Comparison of desired radiographic advancement distance and true advancement distance required for patellar tendon–tibial plateau angle reduction to the ideal 90° in dogs by use of the modified Maquet technique

Paul Pillard Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Paul Pillard in
Current site
Google Scholar
PubMed
Close
 DVM, MS
,
Veronique Livet Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Veronique Livet in
Current site
Google Scholar
PubMed
Close
 DVM, MS
,
Quentin Cabon Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Quentin Cabon in
Current site
Google Scholar
PubMed
Close
 DVM
,
Camille Bismuth Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Camille Bismuth in
Current site
Google Scholar
PubMed
Close
 DVM, MS
,
Juliette Sonet Department of Small Animal Diagnostic Imaging, Veterinary Teaching Hospital, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Juliette Sonet in
Current site
Google Scholar
PubMed
Close
 DVM
,
Denise Remy Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Denise Remy in
Current site
Google Scholar
PubMed
Close
 DVM
,
Didier Fau Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Didier Fau in
Current site
Google Scholar
PubMed
Close
 DVM
,
Claude Carozzo Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Claude Carozzo in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Eric Viguier Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Eric Viguier in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
, and
Thibaut Cachon Department of Small Animal Surgery, Vetagro Sup, University of Lyon, 69280 Marcy l'étoile, France.

Search for other papers by Thibaut Cachon in
Current site
Google Scholar
PubMed
Close
 DVM, MS

Abstract

OBJECTIVE To evaluate the validity of 2 radiographic methods for measurement of the tibial tuberosity advancement distance required to achieve a reduction in patellar tendon–tibial plateau angle (PTA) to the ideal 90° in dogs by use of the modified Maquet technique (MMT).

SAMPLE 24 stifle joints harvested from 12 canine cadavers.

PROCEDURES Radiographs of stifle joints placed at 135° in the true lateral position were used to measure the required tibial tuberosity advancement distance with the conventional (AM) and correction (AE) methods. The MMT was used to successively advance the tibial crest to AM and AE. Postoperative PTA was measured on a mediolateral radiograph for each advancement measurement method. If none of the measurements were close to 90°, the advancement distance was modified until the PTA was equal to 90° within 0.1°, and the true advancement distance (TA) was measured. Results were used to determine the optimal commercially available size of cage implant that would be used in a clinical situation.

RESULTS Median AM and AE were 10.6 mm and 11.5 mm, respectively. Mean PTAs for the conventional and correction methods were 93.4° and 92.3°, respectively, and differed significantly from 90°. Median TA was 13.5 mm. The AM and AE led to the same cage size recommendations as for TA for only 1 and 4 stifle joints, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE Both radiographic methods of measuring the distance required to advance the tibial tuberosity in dogs led to an under-reduction in postoperative PTA when the MMT was used. A new, more accurate radiographic method needs to be developed.

Abstract

OBJECTIVE To evaluate the validity of 2 radiographic methods for measurement of the tibial tuberosity advancement distance required to achieve a reduction in patellar tendon–tibial plateau angle (PTA) to the ideal 90° in dogs by use of the modified Maquet technique (MMT).

SAMPLE 24 stifle joints harvested from 12 canine cadavers.

PROCEDURES Radiographs of stifle joints placed at 135° in the true lateral position were used to measure the required tibial tuberosity advancement distance with the conventional (AM) and correction (AE) methods. The MMT was used to successively advance the tibial crest to AM and AE. Postoperative PTA was measured on a mediolateral radiograph for each advancement measurement method. If none of the measurements were close to 90°, the advancement distance was modified until the PTA was equal to 90° within 0.1°, and the true advancement distance (TA) was measured. Results were used to determine the optimal commercially available size of cage implant that would be used in a clinical situation.

