Mölsä Sari H, Hyytiäinen Heli K, Hielm-Björkman Anna K, Laitinen-Vapaavuori Outi M
BMC Vet Res. 2014 Nov 19;10:266. doi: 10.1186/s12917-014-0266-8.
BACKGROUND: Cranial cruciate ligament (CCL) rupture is a very common cause of pelvic limb lameness in dogs. Few studies, using objective and validated outcome evaluation methods, have been published to evaluate long-term (>1 year) outcome after CCL repair. A group of 47 dogs with CCL rupture treated with intracapsular, extracapsular, and osteotomy techniques, and 21 healthy control dogs were enrolled in this study. To evaluate long-term surgical outcome, at a minimum of 1.5 years after unilateral CCL surgery, force plate, orthopedic, radiographic, and physiotherapeutic examinations, including evaluation of active range of motion (AROM), symmetry of thrust from the ground, symmetry of muscle mass, and static weight bearing (SWB) of pelvic limbs, and goniometry of the stifle and tarsal joints, were done. RESULTS: At a mean of 2.8 ± 0.9 years after surgery, no significant differences were found in average ground reaction forces or SWB between the surgically treated and control dog limbs, when dogs with no other orthopedic findings were included (n = 21). However, in surgically treated limbs, approximately 30% of the dogs had decreased static or dynamic weight bearing when symmetry of weight bearing was evaluated, 40-50% of dogs showed limitations of AROM in sitting position, and two-thirds of dogs had weakness in thrust from the ground. The stifle joint extension angles were lower (P <0.001) and flexion angles higher (P <0.001) in surgically treated than in contralateral joints, when dogs with no contralateral stifle problems were included (n = 33). In dogs treated using the intracapsular technique, the distribution percentage per limb of peak vertical force (DPVF) in surgically treated limbs was significantly lower than in dogs treated with osteotomy techniques (P =0.044). CONCLUSIONS: The average long-term dynamic and static weight bearing of the surgically treated limbs returned to the level of healthy limbs. However, extension and flexion angles of the surgically treated stifles remained inferior to healthy joints, and impairment of AROM and weakness in thrust from the ground in the surgically treated limbs were frequently present. Ground reaction forces may be inadequate as a sole method for assessing functional outcome after cranial cruciate ligament repair.
背景：颅交叉韧带（CCL）断裂是犬后肢跛行的常见原因。很少有研究采用客观且经过验证的结果评估方法来评估CCL修复后的长期（>1年）结果。本研究纳入了47只接受囊内、囊外和截骨技术治疗的CCL断裂犬以及21只健康对照犬。为评估长期手术效果，在单侧CCL手术后至少1.5年，进行了测力板、骨科、影像学和物理治疗检查，包括主动活动范围（AROM）评估、地面推力对称性、肌肉质量对称性以及后肢静态负重（SWB）评估，还有膝关节和跗关节的角度测量。 结果：在术后平均2.8±0.9年时，当纳入无其他骨科问题的犬（n = 21）时，手术治疗犬肢与对照犬肢的平均地面反作用力或SWB无显著差异。然而，在手术治疗的肢体中，约30%的犬在评估负重对称性时出现静态或动态负重降低，40 - 50%的犬在坐姿时AROM受限，三分之二的犬地面推力减弱。当纳入对侧膝关节无问题的犬（n = 33）时，手术治疗侧膝关节的伸展角度较低（P < 0.001），屈曲角度较高（P < 0.001）。在采用囊内技术治疗的犬中，手术治疗肢体的每肢垂直力峰值分布百分比（DPVF）显著低于采用截骨技术治疗的犬（P = 0.044）。 结论：手术治疗肢体的平均长期动态和静态负重恢复到了健康肢体的水平。然而，手术治疗的膝关节伸展和屈曲角度仍不如健康关节，手术治疗肢体中AROM受损和地面推力减弱的情况较为常见。地面反作用力作为评估颅交叉韧带修复后功能结果的唯一方法可能并不充分。
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