Pierre M. Montavon

Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease.

OBJECTIVE To assess functional outcome in dogs with cranial cruciate ligament (CrCL) disease after tibial tuberosity advancement (TTA) using force plate gait analysis, and to evaluate parameters potentially influencing outcome. STUDY DESIGN Prospective clinical study. ANIMALS Consecutive clinical patients (n = 37) with CrCL-deficient stifles (n = 40). METHODS The stifle joints were examined arthroscopically prior to TTA. Meniscal release was not performed if the medial meniscus was intact. Open medial arthrotomy and partial meniscectomy were performed in the presence of meniscal tears. Vertical ground reaction forces were measured preoperatively and at follow-up examinations four to 16 months postoperatively (mean: 5.9 months). The ground reaction forces of a group of 65 healthy dogs were used for the comparison. The potential effects of clinical parameters on functional outcome were evaluated statistically. RESULTS Complete CrCL rupture was identified in 28 joints, and partial CrCL rupture in 12 joints. The medial meniscus was damaged in 21 stifles. Vertical ground reaction forces were significantly higher at follow-up (P < 0.01), but remained significantly lower than those of control dogs (P < 0.01). Complications were identified in 25% of joints, and the dogs with complications had significantly lower peak vertical forces at follow-up than the dogs without complications (P = 0.04). Other clinical parameters did not influence outcome. CONCLUSIONS Tibial tuberosity advancement significantly improved limb function in dogs with CrCL disease, but did not result in complete return to function. Complications adversely affected functional outcome. CLINICAL SIGNIFICANCE A return to a function of approximately 90% of normal can be expected in dogs with CrCL disease undergoing TTA.

Zurich cementless total hip replacement: retrospective evaluation of 2nd generation implants in 60 dogs.

OBJECTIVE To evaluate the results of application, and identify complications, of the 2nd generation of Zurich Cementless Total Hip Replacement (ZCTHR). STUDY DESIGN Case series. ANIMALS Client-owned dogs (n=60) that had ZCTHR (n=65). METHODS Dogs with ZCTHR (2001-2003) with a minimum follow-up > or =6 months were evaluated. Data included signalment, cup position, longest follow-up, complications, management of complications and outcome. RESULTS Mean follow-up was 22.68 months. Eleven cases (17%) had postoperative complications: femoral fracture (n=1; 1.5%), prosthesis luxation (7; 11%), cup loosening (2; 3%), and implant failure (1; 1.5%); 9 cases were successfully revised. Explantation of implants was performed in 1 case because of infection, and 1 dog was euthanatized after reluxation. CONCLUSIONS ZCTHR can restore function in dogs affected by disabling diseases of the coxofemoral joint. The press-fit fixation of the cup allowed for corrections in cases of incorrect positioning. Cases with aseptic loosening were revised successfully by impacting larger cups. Newer stems of this generation are shot peening treated to increase their resistance to breakage. In our cases, infection is a disastrous event, leading to implant removal. After resolution of complications, a successful final outcome was achieved in 97% of THR. CLINICAL RELEVANCE ZCTHR offers a reliable alternative for treating dogs with disabling diseases of the hip joints.

Relationships of Body Weight, Body Size, Subject Velocity, and Vertical Ground Reaction Forces in Trotting Dogs

