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PubMedDate not supplied

An in vitro study to determine the effectiveness of a patellar ligament/fascia lata graft and new tibial suture anchor points for extracapsular stabilization of the cranial cruciate ligament-deficient stifle in the dog.

OBJECTIVE: (1) To determine whether an extracapsular patellar ligament/fascia lata graft would provide stability in the cranial cruciate ligament (CrCL)-deficient stifle comparable with that of the intact stifle. (2) To determine if different tibial anchor points would enhance stability of the CrCLdeficient stifle when compared with the standard fabellar-tibial suture (FTS) placement. STUDY DESIGN: Experimental. ANIMALS: Twenty-eight canine cadaver hind limbs. METHODS: Stifles were mounted in a jig and tested between loads of -65 and 80 N. After testing the intact CrCL, 4 stabilization techniques were tested after CrCL transection: lateral graft technique (LGT) and 3 FTS with different tibial anchor points. RESULTS: There were no significant differences in displacement between the LGT and standard FTS, between the LGT and the intact CrCL, or between the FTS and the intact CrCL, in either the Securos or the Screw-washer experiments. Stiffness of the intact CrCL was significantly greater than that of any stabilization technique and the cut CrCL. The standard FTS showed the least displacement of all suture stabilization techniques. Differences in stiffness were not significant between the suture stabilization techniques. CONCLUSIONS: Securely anchored, the LGT results in a reduction in drawer motion similar to that of the intact CrCL and the standard FTS. Altering the tibial anchor point for the FTS does not improve stiffness or enhance stabilization of the CrCL-deficient stifle. CLINICAL RELEVANCE: The LGT could be used for the treatment of CrCL ruptures in the dog. A clinical study is recommended.

Animals↗
PubMed2006

Vertical patellar position in large-breed dogs with clinically normal stifles and large-breed dogs with medial patellar luxation.

OBJECTIVE: To further define vertical patellar position, as measured by the ratio of patellar ligament length to patellar length (L:P), in large-breed dogs with clinically normal stifles and compare that to the L:P of large-breed dogs with medial patellar luxation (MPL). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Large-breed dogs (n = 50) with clinically normal stifle joints and 30 large-breed dogs with MPL. METHODS: Large-breed dogs with clinically normal stifle joints or MPL were identified and divided into groups (NORM and MPL, respectively). L:P values were determined for each dog by 4 observers from single lateral stifle radiographs. L:P was compared between NORM and MPL groups and 95% confidence intervals (CIs) were calculated. RESULTS: All 4 observers found a significantly higher L:P (more proximally positioned patella) for the MPL group compared with the NORM group. Overall mean (+/-SEM) L:P were: NORM, 1.71+/-0.020 and MPL, 1.87+/-0.025. The 95% CI was determined to be 1.45-1.97 for the NORM group and 1.57-2.17 for the MPL group. CONCLUSIONS: Large-breed dogs with MPL had a significantly more proximal vertical patellar position compared with large-breed dogs with clinically normal stifles. Large-breed dogs with L:P values >1.97 are considered to have patella alta. CLINICAL RELEVANCE: Proximal displacement of the patella within the femoral trochlear groove may play a role in MPL in large-breed dogs.

Analysis of Variance↗
PubMed2006

Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle.

OBJECTIVE: To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). STUDY DESIGN: Retrospective clinical study. ANIMALS: Fifteen client-owned dogs (18 stifle joints). METHODS: Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. RESULTS: Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. CONCLUSIONS: Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. CLINICAL RELEVANCE: TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.

Animals↗
PubMed1999

Radiographic development of osteochondral abnormalities, in the hock and stifle of Dutch Warmblood foals, from age 1 to 11 months.

