ArticlePDF Available

Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau leveling osteotomy


Abstract and Figures

To evaluate the effect of medial meniscal release (MMR) and medial, caudal pole hemimeniscectomy (MCH) on pressure distribution in the cranial cruciate ligament (CCL) deficient canine stifle, and with tibial plateau levelling osteotomy (TPLO). Twelve adult dogs. In experiment one, six pairs of cadaveric canine stifles with an intact CCL were axially loaded with a servo-hydraulic material testing machine and pressure distributions were mapped and quantified using pressure sensitive films. Axial loading of each joint was then repeated following MMR, and again after MCH. In experiment two, six pairs of cadaveric canine stifles with or without TPLO were tested before and after CCL transection, and each MMR and MCH procedure using the same methods of experiment 1. In experiment one, MMR and MCH had significant effects on the pressure distribution resulting in a 2.5-fold increase in the percentage of surface area with pressure higher than 10 MPa. In experiment two, CCL transection resulted in a significant change in pressure distribution only in the stifle without TPLO (P<0.05). Both MMR and MCH resulted in a 1.7-fold increase in the percentage of area with peak pressure in the stifle with TPLO (P<0.05). Meniscal surgery results in a change in pressure distribution and magnitude within the medial compartment of the stifle. Compromised function of the meniscus by either MMR or MCH result in stress concentration which may predispose to osteoarthritis.
Content may be subject to copyright.
Pressuredistributionsonthe medial tibial
plateau aftermedial meniscalsurgeryand tibial
plateau levellingosteotomy in dogs
A. Pozzi
DepartmentofVeterinaryClinical Sciences;
BioMaterialsLaboratory,DepartmentsofOrthopaedics andBiomedical Engineering, TheOhio State
Orthopedic Unit, Repatriation General Hospital, Flinders UniversityofSouth Australia, Australia
Objective: To evaluate theeffect of medial meniscal
release (MMR) andmedial, caudalpole hemimeniscec-
tomy (MCH)onpressure distribution in the cranial cru-
ciateligament (CCL) deficientcaninestifle, and with ti-
bial plateau levellingosteotomy (TPLO). Animals:
Twelve adultdogs. Methods: In experiment one, six
pairs of cadaveric canine stifles with an intactCCL were
axially loadedwithaservo-hydraulic material testing
machineand pressure distributionsweremappedand
quantifiedusing pressure sensitive films. Axial loading
of each joint wasthen repeated followingMMR,and
again afterMCH.Inexperimenttwo,six pairs of cada-
veric canine stifles with or without TPLOweretested be-
fore andafter CCL transection, and each MMRand MCH
procedure usingthe same methods of experiment 1.
Results: In experiment one, MMR andMCH hadsig-
nificanteffectsonthe pressure distribution resultingin
a2.5-fold increaseinthe percentage of surfacearea
with pressure higher than10MPa.Inexperimenttwo,
CCL transection resulted in asignificant change in
pressure distribution only in thestifle withoutTPLO
(P<0.05).BothMMR andMCH resulted in a1.7-fold
increaseinthe percentage of areawithpeakpressure
in the stifle with TPLO(P<0.05). Conclusions: Me-
niscal surgery results in achangeinpressure distribu-
tion andmagnitude withinthe medial compartment of
the stifle. Clinical relevance: Compromised function of
the meniscus by either MMR or MCH result in stress
concentration which may predispose to osteoarthritis.
Canine, cruciate ligament, meniscus, release,load
VetCompOrthopTraumatol 2008; 21: 8–14
Prepublished online November 2, 2007
Themeniscal fibrocartilageshaveimpor-
tant functionsinloadtransmission andsta-
bility in the femoro-tibialjoint in both hu-
mans andotheranimals(1–6). In the dog,
found in conjunction with cranialcruciate
cation to the surgical management of the
CCL deficient stifle by tibialplateau level-
ling osteotomy (TPLO), andothertech-
niques (7–15). Some of the recommended
treatments formeniscal injuriesfound at the
time of surgical reconstruction of the CCL
deficientstifle in dogs arepartialortotal
meniscectomy, depending upon the type of
meniscal lesion (5, 7, 9, 11, 16). However, in
cases wherethe meniscusisfound at sur-
gery to be grosslynormal, controversy re-
mains over the best waytoprevent the devel-
opment of late meniscal injury (12, 15). Re-
lease of the medialmeniscusbyradialtrans-
ection hasbeen recommended in orderto
prevent meniscal injury following TPLO in
dogs (15). Releasing the meniscusallows
caudal retraction of the caudalpole of the
medialmeniscusawayfrom the medialfe-
moral condyle during cranialtranslation of
the tibia, andisthought to prevent the devel-
opment of late meniscal injury (15). How-
ever,medialmeniscal release probablydis-
rupts the load transmission roleofthe me-
niscibecause axialloads acrossthe femoro-
tibial joint arenormallycounteracted by
hoop tension withinthe circumferentially
orientedcollagen fibres(5, 17).