OBJECTIVE To evaluate the relationship of body weight (BW) and size, dog velocity, and vertical ground reaction forces (GRF) from a large number of dogs of various sizes. STUDY DESIGN Clinical research. ANIMALS Orthopedically healthy dogs (n=129) METHODS BW and dog size, represented as height at the withers (WH), were obtained. Stance times (ST), vertical impulses (VI), and peak vertical forces (PVF) of thoracic and pelvic limbs were measured on a force plate at controlled trotting speed. They were evaluated against BW and WH using linear regression analysis in absolute (nonnormalized) values, and when normalized to BW and/or body size according to the theory of dynamic similarity. Relative velocities were calculated for each dog. RESULTS Absolute ST, VI, and PVF showed strong positive correlations with BW and/or body size. When GRFs were normalized to BW, correlations with body size were markedly reduced, but remained positive for VI, and turned negative for PVF. Normalizing the time-dependent variables (ST and VI) also to WH eliminated most size influence. A small dependency of fully normalized GRF on body size remained that was because of differences in relative velocity between dogs of different sizes. Reference values for the fully normalized data are given. CONCLUSIONS The inherent relationship between BW, body size, dog velocity, and vertical GRF was demonstrated. CLINICAL RELEVANCE BW, body size, and relative dog velocity must be accounted for when wanting to obtain GRF variables that are comparable between different dogs.Objective: To evaluate the relationship of body weight (BW) and size, dog velocity, and vertical ground reaction forces (GRF) from a large number of dogs of various sizes. Study Design: Clinical research. Animals: Orthopedically healthy dogs (n=129) Methods: BW and dog size, represented as height at the withers (WH), were obtained. Stance times (ST), vertical impulses (VI), and peak vertical forces (PVF) of thoracic and pelvic limbs were measured on a force plate at controlled trotting speed. They were evaluated against BW and WH using linear regression analysis in absolute (nonnormalized) values, and when normalized to BW and/or body size according to the theory of dynamic similarity. Relative velocities were calculated for each dog. Results: Absolute ST, VI, and PVF showed strong positive correlations with BW and/or body size. When GRFs were normalized to BW, correlations with body size were markedly reduced, but remained positive for VI, and turned negative for PVF. Normalizing the time-dependent variables (ST and VI) also to WH eliminated most size influence. A small dependency of fully normalized GRF on body size remained that was because of differences in relative velocity between dogs of different sizes. Reference values for the fully normalized data are given. Conclusions: The inherent relationship between BW, body size, dog velocity, and vertical GRF was demonstrated. Clinical Relevance: BW, body size, and relative dog velocity must be accounted for when wanting to obtain GRF variables that are comparable between different dogs.

Fixation compliance in a mouse osteotomy model induces two different processes of bone healing but does not lead to delayed union

Delayed unions are a problematic complication of fracture healing whose pathophysiology is not well understood. Advanced molecular biology methods available with mice would be advantageous for investigation. In humans, decreased fixation rigidity and poor reduction are generally associated with delayed unions. In this study, these two factors were combined to observe their effect on bone healing in mice. Two plates with locking screws, one with 14 the bending stiffness of the other, were used to stabilize a 0.45mm gap osteotomy. muCT, radiographs, 4pt-bending tests and histological analysis demonstrated that the different plate types led to two different healing pathways. The less flexible bridging plate induced only intramembranous ossification whereas the more flexible bridging plate induced a mixture of endochondral and intramembranous ossification. However, the different plates led to a delay in healing of only 3-5 days in the period between 14 and 21 post-operative days. In mice, considerable fixation flexibility is necessary to induce secondary bone healing similar to that which occurs in humans, but this was not sufficient to induce a substantial delay in bone healing as would be expected in humans.

Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles An in vitro study

OBJECTIVES This in vitro study compares the femorotibial shear in canine stifles with intact and transected cranial cruciate ligaments (CrCL), before and after tibial tuberosity advancement (TTA) by measuring the distance between origin and insertion of the cruciate ligaments. METHODS Radiodense markers were inserted into bones at the attachment sites of the cruciate ligaments in sixteen cadaveric stifles of adult dogs. Each stifle was then mounted in a testing apparatus. The distances between the markers were measured on mediolateral radiographs, performed on each stifle under three different situations: intact, after CrCL transection, and after performing a TTA. Stifles were loaded to create a constant tibiofemoral reaction force by maintaining the load parallel to the patellar ligament. Radiographs were taken in a preloaded and loaded state in the intact stifle and only in a loaded state after CrCL transection, and after performing a TTA. RESULTS Loading the stifle joints after transection of the CrCL resulted in a mean lengthening of the CrCL marker distance of 22.4%. Loading the transected CrCL stifles after performing a TTA resulted in a mean shortening of the CrCL marker distance by 3.0% compared to the loaded intact condition. CLINICAL SIGNIFICANCE This study demonstrates that, in loaded stifles with transected CrCLs, TTA causes a caudal shift in the cranial shear force, counteracting cranial subluxation of the tibia.

