Köpeklerde TPLO’nun mekanik tibial eksen kayması üzerine etkisi: Sagital düzlemde iki boyutlu kemik çalışması

Year 2022, Volume: 11 Issue: 2, 15 - 20, 28.12.2022

Seyyid Said Sabancı Figen Sevil Kilimci Mehmet Orman

https://doi.org/10.53913/aduveterinary.1150162

Abstract

Köpeklerde tibial plato düzleştirme osteotomisi (TPLO) simülasyonu sonrasında tibial eksen kaymasını (TAS), tibial plato açısındaki (TPA) değişimi ve tibial eklem yüzeyinin konumunu belirlemek için, 23 farklı ırktan 91 köpeğe ait tibialar kullanıldı. TPA, tibial uzunluk, “midshaft” genişliği, tibianın condylus medialis uzunluğu ve tibial eksenle (TA) condylus medialis’in en cranial noktası arasındaki mesafe tibia görüntüleri üzerinden ölçüldü. Simülasyonu gerçekleştirilmiş TPLO'dan sonra tüm ölçümler tekrar gerçekleştirildi. Pre- ve postoperatif değerleri karşılaştırmak için Paired t-test kullanıldı. Pre- ve postoperative TAS değerleri ile tibianın uzunluğu, tibianın genişliği, condylus medialis uzunluğu, ve/veya TPA’nın rotasyon derecesi arasında ilişkinin farklı olup olmadığı değerlendirmek için Pearson korelasyon analizi yapıldı. Çalışmanın sonuçları, TPLO ile medial condylusun en cranial noktasının caudale ve distale, en caudal noktasının ise caudale ve proximale doğru kaydığını gösterdi. Bu kaymalar, operasyon öncesi ve sonrası TA ile en cranial nokta arasındaki mesafe değerinde ve en cranial noktanın condylus medialis uzunluğundaki yüzde değerinde önemli farklılığa neden oldu. TPLO’nun, caudal TAS ve medial condylusun eklem yüzeyinin, tibianın distal parçasına göre pozisyonunu değiştirdiği sonucuna varıldı.

Keywords

Köpek, Tibia, Tibial Eksen, TPLO

Effect of tibial plateau leveling osteotomy on mechanical tibial axis shift in dogs: two dimensional bone study in sagittal plane

Abstract

To determine the tibial axis shift (TAS), change in tibial plateau angle (TPA), and the position of the tibial articular surface after tibial plateau leveling osteotomy (TPLO) simulation in the tibiae of dogs, tibias of 91 dogs from 23 different breeds were used. The TPA, tibial length, midshaft width, medial tibial condyle length, and distances between the tibial axis (TA) and cranial-most point of the medial condyle were measured on the tibial images. After simulated TPLO, all measurements were retaken. Paired t-tests were used to compare pre- and postoperative variables. Pearson correlation analysis was conducted to assess whether the difference between pre- and postoperative TAS was related to tibial length, tibial width, medial condyle length, and/or the degree of TPA rotation. The results showed that TPLO shifted the cranial-most point of the medial condyle caudally and distally, and the caudal-most point caudally and proximally. These shifts resulted in significant differences between pre- and postoperative distances between the TA and the cranial-most point and its percentage to the medial condyle length. It is concluded that the TPLO led to caudal TAS and altered the position of the articular surface of the medial condyle with respect to the distal part of the tibia.