Partialorcompleteremoval of menisci in
humans andexperimentalanimalsresults in
the development of articularcartilage de-
generation andosteoarthritis (18–22). Fur-
thermore,the severity of osteoarthritisthat
followedexperimentalmedial, caudalpole
hemimeniscectomyindogswas similarto
thatarising aftercompletemedialmenis-
cectomy(22). Disruption of meniscal func-
tion of loadtransmission results in ade-
crease in jointcontactareawhich in turn
causes the jointsurfaces to be subjected to
greater loadingstresses (1, 2, 6, 23).As are-
sult, supra-physiological loadingofarticu-
larcartilage induces an upregulation in syn-
thesis anddegradation of cartilage matrix
whichultimately leadstoosteoarthritis (21,
24,25). Therefore it would be important to
determine if medialmeniscal release has
equivalent deleterious effectsonloadtrans-
mission as meniscectomyindogs, because
routine medialmeniscal release mayplaya
role in the development of osteoarthritisin
the CCL deficient canine stifle.
We hypothesizedthatboth medialmenis-
cal release andmedial, caudalpole hemime-
niscectomywould result in disruption of
normal load transmission in the medial
compartment of the femoro-tibialjoint.In
ordertotest our hypothesis, we evaluated
load transmission in the canine cadaveric
stifle jointusing pressure sensitive film and
amaterialtesting machine,similartopre-
viously describedmethodology (26, 27).
Thespecificobjectivesofour study were to
determine the effectsofmedialmeniscal re-
lease andmedial, caudalpole hemimenis-
*The paper waspresented at the Annual Confer-
ence of the European Society of VeterinaryOrtho-
paedics and Traumatology,September 10–12,
2004, Munich, Germany.
ReceivedDecember18, 2006
VetComp OrthopTraumatol1/2008 AcceptedApril 20, 2007
8Original Research
©2008 Schattauer GmbH
VetComp OrthopTraumatol1/2008
Pressuredistribution with meniscectomy andTPLO
cectomyonthe magnitude anddistribution
of pressure on the articularsurface of the
medialtibialcondyle in the normal canine
stifle,and the CCL deficientcanine stifle,
with andwithout TPLO.
Materials and methods
Twelve pairsofcadaveric hindlimbswere
harvested by disarticulation of the coxo-fe-
moral jointwithin twohours of deathfrom
adult male andfemaledogsthatwereeutha-
natized for reasons unrelatedtothe study.
Thedogswereofvariousbreedsand hada
body weightof25to35kg. Aftercollection,
allsoft tissues proximal to the patella were
dissected from the limbs,whilecarefully
preserving the rest of the soft tissuesdis-
tally, including allofthe periarticulartissue
of the stifle joints.Stifleswith anygrossly
evident abnormalities were excludedfrom
the study.
In vitro limb loading
Soft tissueswerekeptmoist during the ex-
periment by spraying the specimens with
isotonic saline.A2.5mmdiameterdrill hole
wasmadeinthe midportion of the patella
from medialtolateral.Braided-steel cable
(7 x7strands) of 1.6mmdiameterwas
threaded through the hole andsecuredinto a
loop using a9.5 mm-long oval compression
wasplaced transverselythrough the femur,
2–3 cm distaltothe greater trochanter, in a
lateraltomedialdirection to permit sub-
sequent loadingofthe limb.Aturn-buckle
anchoredtothe femoral neck by aloop of
cable andtothe patella by the secondloop of
cable wasused to mimic the quadriceps
mechanism, as previouslydescribed(28). A
3cmcaudo-medialarthrotomywas per-
formedjustcaudaltothe medialcollateral
ligamenttoexposethe caudalpole of the
medialmeniscustoallowfor subsequent
meniscal treatments andinsertion of pre-
scalepressure film (29).The arthrotomy
wassutured closed aftereach meniscal
treatment. Each limb wasmounted in a
servo-hydraulic materialtest machine
attaching the proximalSteinmanpin to the
actuator while the foot wasrested on anon-
slip foot-plate thatlimitedcranial, caudal
andlateral translation of the paw(Fig. 1).