Effect of dog breed and body conformation on vertical ground reaction forces, impulses, and stance times.

OBJECTIVES To assess whether fully normalised vertical ground reaction forces and stance times obtained at a trot depend on dog breed or body conformations. METHODS Peak vertical forces (PVF), vertical impulses (VI), stance times (ST), and ratio of forelimb impulse to total impulse (RVI) of 54 dogs of seven different breeds were normalised to body weight and body size according to the theory of dynamic similarity, and were tested for differences between breeds. Breeds were Borzoi, Bernese Mountain dog, Great Dane, Labrador Retriever, Landseer, Rhodesian Ridgeback, and Rottweiler. Body length ratio (BLR) and body mass index (BMI) were also compared between breeds. RESULTS Significant differences between breeds were found for the normalised forelimb PVF, VI and ST, and hindlimb PVF. Looking at individual breeds, it was most evident that Borzois had a lower forelimb VI, and a higher hindlimb PVF than the other breeds. This resulted in Borzois having a lower RVI compared to other dogs, indicating a more caudally located centre of gravity. Only a few differences in gait parameters were found between other dog breeds. The BMI was significantly lower in Borzois than in other breeds, but was otherwise not associated with gait parameters. CLINICAL SIGNIFICANCE Force plate data of dogs of different breeds are not necessarily comparable, even after full normalisation to body weight and body size. Group comparisons should only be made when the groups consist of breeds with similar body conformations.

Repair of long-bone fractures in cats and small dogs with the Unilock mandible locking plate system

OBJECTIVES To retrospectively evaluate stabilisation of long-bone fractures in cats and small dogs using the Unilock system. METHODS Medical histories and radiographs of consecutive patients with long-bone fractures stabilised with the Unilock system were reviewed. Cases with follow-up radiographs taken at least four weeks postoperatively were included. Signalment of the patient, fracture localisation and type, primary fracture repair or revision surgery, single or double plating, and complications for each patient were noted. Additionally, implant size, number of screws, number of cortices engaged with screws, and number of empty holes across the fracture were evaluated in fractures where a single plate had been applied. RESULTS Eighteen humeral, 18 radial, 20 femoral, and 10 tibial fractures were treated. The Unilock system was used for primary repair in 44 fractures and for revision surgery in 22 fractures. Two plates were applied in 17 fractures, and a single plate was applied in 49 fractures. Follow-up radiographs were taken four to 109 weeks postoperatively. Complications were seen in 12 animals and 13 fractures (19.7%). Fixation failure occurred in seven fractures (10.6%). Cases with a single plate that suffered fixation failure had thinner screws in relation to bone diameter than cases with double plates, and more screws in a main fragment than those without fixation failure. CLINICAL SIGNIFICANCE The Unilock system is a suitable implant for fracture fixation of long bones in cats and small dogs.

Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft

Objective: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA). Study Design: Prospective study and case series. Animals: Dogs treated with TTA (n=67). Methods: Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). Case series: nongrafted TTA (4–25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t-tests and ANOVA. Significance was set at P≤.05. Results: Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. Case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2–4). No healing related complications were observed. Conclusion: The osteotomy gap created during TTA healed within expected time regardless of bone graft use.OBJECTIVE To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA). STUDY DESIGN Prospective study and case series. ANIMALS Dogs treated with TTA (n=67). METHODS Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). CASE SERIES nongrafted TTA (4-25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t-tests and ANOVA. Significance was set at P≤.05. RESULTS Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2-4). No healing related complications were observed. CONCLUSION The osteotomy gap created during TTA healed within expected time regardless of bone graft use.