In a longitudinal study the hocks and stifles of Dutch Warmblood foals were radiographed at age 1 month and subsequently at intervals of 4 weeks. Forty-three foals were radiographed until age 5 months and 19 foals until age 11 months. The chance for the development of osteochondrosis was enhanced by using only offspring from diseased sires with radiographically proven OC at either the intermediate ridge of the distal tibia or the lateral ridge of the femoral trochlea. The radiographic appearances of the intermediate ridge of the distal tibia, the distal aspect of the lateral trochlear ridge of the talus and the midregion of the lateral ridge of the femoral trochlea were classified on a 0-4 scale using a standardised radiographic classification. At age 1 month the appearance of the intermediate ridge of the distal tibia was frequently abnormal (grades 1-3: 67%; grade 4: 1%). Abnormal appearances of the distal aspect of the lateral trochlear ridge of the talus were less common (grades 1-3: 25%; grade 4: 6%). The midregion of the lateral ridge of the femoral trochlea was predominantly normal (grade 0: 98%; grade 1: 2%). Initial abnormalities of the intermediate tibial ridge showed a marked tendency for regression. Progression was less common. Normal appearances rarely turned into abnormal. Only 18% of the hocks were still abnormal at this site at age 11 months. Abnormalities of the distal aspect of the lateral trochlear ridge of the talus showed a strong tendency towards resolution. Progression never occurred. Normal appearances seldom turned into abnormal. Only 3% of the hocks were still abnormal at this site at age 11 months. For both predilection sites in the hock normal and abnormal appearances were permanent from age 5 months. In the stifle, abnormal appearances of the midregion of the lateral ridge of the femoral trochlea became obvious from age 3 or 4 months. Subsequent progression was usually followed by regression and resolution, the appearance returned in most cases to normal at age 8 months. At 5 months, 20% of the stifles were abnormal, but at 11 months this percentage had decreased to 3%. Normal and abnormal appearances were permanent from age 8 months. Osteochondrosis of the main predilection sites in the hock and stifle develops very early in life. The majority of the lesions were temporary, the 'age of no return' was 5 months for the hock and 8 months for the stifle.

Animals↗
PubMed2002

Vertical position of the patella in the stifle joint of clinically normal large-breed dogs.

OBJECTIVE: To define the vertical position of the patella in clinically normal large-breed dogs. SAMPLE POPULATION: Cadavers of 13 clinically normal large-breed dog. PROCEDURE: Both hind limbs were harvested with intact stifle joints and mounted on a positioning device that allowed full range of motion of the stifle joint. Lateral radiographic views were obtained with the stifle joints positioned at each of 5 angles (148 degrees, 130 degrees, 113 degrees, 96 degrees, and 75 degrees). Vertical position of the patella through a range of motion was depicted on a graph of mean stifle angle versus corresponding mean proximal patellar position (PPP) and distal patellar position (DPP) relative to the femoral trochlea for each dog. Ratio of length of the patellar ligament to length of the patella (L:P) was determined for each dog. Overall mean, SD, and 95% confidence intervals for L:P were calculated for all dogs. RESULTS: Evaluation of vertical position of the patella through a range of motion revealed a nearly linear relationship between joint angle and PPP and joint angle and DPPF Evaluation of L:P results did not reveal significant differences between limbs (left or right) or among joint angles. Overall mean +/- SD L:P for all dogs was 1.68 +/- 0.18 (95% confidence interval, 1.33 to 2.03). CONCLUSIONS AND CLINICAL RELEVANCE: The L:P proved to be a repeatable measurement of vertical patellar position, which is independent of stifle angles from 75 degrees to 148 degrees. This measurement could be used as a quantitative method for diagnosing patella alta and patella baja in large-breed dogs.

Animals↗
PubMed1993

Feline stifle disease.

The feline patient has an excellent prognosis for return to normal stifle function with all but the most severe knee injuries. Thorough physical and radiographic evaluation of the stifle predicts successful management of stifle injury. By understanding the mechanics of injured structures, the surgeon can integrate repair methods that maximize the chances of the stifle returning to normal function.

Animals↗
PubMed2000

Mini review of canine stifle joint anatomy.

The stifle is a complex, condylar, synovial joint that allows motion in three planes. The complexity of the normal motion is directly related to the structure and functions of the anatomical components that form the joint. Alteration in any one of these components often leads to dysfunction as well as an increased risk of damage to other structures in the joint. Thus understanding of the normal anatomy and function of each stifle joint component is essential for proper diagnosis and treatment of any stifle joint injury. This review highlights the basic anatomy and function of the stifle joint components.

Animals↗
PubMedDate not supplied

The relationship between limb function and radiographic osteoarthrosis in dogs with stifle osteoarthrosis.