Keywords

Dog, Tibia, Tibial Axis, Tibial Plateau Leveling Osteotomy

References

• Allen, M., Mann, K. (2013). Biomechanical considerations in total knee replacement. In: JN. Peck & DJ. Marcellin-Little (Eds.), Advances in small animal total joint replacement, Iowa: Wiley-Blackwell, (pp.131-149).
• Andriacchi, T.P., Mundermann, A., Lane Smith, R. (2004). A framework for the in vivo pathomechanics of osteoarthritis at the knee. Annals of Biomedical Engineering, 32, 447-457.
• Baroni, E., Matthias, R.R., Marcellin-Little, D.J., Vezzoni, A., Stebbins, M.E. (2003). Comparison of radiographic assessments of the tibial plateau slope in dogs. American Journal of Veterinary Research, 64, 586-589.
• Boudrieau, R.J. (2009). Tibial plateau leveling osteotomy or tibial tuberosity advancement? Veterinary Surgery, 38, 1-22.
• Brinker, M.R., O’Conner, D.P. (2010). Principles of malunions. In: RW. Bucholz, D. Heckman, CM. Court-Brown, P. Tornetta, (Eds.) Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams & Wilkins, (pp.664-688).
• Caylor, K.B., Zumpano, C.A., Evans, L.M., Moore, R.W. (2001). Intra- and interobserver measurement variability of tibial plateau slope from lateral radiographs in dogs. Journal of the American Animal Hospital Association, 37, 263-268.
• Christopher, S.A., Beetem, J., Cook, J.L. (2013). Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Veterinary Surgery, 42, 329–334.
• Dismukes, D.I., Tomlinson, J.L., Fox, D.B., Cook, J.L., Song, K.J.E. (2007). Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. Veterinary Surgery, 36, 699-704.
• Dismukes, D.I., Tomlinson, J.L., Fox, D.B., Cook, J.L., Witsberger, T.H. (2008). Radiographic measurement of canine tibial angles in the sagittal plane. Veterinary Surgery, 37, 300-305.
• Duerr, F.M., Duncan, C.G., Savicky, R.S., Park, R.D., Egger, E.L., Palmer, R.H. (2008). Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Veterinary Surgery, 37, 49–62.
• Fettig, A.A., Rand, W.M., Sato, A.F., Solano, M., McCarthy, R.J., Boudrieau, R.J. (2003). Observer variability of tibial plateau slope measurement in 40 dogs with cranial cruciate ligament-deficient stifle joints. Veterinary Surgery, 32, 471-478.
• Griffons, D.J. (2010). A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Veterinary Surgery, 39, 399-409.
• Headrick, J., Cook, J., Helphrey, M., Crouch, D., Fox, D., Schultz, L., Cook, C., Kunkel, J. (2007). A novel radiographic method to facilitate measurement of the tibial plateau angle in dogs. A prospective clinical study. Veterinary and Comparative Orthopaedics and Traumatology, 20, 24-28.
• Hurley, C.R., Hammer, D.L., Shott, S. (2007). Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001–2005). Journal of the American Veterinary Medical Association, 230, 1674-1679.
• Jerram, R.M., Walker, A.M. (2003). Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis, and treatment. New Zealand Veterinary Journal, 51, 149-158.
• Kim, S.E., Pozzi, A., Banks, S.A., Conrad, B.P., Lewis, D.D. (2009). Effect of tibial plateau leveling osteotomy on femorotibial contact mechanics and stifle kinematics. Veterinary Surgery, 38, 23-32.
• Kowaleski, M.P., Apelt, D., Mattoon, J.S., Litsky, A.S. (2005). The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: An in vitro study. Veterinary Surgery, 34, 332-336.
• Kowaleski, M.P., Boudrieau, R.J. (2012). Stifle joint. In: KM. Tobias & SA. Johnston (Eds.) Veterinary surgery: small animal. Elsevier, Missouri, (pp. 906-998).
• Kowaleski, M.P., McCarthy, R.J. (2004). Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope. Veterinary and Comparative Orthopaedics and Traumatology, 17, 30-34.
• Lazar, T.P., Berry, C.R., Dehaan, J.J., Peck, J.N., Correa, M. (2005). Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Veterinary Surgery, 34, 133-141.
• Ley, B., Daubs, B., Bader, J., Silverman, E. (2014). Assessment of the medial collateral ligament as an intra-operative anatomical landmark for tibial plateau levelling osteotomy. Veterinary and Comparative Orthopaedics and Traumatology, 27, 285-287.
• Lister, S.A., Roush, J.K., Renberg, W.C. (2008). Digital measurement of radiographic tibial plateau angle. A comparison to measurement on printed digital images. Veterinary and Comparative Orthopaedics and Traumatology, 21, 129-132.