Effect of Tibial Tuberosity Advancement on the Contact Mechanics and the Alignment of the Patellofemoral and Femorotibial Joints

OBJECTIVE To evaluate the effect of tibial tuberosity advancement (TTA) on patellofemoral (PF) contact mechanics, and alignment of the PF and femorotibial (FT) joints in cranial cruciate ligament (CrCL)-deficient stifles of dogs. STUDY DESIGN Ex vivo biomechanical study. ANIMALS Unpaired cadaveric hind limbs (n=9). METHODS Digital pressure sensors placed in the PF joint were used to measure contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. The FT and PF poses were obtained using a 2-dimensional computer digitization technique. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Data was normalized and analyzed, after testing for normality by Wilk-Shapiro, using 1 sample T-test, paired T-test, and ANOVA; P≤.05 was considered significant. Bonferronis correction was used when needed. RESULTS A significant cranioproximal tibial displacement and increase in patellar tilt were found in the CrCL-deficient joints. Both FT and PF alignments were restored after TTA. Contact areas and peak pressure did not vary between conditions. Peak pressure location displaced proximally from intact to CrCL-deficient condition and returned to normal after TTA. Total force measured in the CrCL-deficient stifle and TTA conditions were significantly lower than in the control. CONCLUSION TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%.

Correlation of Radiographic Changes after Tibial Tuberosity Advancement in Dogs with Cranial Cruciate‐Deficient Stifles with Functional Outcome

Objective: To (1) evaluate radiographic changes associated with osteoarthrosis (OA) before and after tibial tuberosity advancement (TTA) and (2) determine if these changes are indicative of limb function as determined by kinetic gait analysis. Study Design: Prospective clinical study. Animals: Dogs (n=35) with cranial cruciate ligament (CCL) deficient stifles (38). Methods: Variables recorded were: complete or partial CCL rupture, meniscal lesions, arthroscopically graded cartilage lesions, complications, and revision surgeries. Radiographic evaluation and kinetic gait analysis (vertical ground reaction forces [GRFs]) were conducted pre- and 4–16 months postoperatively (mean, 5.9 months). Radiographs were evaluated without knowledge of operative findings and functional outcome. A score (0–3) based on new bone production at 11 specific sites was used to grade OA. Soft tissue changes were classified separately as normal or excessive. Preoperative scores were correlated with clinical variables. Postoperative scores and progression of OA scores were correlated with clinical variables and GRFs. Results: OA remained unchanged in 17 joints and progressed in 21 (55%). Dogs with meniscal lesions had higher OA scores preoperatively, but not at follow-up. Dogs with severe cartilage lesions at surgery had more progression of OA. GRFs improved after surgery and were not correlated with any of the radiographic OA scores. Conclusion: Progression of OA was greater in the presence of severe cartilage lesions at surgery. OA scores were not correlated with GRFs. Clinical Relevance: Progression of OA is generally expected to occur after TTA despite improvement of limb function.OBJECTIVE To (1) evaluate radiographic changes associated with osteoarthrosis (OA) before and after tibial tuberosity advancement (TTA) and (2) determine if these changes are indicative of limb function as determined by kinetic gait analysis. STUDY DESIGN Prospective clinical study. ANIMALS Dogs (n=35) with cranial cruciate ligament (CCL) deficient stifles (38). METHODS Variables recorded were: complete or partial CCL rupture, meniscal lesions, arthroscopically graded cartilage lesions, complications, and revision surgeries. Radiographic evaluation and kinetic gait analysis (vertical ground reaction forces [GRFs]) were conducted pre- and 4-16 months postoperatively (mean, 5.9 months). Radiographs were evaluated without knowledge of operative findings and functional outcome. A score (0-3) based on new bone production at 11 specific sites was used to grade OA. Soft tissue changes were classified separately as normal or excessive. Preoperative scores were correlated with clinical variables. Postoperative scores and progression of OA scores were correlated with clinical variables and GRFs. RESULTS OA remained unchanged in 17 joints and progressed in 21 (55%). Dogs with meniscal lesions had higher OA scores preoperatively, but not at follow-up. Dogs with severe cartilage lesions at surgery had more progression of OA. GRFs improved after surgery and were not correlated with any of the radiographic OA scores. CONCLUSION Progression of OA was greater in the presence of severe cartilage lesions at surgery. OA scores were not correlated with GRFs. CLINICAL RELEVANCE Progression of OA is generally expected to occur after TTA despite improvement of limb function.