Axialloading of the limbs wasperformed
with the stifle jointataninitial angle of
145°. Thejoint angle variedduring loading
from 145° to approximately105°. Thetest
machine wasprogrammedtoapplya200 N
axialload(about 50% body weightofthe
dogs from whichlimbs were harvested)ina
‘ramp up-plateau-release’ loadingpattern
beginning with a15s‘ramp up’ from 0–
200 N, followedbya15 s200 Nplateau and
thenanimmediate release of load.
Prescale pressure sensitivefilm
Pressure distributions in joints were
measuredbyusing prescale pressure sensi-
tive films thathad apressure range of 2–10
.Prescale films consistedofanAlayer
andaClayer thathad acombinedthickness
of 0.2mm. The Alayer containedmicrocap-
suleswhich ruptured at specificpressures
andreacted with adevelopercontainedin
the Clayer to produceared stain, the inten-
sity of whichcorrelatedwith the magnitude
of local pressure (30). The colourdensity of
the film could therefore be calibrated as a
function of the contactpressure.The film
wascut to matchapproximatelythe dimen-
sions of the articularsurface of the medial
tibial condyle. Each film hadasmalltab
protruding from the caudo-medialedge that
waspositioned adjacenttothe medialcollat-
eral ligament. The films were sealed be-
tween twosheetsofselfadhesive polyethy-
in ordertoprevent wetting by synovial
fluid (31). This packet wascarefullyinserted
beneath themedial meniscusthrough the
caudo-medial arthrotomy. After the stifles
had been axiallyloaded, the film wasre-
moved. Twotothreefilms were stained for
each meniscal treatment. Exclusion criteria
of the films included damage of the seal pack
or of the actual film, artefacts caused by
handling anddisplacement duringloading.
Thefilms that were damaged during inser-
tion were alsoexcludedfrom the analysis,
andthe film with fewest artefacts wasused
for the analysis. All procedureswereper-
formedbyone investigator,(K. A. Johnson)
to reduce variabilitybetween subjects.
Experiment1-meniscal disruption
in normaljoints
Standard radiographic views (cranio-caudal
andmedio-lateral) were takenofsix pairs of
limbs to ensure the stifle joints were freeof
radiographic evidenceofosteoarthritis and
to measure the tibial plateau angle (TPA),
using previously describedmethods (14,
15). Thelimbs were axiallyloadedtodeter-
Fig.1 Schematic representation of limb mountedina
servo-hydraulic test machine with apin placedtransversely
slipfoot plate. Aturn-buckle andcablefromthe proximal
femur to the patella mimicsthe quadriceps mechanism.
Bionix858, MTS System Corporation, Eden
Prairie, MN,USA.
SPI Sensor Products Inc,East Hannover, NJ,
Tegaderm, 3M Health Care, St. Paul, MN,USA
McMaster-CarrSupply Company,Cleveland,OH,
VetComp OrthopTraumatol1/2008
Pozzi et al.
mine the pressure distribution in the medial
compartment of the femoro-tibialjoint to
establishcontrol baseline data.The axial
loadingofeach jointwas thenrepeated fol-
lowing medialmeniscal release andthen
againfollowing medialcaudalpole he-
Experiment2-meniscal disruption
and TPLOincranial cruciate
ligamentdeficient joints
Standard radiographic views (cranio-caudal
andmedio-lateral) were takenofsix pairs of
limbs to ensure thatthe stifle joints were
freeofradiographic evidenceofosteoarthri-
tis andtomeasure the tibial plateau angle
(TPA), using previously describedmethods
(14, 15). Pairedlimbs were randomlyas-
signedtothe standard TPLO group or a
shamTPLO group (SHAM).The TPLO was
performed as previouslydescribedtopro-
duceaTPAinthe range of to (14). In
the SHAMgroup the standard TPLO pro-
cedure wasperformedwithout alteringthe
TPA. As for experiment 1, each limb was
axiallyloadedand pressure distributions
were recordedinthe medialcompartmentof
the femoro-tibialjoint with the CCL andthe
medialmeniscusintact, andthenagain fol-
lowing CCL transection,medialmeniscal
release, andmedial, caudalpole hemime-
niscectomyrespectively. Twotothreefilms
were stainedfor each meniscal treatment.
