Ober Ciprian, Berger Chen, Cohen Liat, Milgram Joshua
Department of Surgery and Intensive Care, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania.
The Laboratory of Biomechanics, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Jerusalem, Israel.
Front Vet Sci. 2022 Jun 30;9:914763. doi: 10.3389/fvets.2022.914763. eCollection 2022.
Cranial cruciate ligament (CCL) disease is a well-known pathology that generates both rotational and translational instability of the stifle joint that leads to osteoarthritis in dogs. Tibial tuberosity advancement (TTA) is a common surgical technique used to dynamically neutralize the tibiofemoral shear forces to achieve stifle joint stability. However, significant persistent instability has been documented in clinical cases. The purpose of this study was to evaluate the effect of increasing quadriceps load, increasing tibial tuberosity advancement, and increasing joint flexion angle on the cranial translation of the tibia relative to the femur in the cranial cruciate ligament deficient stifle joint.
Six cadaveric hind limbs were collected from six healthy mixed breed dogs of medium build and prepared for biomechanical testing. The specimen was placed into a custom-made joint testing machine, and translation of the tibia relative to the femur was measured at stifle angles of 135°, 120°, and 105°. Cranial tibial thrust was generated by applying a vertical load to the metatarsal pad and the quadriceps muscle was simulated with loads of 0, 5, and 10 kg applied to the patella a system of weights and pulleys. All specimens were tested with the CCL intact and cut, both of which served as controls. The tibial tuberosity was then advanced using both 6 mm and 9 mm cages, and the specimen was tested using the identical technique. Each specimen was loaded to failure by increasing the load applied to the pes until the sudden marked cranial translation of the tibia. Tibial tuberosity advancement with an applied quadriceps load was successful in limiting cranial tibial translation in 54/62 tests. Under similar loading conditions, TTA failed to limit cranial translation in 8 tests. The failures occurred at all angles of flexion examined. In the cases that failed cranial translation could be limited by either increasing the quadriceps load or increasing the amount of tibial tuberosity advancement.
This study showed that TTA with an applied quadriceps load is effective at decreasing cranial tibial translation at functional joint angles.
颅交叉韧带（CCL）疾病是一种众所周知的病理状况，会导致犬类膝关节出现旋转和平移不稳定，进而引发骨关节炎。胫骨结节前移术（TTA）是一种常用的外科技术，用于动态中和胫股剪切力，以实现膝关节稳定。然而，临床病例中已记录到明显的持续性不稳定情况。本研究的目的是评估增加股四头肌负荷、增加胫骨结节前移量以及增加关节屈曲角度对颅交叉韧带缺损的膝关节中胫骨相对于股骨的向前平移的影响。
从六只中等体型的健康混种犬身上采集了六个尸体后肢，准备进行生物力学测试。将标本放入定制的关节测试机中，在膝关节角度为135°、120°和105°时测量胫骨相对于股骨的平移。通过对跖垫施加垂直负荷来产生胫骨向前推力，并使用一个由砝码和滑轮组成的系统，对髌骨施加0、5和10千克的负荷来模拟股四头肌。所有标本在颅交叉韧带完整和切断的情况下均进行测试，这两种情况均作为对照。然后使用6毫米和9毫米的固定架推进胫骨结节，并使用相同技术对标本进行测试。通过增加施加在足部的负荷，直至胫骨突然明显向前平移，对每个标本加载至破坏。在62次测试中，54次通过施加股四头肌负荷并推进胫骨结节成功限制了胫骨向前平移。在类似的负荷条件下，有8次测试中TTA未能限制胫骨向前平移。在所有检查的屈曲角度下均出现了失败情况。在失败的病例中，通过增加股四头肌负荷或增加胫骨结节前移量，均可限制胫骨向前平移。
本研究表明，施加股四头肌负荷的TTA在功能关节角度下能有效减少胫骨向前平移。