• Liu, W., Maitland, M.E. (2003). Influence of anthropometric and mechanical variations on functional instability in the ACL-deficient knee. Annals of Biomedical Engineering, 31, 1153-1161.
• Moreland, J.R., Bassett, L.W., Hanker, G.J. (1987). Radiographic analysis of the axial alignment of the lower extremity. The Journal of Bone&Joint Surgery: American Volume, 69, 745-749.
• Morris, E., Lipowitz, A.J. (2001). Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries. Journal of the American Veterinary Medical Association, 218, 363-366.
• Nanda, A., Hans, E.C. (2019). Tibial Plateau Leveling Osteotomy for Cranial Cruciate Ligament Rupture in Canines: Patient Selection and Reported Outcomes. Veterinary Medicine: Research and Reports, 10, 249-255.
• Nelson, S.A., Krotscheck, U., Rawlinson, J., Todhunter, R.J., Zhang, Z., Mohammed, H. (2013). Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Veterinary Surgery, 42, 38-50.
• Ocal, M.K., Sabanci, S.S. (2013a). Effect of anatomic variation in caudal tibial plateau on the tibial plateau angle in dogs: a cadaveric study. Journal of Small Animal Practice, 54, 537-540.
• Ocal, M.K., Sabanci, S.S., Onar, V. (2013b). Variation of tibial plateau geometry and cruciate ligament coordinates in six breeds of dogs. Veterinary and Comparative Orthopaedics and Traumatology, 26, 110-116.
• Oxley, B., Gemmill, T.J., Renwick, A.R., Clements, D.N., McKee, W.M. (2013). Comparison of complication rates and clinical outcome between tibial plateau leveling osteotomy and a modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament disease in dogs. Veterinary Surgery, 42, 739-750.
• Paley, D. (2002). Normal lower limb alignment and joint orientation. In: JE. Herzenberg (Ed.) Principles of deformity correction. Springer-Verlag, Berlin Heidelberg, (pp.1-18).
• Reif, U., Dejardin, L.M., Probst, C.W., DeCamp, C.E., Flo, G.L., Johnson, A.L. (2004). Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. Veterinary Surgery, 33, 368-375.
• Reif, U., Hulse, D.A., Hauptman J.G. (2002). Effect of tibial plateau leveling on stability of the canine cranial cruciate–deficient stifle joint: An in vitro study. Veterinary Surgery, 31, 147-154.
• Ritter, M.J., Perry, R.L., Olivier, N.B., Kim, S.Y., Dejardin, L.M. (2007). Tibial plateau symmetry and the effect of osteophytosis on tibial plateau angle measurements. Journal of the American Animal Hospital Association, 43, 93-98.
• Roh, Y.H., Yun, J.W., Lee, J.H., Lee, H.B. (2020). Effect of jig on the precision of tibial plateau leveling osteotomy in toy-breed dogs. Pakistan Veterinary Journal, 40 (4), 484-488.
• Sathya, S., Gilbert, P., Sharma A., Hendrick, S. (2014). Effect of tibial plateau leveling osteotomy on patellar tendon angle: A prospective clinical study. Veterinary and Comparative Orthopaedics and Traumatology, 27, 346-350.
• Shahar, R., Milgram, J. (2006). Biomechanics of tibial plateau leveling of the canine cruciate- deficient stifle joint: A theoretical model. Veterinary Surgery, 35, 144-149.
• Shimada, M., Mizokami, N., Ichinohe, T., Kanno N., Suzuki, S., Yogo T., Harada Y., Hara, Y. (2020). Long-term outcome and progression of osteoarthritis in uncomplicated cases of cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy in dogs. The Journal of Veterinary Medical Science, 82 (7), 902-916.
• Slocum, B., Devine, T. (1983). Cranial tibial thrust: A primary force in the canine stifle. Journal of the American Veterinary Medical Association, 183, 456-459.
• Thieman, K.M., Tomlinson, J.L., Fox, D.B., Cook, C., Cook, J.L. (2006). Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Veterinary Surgery, 35, 705-710.
• Tomlinson, J., Fox, D., Cook, J.L., Keller, G.G. (2007). Measurement of femoral angles in four dog breeds. Veterinary Surgery, 36, 593-598.
• Warzee, C.C., Dejardin, L.M., Arnoczky, S.P., Perry, R.L. (2001). Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: An in vitro experimental study. Veterinary Surgery, 30, 278-286.
• Wood, M.C., Fox, D.B., Tomlinson J.L. (2014). Determination of the mechanical axis and joint orientation lines in the canine humerus: A radiographic cadaveric study. Veterinary Surgery, 43, 414-417.