Quantificationofprescale pressure
The stained films were digitized using are-
.After digitalizationofthe
images an oval template wasused to define a
standard areaofinterest
.The oval template
waspositioned on thefilm with thelong axis
parallel to thelong axisofthe film. The tem-
platewas centred on the film andcaudally
aligned with thetab that defined the position
of the medial collateral ligament. The contact
stresses were measured as percentagesofthe
total oval area. The parameters of interest for
each imagewere extracted using computer-
ized imageanalysistechniques with commer-
ciallyavailable software
.Thissystem has the
capability of reading area and pressurefor all
areasofinterestaswell as providing informa-
tion about the pressure distributions. From
this informationwecalculated percentages of
area corresponding to pressure ranges of 0to
<4, 4to<6, 6to<8, 8to<10 and >10 MPa.
Calibration stains of theprescale film were
obtained using amaterial testing machine
usingthe method of Liggins (32).Thisin-
volved theapplicationof12differentload re-
gimes in therangefrom282 to 1131 Nover
known contact areas of 113mm
ameter circle). Applied pressurefor each load
wasthen calculated using theformula: press-
ure=load ÷area.The stains producedwere
then digitized,resulting in atabulation of
mean greyscale levelversus applied pressure.
Asixth-order polynomial wasthen fittothe
datatobeused as acalibration curve.The cali-
brationcurve wasthen usedtoconvert the
greyscale levels in thedigitalized contactpat-
terns to pressure units.
Statistical analysis
Experiment 1-meniscal disruption in normal
Sincethe data derivedfrom pressure sensi-
tive films were organizedinto ranges, or cat-
egories, it could not be consideredtobecon-
tinuous data. As such, parametricmethods
of data analysis could not be applied.There-
fore, pressure distributions in the threedif-
ferent meniscal treatments were compared
with χ
test for homogeneity (33). Data from
twoofthe 12 stifleswereexcluded from the
analysis due to the presence of artefactsin
the films thathad developed during the pro-
cess of film digitization.The remaining 10
stifleswererandomlydividedinto two
groups of five limbs each (group Aand
group B). Splitting the data allowedusto
compare pressure distributions from differ-
entpopulations, thus avoiding the potential
for covariance. Thepressure distributions
samples for the ‘intactmeniscus’of groupA
were comparedwith samples for ‘meniscal
release’ of group B. Next,samples for ‘me-
niscal release’ of group Awerecompared
with samples for ‘hemimeniscectomy’ in
group B. Significancewas set at P<0.05.
Experiment 2-meniscal disruption andTPLO
in cranial cruciate ligamentdeficient joints
Using datafrom experiment 1, it waspossi-
bletoidentify the pressure range (>10 MPa)
thatlargely contributed to the non-homo-
geneity. Therefore,datafrom this pressure
range wasused as an outcome measure to
performthe analysis in experiment 2. By
using data from asingle pressure range,we
were able to useanANOVA test for experi-
ment 2. Theeffect of CCL treatment and
meniscal treatment on pressure distribution
andtheir interaction were analyzed using a
two-way repeated-measuresANOVA .The
factors that were analyzed were TPLO,me-
niscal treatment andtheir interaction.Sig-
nificantdifferences among groups were
evaluated with Bonferroni post-hoc test.
19.18 ±6.92
23.37 ±6.98
22.97 ±3.31
INTACT,intact meniscus; MMR, medial meniscusrelease;MCH,medial caudal pole hemi-meniscectomy. Between groups different lettersdenotesignificant difference
32.7 ±7.72
26.05 ±7.85
21.68 ±5.89
8to<10 MPa
8.41 ±3.14
3.35 ±1.39
4.28 ±2.37
25.43 ±7.31
12.33 ±3.48
11.39 ±2.6
14.25 ±8.23
34.92 ±13.97
39.71 ±8.52
UMAX 2200, UMAX Australia, Melbourne,
Victoria, Australia.