OBJECTIVE: To evaluate the relationship between limb function and radiographic evidence of stifle osteoarthrosis (OA) in dogs. STUDY DESIGN: The relationship between force platform data and radiographic OA score was evaluated on 2 separate days using regression analysis. Interday variation was also assessed. ANIMALS: Forty-one dogs with visible lameness and radiographic evidence of stifle OA. METHODS: Force platform data were collected at a velocity of 1.7 to 2.0 m/s for 5 trials on day 1 and day 8. Radiographs taken on day 1 were scored using a previously reported OA scoring system. RESULTS: No significant relationship was found between force platform data and OA score. No significant differences were found between any day 1 and day 8 force platform values. CONCLUSIONS: Although radiographic evidence of stifle OA provides evidence of pathology, it does a poor job of representing limb function. In addition, the absence of significant differences between day 1 and day 8 values in this population of dogs supports use of only a single force platform evaluation before measuring a treatment effect. CLINICAL RELEVANCE: The presence of OA in the stifle joint does not correlate with clinical function; radiographic outcome should be used cautiously as a predictor of clinical outcome.

Animals↗
PubMedDate not supplied

Sonography of the canine stifle.

When diagnosing disease of the stifle in dogs ultrasonography is a good addition to clinical and radiological examination. Radiology can evaluate the bony aspects of the joint and their relationship to each other. In contrast, sonography allows visualization of the soft tissue. For most evaluations the 7.5 MHz linear scanner is suited best. Normal stifles of 58 dogs of different breeds were evaluated using a standardized examination procedure. This procedure had been derived from that used in humans. The stifle is divided into several regions which are examined and evaluated. These are the suprapatellar, infrapatellar, lateral, caudal and medial region. One hundred twenty seven patients which had problems associated with the stifle joint were examined sonographically after a clinical and radiographic exam. Osteochondrosis dissecans, ruptured cranial cruciate ligament, meniscal damage, arthritis, tumor, post surgical conditions, injuries of the patella, patellar ligament or tibial tuberosity and luxating patella were examined sonographically and the findings recorded.

Animals↗
PubMedDate not supplied

Echographic examination of the stifle joint affected by cranial cruciate ligament rupture in the dog.

Ultrasound is a useful technique for the study of normal and pathologic stifle joints, in particular for soft tissue examination. The aim of this study was to evaluate sonography for examination of stifle joints affected by cranial cruciate ligament rupture. Forty-two medium to giant breed dogs were studied. Tibial compression radiography was performed. A 7.5 MHz transducer with an incorporated 2 cm thick standoff was employed. Sagittal and midsagittal images were collected. The stifle was positioned in maximum flexion during sonography. Sonographic findings were compared with pathologic findings at surgery. Ultrasound was useful in evaluating the presence of fibrous tissue within the joint due to repair processes. It was observed in 70% of stifles with radiographic evidence of chronic osteoarthritis. In 19.6% of the joints it was possible to identify the ruptured cranial cruciate ligament. Ultrasound was not an accurate test for cruciate rupture evaluation, but was specific for the soft tissue pathologic changes which were observed consequent to joint instability.

Animals↗
PubMedDate not supplied

Computed tomographic arthrography of the normal canine stifle.

Computed tomographic (CT) imaging of eight normal cadaveric canine stifles was performed before and after intra-articular administration of iodinated contrast medium. Transverse CT images were reconstructed in dorsal, parasagittal, and oblique planes. The following ligamentous structures were identified on transverse CT images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, and the medial and lateral collateral ligaments. The following ligamentous structures were identified on transverse computed tomographic arthrography (CTA) images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, meniscofemoral ligament, cranial meniscotibial ligaments, caudal meniscotibial ligaments, intermeniscal (transverse) ligament, and the medial and lateral collateral ligaments. The patellar tendon was identified on transverse and reconstructed dorsal and sagittal CT and CTA images in all stifles. Multiplanar reconstructions enabled further evaluation of the continuity of the cranial and caudal cruciate ligaments and menisci. The medial and lateral collateral ligaments were not clearly identified on CT or CTA multiplanar reconstructed images.

Animals↗
PubMed1998

Multiple ligamentous injuries of the canine stifle joint: a study of 12 cases.

