STABILIZATION OF RUPTURED CRUCIATE LIGAMENT OF THE FRONT KNEE

The knee is a complex joint which moves in two main layers. This is secured by cranial and caudal cruciate ligaments. During exercise, the cranial cruciate ligament prevents the tibia or the knee from drifting forward or cranial, as well as prevents internal rotation and also partial knee hyperextension. Rupture (tear) of the ligament is one of the most common causes of hind limb lameness in dogs. This results from several anatomical anomalies, such as a steep tibial plateau, patellar luxation, or autoimmune arthritis. Affected dogs usually begin to limp acutely in a graduated scale on one of the hind limbs to alleviate loading on that leg. Ligament rupture occurs most frequently as a result of chronic progressive degeneration of the ligament around the age of 5 years (+/-2 years) or due to sudden trauma. Such patients may have a history of chronic intermittent lameness.

Diagnosis is made by clinical examination, either arthroscopically or utilizing highly sophisticated techniques such as magnetic resonance imaging (MRI).

Different surgical techniques have been developed to return joint stability and avoid damage to the meniscus and articular cartilage. Intracapsular technique consists of transposing the body of periarticular tissues. Extracapsular technique is used for long-term stabilization via non-reabsorbable synthetic substitutes, which leads to joint capsule stability. These methods are mostly used for small and medium-sized breeds or for large breeds when other methods are not appropriate.

TPLO and TTA are both types of high tibial osteotomy, which eliminates shearing forces on the front cruciate ligament, removing the need for its functionality. Their principle is a modification of anatomy so that the load angle of the tibial plateau is perpendicular to the long axis of the tibia relative to the horizontal plane, thus eliminating anterior tibial displacement for support.

TPLO is achieved by modifying the geometry of the bicondylar area of the tibial plateau, which then creates a plateau fragment that turns with the corrected degree and is secured with fixation plates. The tibial plateau is the uneven top surface of the tibia which articulates with the femur.

The TTA method moves the insertion of the patellar ligament in the vertical position, forming a 90 ° angle with the tibial plateau and includes a linear ridge tibia osteotomy and fixation with a titanium plate / cage. The tibial crest is the front edge of the knee bone below the knee joint where the patellar tendon ends. For both methods care must be taken not to exceed the breaking point or unduly encumber the posterior cruciate ligament.

The decision for the correct method of stabilizing the knee should be in the hands of an experienced surgeon and should be based on the specific findings for the individual patient, including its general condition, temperament and lifestyle. At our clinic we use methods proven worldwide in the field of veterinary medicine. The use, selection, and materials of these methods are the result of long-term verifications of practices and years of published studies.  These studies include side effects, postsurgical function, and follow ups from a number of orthopedic specialists from around the world.

An essential part of any knee stabilization is revision of the meniscus.

SIBRA-centrum veterinárnej medicíny, Bratislava, www.sibra.sk

 

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