosby Elsevier. 2012: 906-998.