Multiple ligamentous injuries of the canine stifle are uncommon. In this study, they affected mainly adult, male, working or sporting dogs and occurred secondary to severe trauma, or where chronic joint infection had weakened the supporting structures. Rupture of the cranial cruciate, caudal cruciate and lateral collateral ligaments was the most common injury observed and this occurred after catching the limb in a fence or gate. Reconstruction of the collateral and cranial cruciate ligaments, and careful repair of damaged menisci and joint capsule, was an effective method of treatment for medium- and large-size dogs. Reconstruction of the caudal cruciate ligament and postoperative limb support was not found to be essential. All dogs with subluxated stifles had good to excellent limb function with minimal loss of mid-thigh circumference or stifle joint range of motion at follow-up. Less favourable results were achieved where there was stifle joint luxation with extensive disruption to secondary joint restraints.

Animals↗
PubMed1999

Stifle joint luxation in the cat: treatment using transarticular external skeletal fixation.

Extra-articular suturing techniques and transarticular external skeletal fixators were used to repair traumatic luxation of the stifle joint in four cats. Rupture of the cranial cruciate, caudal cruciate and medial collateral ligaments, together with injury to one or both menisci, were the most common injuries observed. The method of stifle repair was successful in all cases, but serious complications occurred when cats with transarticular external fixators were not kept confined indoors. Complications consisted of pin loosening and disruption of the fixator, or fractures through proximal or distal pins. Transarticular external skeletal fixation was considered to be a simple and effective method of maintaining short-term joint stability to allow healing of injured soft tissue structures. The apparatus facilitated early weightbearing and, on removal, allowed for the return of near-normal stifle function. Careful pin insertion and owner compliance in enforcing confinement are essential in minimising complications associated with immobilising the stifle joint using transarticular external skeletal fixation.

Animals↗
PubMed2001

Radiographic features of a lateral extracapsular wire suture in the canine cranial cruciate deficient stifle.

Radiographs of 74 dogs (84 stifles) presented with a cranial cruciate ligament rupture and surgically treated using a lateral extracapsular wire (LEW) were reviewed. A strand of orthopaedic wire was surgically placed caudally around the lateral fabella and through a predrilled hole in the tibial crest. At six week follow-up, the LEW was broken at least once in 26 of 33 stifles, predominantly in the area of the lateral fabella. In five stifles, the LEW had slipped off the fabella and was displaced distally along the gastrocnemius muscle. Six months after surgery, the LEW was often broken at several sites. LEW migration was rare. Osteolysis and sclerosis at the site of LEW penetration through the tibial crest occurred in about two-thirds of the stifles examined.

Animals↗
PubMed1997

Mechanical comparison of materials used for extra-capsular stabilisation of the stifle joint in dogs.

OBJECTIVE: The mechanical properties of three materials (No. 2 polypropylene, No. 5 polybutilate-coated multifilament polyester and 18, 27 and 36 kg test monofilament nylon leader material) commonly used for extra-capsular stabilisation of the stifle in dogs with cranial cruciate ligament insufficiency were determined. The ability of No. 5 polybutilate-coated multifilament polyester and 36 kg test monofilament nylon leader material, when placed as extra-capsular sutures, to mitigate cranial drawer was evaluated in hindlimbs of cadavers. DESIGN: An in vitro mechanical study. ANIMALS: Seven pairs of hindlimbs harvested from adult greyhound dogs recently euthanased for other reasons. PROCEDURE: Samples of each material, including samples of 27 kg test leader material that had been sterilised by one of three methods (ethylene oxide, one or five cycles in an auto-clave), were loaded to determine tensile and stress relaxation properties. The effect of cyclic loading on a No. 5 polybutilate-coated multifilament polyester and 36 kg test leader material was also determined. Using the harvested hindlimbs, cranial drawer was measured before and after transection of the cranial cruciate ligament and on the first and twelfth cycle following extra-capsular stabilisation with either No. 5 polybutilate-coated multifilament suture or 36 kg test leader material. RESULTS: Leader material was found to have the most suitable mechanical characteristics for use as extracapsular stabilisation of the cranial cruciate ligament deficient stifle. Of the sterilisation methods, ethylene oxide was found to have the least detrimental effects on the handling and material characteristics of the leader material. Stifles stabilised with 36 kg test leader material had significantly less drawer than those stabilised with No. 5 polybutilate-coated multifilament polyester suture. CLINICAL IMPLICATIONS: Monofilament nylon leader material would appear to have suitable mechanical properties for extra-capsular stabilisation of the cranial cruciate ligament deficient stifle. If possible the material should be sterilised using ethylene oxide.

