Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark.
Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
Vet Surg. 2022 Aug;51(6):940-951. doi: 10.1111/vsu.13801. Epub 2022 Mar 15.
OBJECTIVE: To evaluate the effect of center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) and hamstring load on stifle stability following cranial cruciate ligament transection (CCLx) and medial meniscal release (MMR). STUDY DESIGN: Ex vivo experimental study. SAMPLE POPULATION: Cadaver hind limb preparations (n = 7). METHODS: After instrumentation, constant quadriceps and gastrocnemius loads with an optional hamstring load in a 3:1:0.6 ratio were applied, and stifles were extended from fully flexed using an electrical motor during fluoroscopic recording. The recording process was repeated after each of CCLx, MMR and CBLO and the extracted landmark coordinates were used for calculation of cranial tibial translation (CTT) and patellar ligament angle (PTA). RESULTS: Mean initial tibial plateau angle was 28.1°: post-CBLO the mean was 9.7°. Cranial tibial translation developed from 50° and 75° with CCLx and MMR respectively (p < .04, < .02) without hamstring loading. Hamstring loading mitigated CTT due to CCLx and delayed CTT until 120° for MMR (P < .02) in this model. CBLO prevented CTT, except at 140° without hamstring loading (P = .01). Similar results were seen for PTA, but CBLO curves were parallel to and lower than intact values at all tested angles (P < .04), consistent with induced effective joint flexion. CONCLUSION: CBLO to a target tibial plateau angle of 10° largely eliminated CTT induced by CCLx and MMR. Hamstring loads of 20% quadriceps load improved stifle stability in this model. IMPACT: Stifle stability following CBLO appears to be multifactorial and depends on meniscal integrity, joint angle, and hamstring strength.
目的:评估基于旋转中心的角度调整截骨术(CBLO)和腘绳肌负荷对前十字韧带切断(CCLx)和内侧半月板切除(MMR)后膝关节稳定性的影响。 研究设计:离体实验研究。 样本人群:尸体后肢标本(n=7)。 方法:在仪器化后,在 3:1:0.6 的比例下施加恒定的股四头肌和腓肠肌负荷,并在透视记录过程中使用电动马达从完全弯曲状态下伸展膝关节。在 CCLx、MMR 和 CBLO 后重复记录过程,并提取地标坐标,用于计算胫骨平台前向平移(CTT)和髌韧带角(PTA)。 结果:初始胫骨平台角平均为 28.1°:CBLO 后平均为 9.7°。CCLx 和 MMR 分别使 CTT 从 50°和 75°发展(p <.04,<.02),而没有腘绳肌负荷。腘绳肌负荷减轻了由于 CCLx 引起的 CTT,并使 MMR 的 CTT 延迟到 120°(P <.02)。CBLO 防止了 CTT,除非在没有腘绳肌负荷的 140°(P =.01)。PTA 也出现了类似的结果,但 CBLO 曲线在所有测试角度均平行于且低于正常值(P <.04),与诱导的有效关节屈曲一致。 结论:将 CBLO 目标胫骨平台角调整为 10°,可在很大程度上消除 CCLx 和 MMR 引起的 CTT。20%股四头肌负荷的腘绳肌负荷可提高该模型的膝关节稳定性。 影响:CBLO 后膝关节稳定性似乎是多因素的,取决于半月板完整性、关节角度和腘绳肌力量。
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