RESULTS Median AM and AE were 10.6 mm and 11.5 mm, respectively. Mean PTAs for the conventional and correction methods were 93.4° and 92.3°, respectively, and differed significantly from 90°. Median TA was 13.5 mm. The AM and AE led to the same cage size recommendations as for TA for only 1 and 4 stifle joints, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE Both radiographic methods of measuring the distance required to advance the tibial tuberosity in dogs led to an under-reduction in postoperative PTA when the MMT was used. A new, more accurate radiographic method needs to be developed.

Contributor Notes

Dr. Bismuth's present address is Department of Small Animal Surgery, Fregis Veterinary Hospital, 43 Ave Aristide Briand, 94110 Arcueil, France.

Address correspondence to Dr. Pillard (paul.pillard@vetagro-sup.fr).
  • 1. Arnoczky SP. Pathomechanics of cruciate ligament and meniscal injuries. In: Bojrab MJ, eds. Disease mechanisms in small animal surgery. Philadelphia: Lea & Febiger, 1993; 764777.

    • Search Google Scholar
    • Export Citation
  • 2. Elkins AD. A retrospective study evaluating the degree of degenerative joint disease in stifle of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533539.

    • Search Google Scholar
    • Export Citation
  • 3. Johnson JM, Johnson AL. Cranial cruciate ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Vet Clin North Am Small Anim Pract 1993; 23: 717733.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Vasseur PB, Berry CR. Progression of stifle osteoarthritis following reconstruction of the cranial cruciate ligament in 21 dogs. J Am Anim Hosp Assoc 1992; 28: 129136.

    • Search Google Scholar
    • Export Citation
  • 5. Wilke VL, Robinson DA, Evans RB, et al. Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States. J Am Vet Med Assoc 2005; 227: 16041607.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Apelt D, Kowaleski M, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study. Vet Surg 2007; 36: 170177.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Kipfer NM, Damur DM, Guerrero T, et al. Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles: an in vitro study. Vet Comp Orthop Traumatol 2008; 21: 385390.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. Reif U, Hulse DA, Hauptman JG. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31: 147154.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777795.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Warzee CC, Déjardin LM, Arnoczky SP, et al. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30: 278286.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Miller JM, Shires PK, Lanz OI, et al. Effects of 9 mm tibial tuberosity advancement on cranial tibial translation in the canine cranial cruciate ligament deficient stifle. Vet Surg 2007; 36: 335340.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Butler JR, Syrcle JA, McLaughlin RM, et al. The effect of tibial tuberosity advancement and meniscal release on kinematics of the cranial cruciate ligament-deficient stifle during early, middle, and late stance. Vet Comp Orthop Traumatol 2011; 24: 342349.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Hoffmann DE, Kowaleski MP, Johnson KA, et al. Ex vivo biomechanical evaluation of the canine CrCL deficient stifle with varying angles of stifle joint flexion and axial loads after TTA. Vet Surg 2011; 40: 311320.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Etchepareborde S, Barthelemy N, Mills J, et al. Mechanical testing of a modified stabilization method for tibial tuberosity advancement. Vet Comp Orthop Traumatol 2010; 23: 400405.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Etchepareborde S, Brunel L, Bollen G, et al. Preliminary experience of a modified Maquet technique for repair of cranial cruciate ligament rupture in dogs. Vet Comp Orthop Traumatol 2011; 24: 223227.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Samoy Y, Verhoeven G, Bosmans T, et al. TTA rapid: description of the technique and short term clinical trial results of the first 50 cases. Vet Surg 2015; 44: 474484.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Kyon Veterinary Surgical Products. The TTA-2 innovation. Available at: www.kyon.ch/current-products/tibial-tuberosity-advancement-tta/tta-2-development-technique. Accessed August 2012.

    • Search Google Scholar
    • Export Citation
  • 18. Rapid TTA. TTA rapid technique and implant. Available at: www.tta-rapid.com. Accessed February 2013.

  • 19. Hoffmann DE, Miller JM, Ober CP, et al. Tibial tuberosity advancement in 65 stifles. Vet Comp Orthop Traumatol 2006; 19: 219227.