AdobePhotoshop 7.0, Adobe Systems Inc,
Seattle, WA,USA.
Interactive Data Language, Research Systems
Inc.,Boulder,CO, USA.
Instron 810 Servohydraulic Testing system,
Instron, Wycombe, UK.
Table 1 Effectof medialmeniscalreleaseormedialcaudalpole hemimeniscectomyon pressuredistributions,expressedas
apercentagearea, of the medial tibialplateau of normalcanine stifle joints (mean ±SD)
VetComp OrthopTraumatol1/2008
Pressuredistribution with meniscectomy andTPLO
Significancefor the two-way ANOVA was
set at P<0.15,and for the post-hoc tests at
P<0.05. Data from four out of 12 legs were
lostdue to artefactsinthe films,and could
not be includedinthe analysis.
Experiment1-meniscal disruption
in normaljoints
Medial meniscal release hadasignificant
effect on the pressure distribution in the
medialcompartmentofthe stifle (P<0.05)
(Table 1).Following the release a2.5-fold
increase in percentage of area with peak
pressure (>10 MPa) from the control intact
stifle wasnoted,but thisspecificcompari-
sonwas not evaluated statistically (Fig. 2,
Table1). In the control intact stiflesmuchof
the area measuredinthe mid-range of press-
ure (32% of area with 4to<6MPa), where-
as in the medialmeniscal release stifle much
of the area measuredinthe peak pressure
(35% of area with >10 MPa) (Table 1).The
differences between medialmeniscal re-
lease, andmedialcaudal-pole hemimenis-
cectomyfor the pressure distribution in the
medialcompartment, were not significant
(P>0.05). It wasapparent that alarge por-
tion of the χ
value wasattributabletodiffer-
ences at the >10 MParange.Following
medialmeniscal release the peak pressure
area apparentlytranslatedfrom its central
position andshifted caudally, justcranialto
the caudalmenisco-tibial ligament, al-
thoughthis change wasnot evaluated
quantitatively (Fig. 3).
Experiment2-meniscal disruption
and TPLOincranial cruciate
ligamentdeficient joints
Basedonthe information obtainedfrom ex-
periment 1, data from the >10 MPacategory
were used as the outcome measure for ex-
periment 2. Data from four out of 12 legs
were lostdue to artefactsinthe films,and
could not be includedinthe analysis. Asig-
nificantinteraction by the two-wayANOVA
(P=0.1315), with the major sourceofvari-
ation being meniscal treatment (P<0.0001).
Thepost-hoc tests found asignificantin-
crease in percentofpeak pressure (>10
MPa) after transecting the CCL in the
SHAMstifle (P<0.05) (Fig 4).Medialme-
niscal release andmedialcaudalpole he-
mimeniscectomydid nothaveany further
significant effect (P>0.05). In the TPLO
stifle asignificantincrease in percentage of
highpressure wasfound aftermedialmenis-
cal release (P<0.05) (Table 2).Performing
medialcaudal-pole hemimeniscectomyfol-
lowing medialmeniscal release did not have
anyfurther significant effect on percentof
high pressure (P>0.05) (Table 2).Acaudal
shift of the contactareawas noted as in ex-
periment 1following medialmeniscal re-
lease andmedialcaudalpole hemimenis-
cectomy(Fig. 3).
In our study we found thatmedialmeniscal
release, medialcaudalpole hemi-meniscec-
tomyand CCL transection in vitro resulted
in significant alterationsinthe load trans-
mission function of the medialmeniscusin
the canine stifle.Afterperforming amedial
meniscal release andsimilarlyamedial,
caudalpole hemimeniscectomyinintact
andCCL deficient stifle stabilized by
TPLO,weobservedafocal area of high
pressure in the caudalregion of the medial
tibialcondyle. Cranial cruciate ligament
transection caused asimilarareaofhigh
pressure in the CCLdeficient stifle thatwas
not stabilized by TPLO.
The role of themenisci as load bearing el-
ements has been already studied in depth in
human and animals models (1–4,6,23, 34).
Pressure sensitivefilms
stainedbefore medial
meniscal release(A), fol-
lowing medial meniscal
release (B) andafter
medial caudal pole he-
mimeniscectomy (C).
