Effect of Stifle Flexion Angle on the Repeatability of Real-Time Elastosonography of the Patellar Ligament in Medium- to Large-Breed DogsFunding None.
Objective The aims of this study were to describe the elastosonographic findings of the patellar ligament in healthy dogs >15 kg in different positions and determine the most appropriate stifle angle to perform elastosonography of the patellar ligament.
Study Design Eighteen clinically healthy dogs, weighing >15 kg, were prospectively recruited. B-mode ultrasound and real-time elastosonography of both patellar ligaments were performed on days 0 and 14. Elastosonography examinations were performed with the stifle in four positions: standing position, lateral recumbency with the stifle positioned at 135 degrees extension and in full passive flexion and extension.
Results The percentage hardness of the patellar ligament was significantly lower when the elastosonographic examination was performed with the dog standing, compared with the other positions (p < 0.005). The variability in the elastosonography readings for each stifle position was lowest when the dog was standing (89.32%).
Conclusion Elastosonography is a feasible technique for evaluating the elasticity of the normal canine patellar ligament in dogs >15 kg and would be a useful technique for investigating the mechanical changes within the patellar ligament following stifle surgery. Elastosonography of the patellar ligament should be performed with the dog standing to provide the most accurate elastosonograms with lowest variability between readings.
J.M. participated in study design, enrolment of dogs, co-ordination of imaging, performed the statistical analysis, drafted and critically reviewed the manuscript. M.L. participated in study design, performed the imaging studies and critically revised the manuscript. C.P. participated in study design, co-ordination of imaging and critically revised the manuscript. T.L. participated in study design, supervised and reviewed the imaging and critically revised the manuscript. L.R.M. participated in study design, performed histological analysis of the patellar tendons and critically revised the manuscript. H.B. participated in study design, provided advice and recommendations on statistical analysis and critically reviewed the manuscript. D.C. participated in study design and critically revised the manuscript. All authors read and approved the final manuscript.
Received: 03 March 2020
Accepted: 05 June 2020
17 September 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau levelling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998–2001). J Am Vet Med Assoc 2003; 222 (02) 184-193
- 2 Priddy NH, Tomlinson JL, Dodam JR. et al. Complications with and owner assessment of the outcome of tibial plateau levelling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997–2001). J Am Vet Med Assoc 2003; 222: 1726-1732
- 3 Carey K, Aiken SW, DiResta GR. et al. Radiographic and clinical changes of the patellar tendon after tibial plateau levelling osteotomy. Vet Comp Orthop Traumatol 2005; 18: 235-242
- 4 Mattern KL, Berry CR, Peck JN. et al. Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau levelling osteotomy. Vet Radiol Ultrasound 2006; 47: 185-191
- 5 Gallagher A, Cross AR, Sepulveda G. The effect of shock wave therapy on patellar ligament desmitis after tibial plateau levelling osteotomy. Vet Surg 2012; 41: 482-485
- 6 Kűhn K, Ohlerth S, Makara M. et al. Radiographic and ultrasonographic evaluation of the patellar ligament following tibial tuberosity advancement. Vet Radiol Ultrasound 2011; 52 (04) 466-471
- 7 Pettitt R, Cripps P, Baker M. et al. Radiographic and ultrasonographic changes of the patellar ligament following tibial tuberosity advancement in 25 dogs. Vet Comp Orthop Traumatol 2014; 27: 216-221
- 8 Hodgson RJ, O'Connor PJ, Grainger AJ. Tendon and ligament imaging. Br J Radiol 2012; 85: 1157-1172
- 9 Ricciardi M, Lenoci D. Comparative diagnostic imaging of a partial patellar ligament tear in a dog. Open Vet J 2018; 8 (02) 160-167
- 10 Ooi CC, Richards PJ, Maffulli N. et al. A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players. J Sci Med Sport 2016; 19: 373-378
- 11 Galletti S, Oliva F, Masiero S. et al. Sonoelastography in the diagnosis of tendinopathies: an added value. Muscles Ligaments Tendons 2015; 5 (04) 325-330
- 12 Varghese T, Ophir J, Konofagou E. et al. Trade offs in elastographic imaging. Ultrason Imaging 2001; 23: 216-248
- 13 Longo M, Bavcar S, Handel I. et al. Real-time elastosonography of lipomatous vs. malignant subcutaneous neoplasms in dogs: preliminary results. Vet Radiol Ultrasound 2018; 59: 198-202
- 14 Ozcan ANS, Tan S, Tangal NG. et al. Real-time sonoelastography of the patellar and quadriceps tendons: pattern description in professional athletes and healthy volunteers. Med Ultrason 2016; 18 (03) 299-304
- 15 Porta F, Damjanov N, Galluccio F, Iagnocco A, Matucci-Cerinic M. Ultrasound elastography is a reproducible and feasible tool for the evaluation of the patellar tendon in healthy subjects. Int J Rheum Dis 2014; 17 (07) 762-766
- 16 Tas S, Yilmaz S, Onur MR. et al. Patellar tendon mechanical properties change with gender, body mass index and quadriceps femoris muscle strength. . Acta Orthopaed Traumatol Turc 2017; 51: 54-59
- 17 Fusini F, Langella F, Busilacchi A. et al. Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review. Muscles Ligaments Tendons J 2017; 7 (03) 467-477
- 18 De Zordo T, Chhem R, Smekal V. et al. Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers. Ultraschall Med 2010; 31 (04) 394-400
- 19 Frey H. Real time elastography. A new ultrasound procedure for the reconstruction of tissue elasticity. Radiologe 2003; 43: 850-855
- 20 Zhang ZJ, Ng GY, Lee WC. et al. Changes in morphological and elastic properties of patellar tendinopathy and their relationships with pain and functional disability. PLoS One 2014; 9 (10) e108337
- 21 Jeon S, Lee G, Lee S-K. et al. Ultrasonographic elastography of the liver, spleen, kidneys and prostate in clinically normal beagles. Vet Radiol Ultrasound 2015; 56 (04) 425-431
- 22 Seiler GS, Griffith E. Comparisons between elastographic stiffness scores for benign versus malignant lymph nodes in dogs and cats. Vet Radiol Ultrasound 2018; 59: 79-88
- 23 Piccionello AP, Serrani D, Busoni V. et al. Sonoelastographic features of the patellar ligament in clinically normal dogs. Vet Comp Orthop Traumatol 2018; 31: 279-284
- 24 Stanziano A, Caringella AM, Cantatore C. et al. Evaluation of the cervix tissue homogeneity by ultrasound elastography in infertile women for the prediction of embryo transfer ease: a diagnostic accuracy study. Reprod Biol Endocrinol 2017; 15: 64
- 25 Berko NS, Mehta AK, Levin TL. et al. Effect of knee position on the ultrasound elastography appearance of the patellar tendon. Clin Radiol 2015; 70: 1083-1086
- 26 Kramer M, Stengel H, Gerwing M. et al. Sonography of the canine stifle. Vet Radiol Ultrasound 1999; 40 (03) 282-293
- 27 Reed AL, Payne JT, Constantinescu GM. Ultrasonographic anatomy of the normal canine stifle. Vet Radiol Ultrasound 1995; 36 (04) 315-321
- 28 Ragetly CA, Griffon DJ, Thomas JE. et al. Non-invasive determination of body segment parameters of the hind limb in Labrador Retrievers with and without cranial cruciate ligament disease. Am J Vet Res 2008; 69: 1188-1196
- 29 Adrian CP, Haussler KK, Kawak C. et al. The role of muscle activation in cruciate disease. Vet Surg 2013; 42: 765-773
- 30 Hayes GM, Granger N, Langley-Hobbs SJ. et al. Abnormal reflex activation of hamstring muscles in dogs with cranial cruciate ligament rupture. Vet J 2013; 196: 345-350
- 31 Gordon-Evans WJ, Griffon DJ, Bubb C. et al. Comparison of lateral fabellar suture and tibial plateau levelling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243 (05) 675-680