Animals↗
PubMed1982

Subchondral cystic and related lesions affecting the equine pedal bone and stifle.

Twenty-nine horses were examined over a period of 8 years and found to have cystic lesions in the stifle (14 cases) or pedal bone (15 cases). The lesions are described and illustrated with radiographs. In the stifle 12 lesions were found on the femoral condyles (11 medially and one laterally) and 10 were typical subchondral cysts. One lesion was observed in the tibia and 3 in the patella. Bone cysts wee found unilaterally in the pedal bone (14 in the forelimbs and one in the hindlimb). All but 2 of the horses with lesions in the stifle or pedal bone were lame. The only treatment was rest. For the stifle lesions, the prognosis was reasonable for young horses but poor for those over 4 years of age; for the pedal bone lesions the prognosis was guarded. Trauma is advanced as the most likely major aetiological factor.

Animals↗
PubMed2006

Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease.

OBJECTIVE: To measure the angles between the patellar ligament and the tibial plateau and between the patellar ligament and the common tangent at the tibiofemoral contact point (TFCP) throughout the full range of motion of the stifle joint in dogs and determine the flexion angles at which the patellar ligament is perpendicular to the tibial plateau or to the common tangent. SAMPLE POPULATION: 16 hind limbs from cadavers of 9 adult dogs without radiographically detectable degenerative joint disease. PROCEDURES: Mediolateral radiographic views of the stifle joints from full extension through full flexion were obtained (10 degrees increments). Angles between the tibial and femoral long axes (beta), between the patellar ligament and the tibial plateau gamma), and between the patellar ligament and the common tangent at TFCP (alpha) were measured. Data were analyzed via simple linear regression. RESULTS: In canine stifle joints, angles gamma and alpha decreased linearly with increasing flexion (angle beta). The patellar ligament was perpendicular to the tibial plateau and perpendicular to the common tangent at the TFCP at 90 degrees and 110 degrees of flexion, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: By use of the conventionally defined tibial plateau, data suggest that at approximately 90 degrees of flexion in stifle joints of dogs, shear force in the sagittal plane exerted on the proximal portion of the tibia shifts the loading from the cranial to the caudal cruciate ligament. Analyses involving the common tangent at the TFCP (a more anatomically representative reference point) identified this crossover point at approximately 110 degrees of joint flexion.

Animals↗
PubMed2004

Absolute and relative cell counts for synovial fluid from clinically normal shoulder and stifle joints in cats.

OBJECTIVE: To determine absolute and relative cell counts for synovial fluid from grossly, radiographically, and histologically normal shoulder and stifle joints in healthy cats. DESIGN: Clinical study. ANIMALS: 52 cats scheduled to be euthanatized for unrelated reasons. PROCEDURE: Arthrocentesis of the shoulder and stifle joints was performed bilaterally, and synovial fluid was analyzed for absolute WBC count, WBC morphology, and percentages of neutrophils and mononuclear cells. Joints were examined grossly and radiographically, and synovial membrane specimens were submitted for histologic examination. Synovial fluid samples that were contaminated with blood and samples from joints with any gross, radiographic, or histologic abnormalities were excluded. RESULTS: 82 of the 208 synovial fluid samples were excluded because abnormalities were identified during physical examination; the volume of fluid obtained was insufficient for analysis; there was evidence of blood contamination; or the joint had gross, radiographic, or histologic abnormalities. Median WBC count for the remaining 126 synovial fluid samples was 91 cells/microL (96.4% mononuclear cells and 3.6% neutrophils); WBC count was not significantly different between left and right joint samples or between shoulder and stifle joint samples. Body weight was associated with synovial fluid WBC count, with WBC count increasing as body weight increased. Sixteen of the 52 (30%) cats had radiographic evidence of osteoarthritis involving at least 1 joint. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that synovial fluid can be obtained reliably from shoulder and stifle joints in cats.

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