Pressure sensitivefilm
stainedfollowing medial
meniscalrelease illus-
trates the caudallocation
of the areaofhighpress-
ure on the medial tibial
VetComp OrthopTraumatol1/2008
Pozzi et al.
Several studies have shown that meniscec-
tomy causes an immediate, acute increase in
stiflecontactpeak pressure and that these
changes in stress distribution cause remod-
elling of bone and soft tissue (1, 2, 4, 23).
Ahmed andBurke reported that theremoval
of themedial meniscus caused areduction in
the compartment area by 50–70% and a
marked increaseinpeak pressure in the
human knee (1). Krause et al. showedthat
canine menisci transmit 65% of theweight
bearing and that atwo-fold increaseincom-
pressive deformationofcartilage and sub-
chondral bone occurred after meniscectomy
(35). Shriveetal. reported that radial trans-
ectionofthe porcine and human meniscus
wasequivalenttomeniscectomyinterms of
load-bearing, suggesting that the loss of
‘hooptension’ wasresponsible for highand
non-uniform pressuredistribution(17).In
our experimentwefound that themedial me-
niscusisalso an importantload bearingel-
ementinthe normal andCCL deficientca-
ninestifle, stabilized by TPLO.Medial me-
niscal release and medial, caudal pole he-
mimeniscectomyimpaired theload trans-
missionfunctionofthe meniscusand pro-
ducedatwo-fold increaseinpeak pressure
area and anon-uniform pressuredistribu-
tion. These results concur with findings re-
ported by other authorsafter meniscectomy
in canineand human models(2, 23, 34, 35).
As Shrive et al. suggested,the transectionof
thecircumferential fibres of themeniscus
disrupts the hoop tensionwhich is respon-
siblefor theload bearingfunction(17).
In aprevious study of load transmission
in canine stifles, it wasfound that CCL
transection caused acaudalshiftofthe stifle
contactareas, without anychange in press-
ure magnitude (36). In our study we like-
wise found acaudalshiftofthe contactarea
following CCL transection butwenoted a
significant increase in peak pressure.The
different results of the twostudiesmay be
relatedtothe different model, film sensitiv-
ity or specimen preparation. Thecaudal
shift of the area of high peak pressure prob-
ably occurred during cranialtibialtrans-
lation. One mathematical analysis of femo-
ro-meniscal loadingfound that axialload-
ing by the condyle through the centroidal
axis of symmetryofthe meniscusresulted
in generation of uniform hoop tension in the
meniscus(17). During weightbearing on an
unstable stifle,the medialfemoralcondyle
shifts caudallyand losesits normal central
position in the crescentshapedmeniscus
(13). This condylar translation maydisrupt
the normal ‘hoop tension’ by applying a
high pressure in aperipheral area of the me-
niscus,and potentiallyincreasing the risk of
injuryofthe caudalpole of the meniscus. In
our study we also found thatthe magnitude
of peak pressure diminished in the stifle
treated by TPLO,which suggeststhatthe
detrimentaleffect of CCL transection on
loadtransmission waseliminatedbyneu-
tralizing the cranialtibialthrustwith TPLO
(26).Performing aTPLOinthe presence of
an intact meniscusmay maintain the load
transmission function of the medialmenis-
cusinaCCL deficient stifle.The results of
the pressure distributions in TPLO stifles
suggested some interesting points fordis-
cussion. Despite ahomogeneous distribu-
tion,the magnitude of the pressure
measuredinthe normal stifle with TPLO
washigher thaninthe normal stifle without
anytreatment. This would suggest that
Fig. 4 Pressure sensitivefilms fromastifletreated with aSHAMTPLOstainedbefore medial meniscal releaseand CCL
transection (A), following CCL transection (B), following medial meniscalrelease (C) and aftermedial caudalpole hemime-
niscectomy (D). Pressure sensitivefilms fromastifletreated with aTPLOstainedbefore medial meniscal releaseand CCL
transection (E), following CCL transection (F), following medial meniscalrelease (G)and after medial caudal pole hemime-
niscectomy (H).