  • 20. Lafaver S, Miller NA, Stubbs WP, et al. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results and complication in 101 dogs. Vet Surg 2007; 36: 573586.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21. Steinberg EJ, Prata RG, Palazzini K, et al. Tibial tuberosity advancement for treatment of CrCL injury: complications and owner satisfaction. J Am Anim Hosp Assoc 2011; 47: 250257.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. Stein S, Schmoekel H. Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. J Small Anim Pract 2008; 49: 398404.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. Voss K, Damur DM, Guerrero T, et al. Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2008; 21: 243249.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Hottinger HA, DeCamp CE, Olivier NB, et al. Noninvasive kinematic analysis of the walk in healthy large-breed dogs. Am J Vet Res 1996; 57: 381388.

    • Search Google Scholar
    • Export Citation
  • 25. Nisell R, Ne'meth G, Ohlse'n H. Joint forces in the extension of the knee: analysis of a mechanical model. Acta Orthop Scand 1986; 57: 4146.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26. Dennler R, Kipfer NM, Tepic S, et al. Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease. Am J Vet Res 2006; 67: 18491854.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Schwandt CS, Bohorquez-Vanelli A, Tepic S, et al. Angle between the patellar ligament and tibial plateau in dogs with partial rupture of the cranial cruciate ligament. Am J Vet Res 2006; 67: 18551860.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28. Bush MA, Bowlt K, Gines JA, et al. Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement. Vet Comp Orthop Traumatol 2011; 24: 205210.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Bielecki MJ, Schwandt CS, Scharvogel S. Effect of tibial subluxation on the measurements for tibial tuberosity advancement in dogs with cranial cruciate ligament deficiency. An ex vivo study. Vet Comp Orthop Traumatol 2014; 27: 470477.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Millet M, Bismuth C, Labrunie A, et al. Measurement of the patellar tendon-tibial plateau angle and tuberosity advancement in dogs with cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2013; 26: 469478.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31. Cadmus J, Palmer RH, Duncan C. The effect of preoperative planning method on recommended tibial tuberosity advancement cage size. Vet Surg 2014; 43: 9951000.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32. Etchepareborde S, Mills J, Busoni V, et al. Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2011; 24: 2731.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. Bismuth C, Ferrand FX, Millet M, et al. Comparison of radiographic measurements of the patellar tendon-tibial plateau angle with anatomical measurements in dogs. Validity of the common tangent and tibial plateau methods. Vet Comp Orthop Traumatol 2014; 27: 222229.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34. Reif U, Dejardin LM, Probst CW, et al. Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. Vet Surg 2004; 33: 368375.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35. Brunel L, Etchepareborde S, Barthélémy N, et al. Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the modified Maquet technique. Vet Comp Orthop Traumatol 2013; 26: 4753.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36. Lin LIK. A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45: 255268.

  • 37. Lin LIK. A note on the concordance correlation coefficient. Biometrics 2000; 56: 324325.

  • 38. King TS, Chinchilli VM. A generalized concordance correlation coefficient for continuous and categorical data. Stat Med 2001; 20: 21312147.

  • 39. Barnhart HX, Haber M, Song J. Overall concordance correlation coefficient for evaluating agreement among multiple observers. Biometrics 2002; 58: 10201027.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40. Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 1998; 52: 119126.

    • Search Google Scholar
    • Export Citation
  • 41. Burns CG, Bourdieau RJ. Modified tibial tuberosity advancement procedure with tibial tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints. Vet Comp Orthop Traumatol 2008; 21: 250255.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42. Skinner OT, Kim SE, Lewis DD, et al. In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. Vet J 2013; 196: 8691.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43. Wolf RE, Scavelli TD, Hoelzler MG, et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007–2009). J Am Vet Med Assoc 2012; 240:14811487.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44. Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 329334.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement