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, Table of Contents

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

A. Bolia

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

,

P. Böttcher

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

› Author Affiliations

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

Full Text

References

References
1 Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L, Friederich N, Grood E, Hertel P, Jakob R. et al. Proceedings of the ESSKA Scientific Workshop on Reconstruction of the Anterior and Posterior Cruciate Ligaments. Knee Surg Sports Traumatol Arthrosc 1994; 02: 124-132.
2 Arnoczky S. The “over the top” procedure: a technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-290.
3 Bolia A, Winkels P, Bottcher P. Radiographic location of the femoral footprint of the cranial cruciate ligament in dogs. Tierärztl Prax 2015; 45 (K): 23-30.
4 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 329-334.
5 Conzemius MG, Evans RB, Besancon MF, Gordon WJ, Horstman CL, Hoefle WD, Nieves MA, Wagner SD. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226: 232-236.
6 Duval JM, Budsberg SC, Flo GL, Sammarco JL. Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs. J Am Vet Med Assoc 1999; 215: 811-814.
7 Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy: the journal of arthroscopic & relate pre-operative d surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2007; 23: 1218-1225.
8 Fu FH, Bennett CH, Lattermann C, Ma CB. Current trends in anterior cruciate ligament reconstruction. Part 1: Biology and biomechanics of reconstruction. Am J Sports Med 1999; 27: 821-830.
9 Gatineau M, Huneault L, Lussier B, Lefevre-Lavoie J. Mechanical Evaluation of Hydrogen Peroxide Gas Plasma Sterilization of Nylon Lines Used for Extra-Articular Stabilization of the Canine Stifle Joint. Vet Surg 2010; 39: 48-53.
10 Gordon-Evans WJ, Griffon DJ, Bubb C, Knap KM, Sullivan M, Evans RB. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243: 675-680.
11 Grant JA. Updating Recommendations for Rehabilitation after ACL Reconstruction: a Review. Clin J Sport Med 2013; 23: 501-502.
12 Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament. Am J Sports Med 1989; 17: 208-216.
13 Isberg J, Faxen E, Laxdal G, Eriksson BI, Karrholm J, Karlsson J. Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1634-1642.
14 Johnson J, Austin C, Breuer G. Incidence of canine appendicular musculosceletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 07: 56-69.
15 Kalff S, Meachem S, Preston C. Incidence of medial meniscal tears after arthroscopic assisted tibial plateau leveling osteotomy. Vet Surg 2011; 40: 952-956.
16 Kim HS, Seon JK, Jo AR. Current trends in anterior cruciate ligament reconstruction. Knee Surg Relat Res 2013; 25: 165-173.
17 Kim SE, Lewis DD, Pozzi A. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing. Vet Surg 2012; 41: 465-470.
18 Knebel J, Meyer-Lindenberg A. [Aetiology, pathogenesis, diagnostics and therapy of cranial cruciate ligament rupture in dogs]. Tierärztl Prax 2014; 42 (K): 36-47.
19 Leighton RL. Preferred method of repair of cranial cruciate ligament rupture in dogs: a survey of ACVS diplomates specializing in canine orthopedics. American College of Veterinary Surgery. Vet Surg 1999; 28: 194.
20 Manley P. Intra-articular stabilization. In: Advances in the Canine Cranial Cruciate Ligament. Muir P. ed. Ames, Iowa, USA: Wiley-Blackwell; 2010: 189-193.
21 Matsumoto H, Fujikawa K. Leeds-Keio artificial ligament: a new concept for the anterior cruciate ligament reconstruction of the knee. Keio J Med 2001; 50: 161-166.
22 Nelson SA, Krotscheck U, Rawlinson J, Todhunter RJ, Zhang Z, Mohammed H. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42: 38-50.
23 Niklaus F, Müller F. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 2000; 08: 207-213.
24 Paatsama S. Ligament injuries of the canine stifle joint: A clinical and experimental study. Master’s thesis, Helsinki. 1952
25 Petersen W, Forkel P, Achtnich A, Metzlaff S, Zantop T. [Anatomic reconstruction of the anterior cruciate ligament in single bundle technique]. Oper Orthop Traumatol 2013; 25: 185-204.
26 Porter MD, Shadbolt B. “Anatomic” single-bundle anterior cruciate ligament reconstruction reduces both anterior translation and internal rotation during the pivot shift. Am J Sports Med 2014; 42 (12) 2948-2954.
27 Skinner OT, Kim SE, Lewis DD, Pozzi A. In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. Vet J 2013; 196: 86-91.
28 Smith GK, Torg JS. Fibular head transposition for repair of cruciate-deficient stifle in the dog. J Am Vet Med Assoc 1985; 187: 375-383.
29 Speziali A, Delcogliano M, Tei M, Placella G, Bartoli M, Menghi A, Cerulli G. Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies. Musculoskelet Surg 2014; 98 (03) 179-187.
30 Tompkins M, Milewski MD, Brockmeier SF, Gaskin CM, Hart JM, Miller MD. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med 2012; 40: 1313-1321.
31 van Eck CF, Lesniak BP, Schreiber VM, Fu FH. Anatomic singleand double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 2010; 26: 258-268.
32 Vasseur PB, Stevenson S, Gregory CR, Rodrigo JJ, Pauli S, Heitter D, Sharkey N. Anterior cruciate ligament allograft transplantation in dogs. Clin Orthop Rel Res 1991; 269: 295-304.
33 Winkels P, Werner H, Grevel V, Oechtering G, Böttcher P. Development and in situ application of an adjustable aiming device to guide extrato intra-articular tibial tunnel drilling for the insertion of the cranial cruciate ligament in dogs. Vet Surg 2010; 39: 324-333.
34 Winkels P, Grevel V, Oechtering G, Böttcher P. Röntgenologische Lage des vorderen Kreuzbandansatzes bei mittelund großwüchsigen Hunden. Tierärztl Prax 2010; 38 (K): 277-284.
35 Wolf R, Lemak L. Revision anterior cruciate ligament reconstruction surgery. J South Orthop Assoc 2002; 11: 25-32.
36 Zavras TD, Race A, Amis AA. The effect of femoral attachment location on anterior cruciate ligament reconstruction: graft tension patterns and restoration of normal anterior-posterior laxity patterns. Knee Surg Sports Traumatol Arthrosc 2005; 13: 92-100.