Table 2 Effectof cranialcruciateligamenttransection andmedial meniscalsurgeryonthe percentageofareaon themedi-
al tibialplateau with pressuredistributions of >10MPA (meaSD) in stifle joints with atibialplateau levelling osteo-
tomy (TPLO) or ashamTPLO(SHAM) procedure
TPLO 20.611.43
SHAM 3.51 ±2.99
ICCL+IM, intact cranial cruciateligamentand intact medial meniscus; TCCL+IM,transectedcranial cruciate ligament and intact medial meniscus; TCCL+MMR, trans-
ected cranialcruciate ligament and medial meniscus release; TCCL+MMR, transected cranialcruciate ligament and medial caudal pole hemi-meniscectomy. Within
each row, differentlettersdenotesignificant difference (P <0.05).
28.08 ±7.93
38.13 ±11.11
47.48 ±13
45 ±10.9
55.75 ±12.17
52.63 ±5.45
VetComp OrthopTraumatol1/2008
Pressuredistribution with meniscectomy andTPLO
TPLO maychange the normal stifle bio-
mechanicsinvivoand mayincrease the
forces acting on the tibialplateau without
changing itsdistribution. However, the ef-
fect of TPLO on pressure distribution was
not our specific objective.
Thelink betweenmeniscal damage or me-
niscectomy andosteoarthritisispoorly
understood (25, 37–41). It hasbeen proposed
thatcompression of the cartilageatphysio-
logical strains serves as asignal to modulate
chondrocyte responses,whileprolonged
compression at higherstrains mayberespon-
siblefor tissueand cell damage (40). Radin et
al. reportedthatfailure to properlyabsorb im-
pact leadstomicrodamage in the subchon-
dralplate and cartilage which causes reacti-
vation of the secondary centreofossification
andthe development of subchondralbone
sclerosis (42, 43). This mechanical overload
can activate abiological responsethatpo-
tentiates theprogression of arthritis(42, 43).
Clements et al. reportedthatrepetitive com-
pressive loadingwith peak stress ranging be-
tween 3.5and 14 MPacausedanimmediate
dose-relatedincreaseincollagen denatu-
ration in bovine articular cartilage(44). In ad-
dition, it wasreportedthatthe application of
a15MPa impact to the femoral condyle of
dogs resulted in hypertrophic changesinthe
articular cartilageafter12weeks, which is
consistent with earlychangesofosteoarthri-
tis (45). There is alsoabody of clinical litera-
ture thatsuggeststhatthe surgicalremovalof
the medial meniscus constitutes ariskfactor
for the laterappearance of joint cartilage
changes(46–48). In our study we measureda
focalpeak pressure on the cartilageofthe
caudalmedial tibialplateau higher than 10
MPafollowing medial meniscalreleaseand
medial, caudalpole hemimeniscectomy..
Theseobservationssuggest that the caudal
regionofthe medialcompartment of stifle
could be at ahigher riskofcartilagedamage
after medial meniscal releaseand medial,
caudalpole hemimeniscectomy in dogs.This
is consistent with experimentalstudies which
foundearly cartilagedegeneration of the
medialfemoralcondyle andmedial caudalti-
bial plateaufollowing medial meniscalre-
leaseand medial, caudalpole hemimeniscec-
tomy in the dog(22).
Alimitation of the mechanical testing
apparatus used for our study wasthatites-
sentiallylimitedstifle jointmotion to
flexion-extension duringthe application of
axialloads.Use of the Oxford rigfor our
testing mayhavemore closelyapproxi-
mated in vivo loadingconditions. TheOx-
ford rigwas designedfor the biomechanical
testing of cadaveric humankneejoint speci-
mens duringsimulatedflexed-kneestance
(49).Using the Oxford rig, load is applied
through the hip,allowing the knee specimen
its natural sixdegrees-of-freedom of move-
In ourmodel, load transmission was
evaluatedbythe measurement of the magni-
tude anddistributionofpressure using
pressure sensitive films.Pressure sensitive
film hasseveral limitations, notably the
rangebetween threshold andsaturation and
the sensitivity of the film to loadingrateand
environmentalconditions. Thepeak press-
uresofthe CCL deficientjointsand that of
the stifle aftermedialmeniscal release or
medial, caudalpole hemimeniscectomy
were beyond the 10 MPathresholds. We
consideredpressureshigher than10MPa as
supraphysiologic as suggested by previous
studies (44). Theresults frompressure sen-
sitive film also areaffected by shear
stresses, the time between testing andanaly-
sis, and environmentalconditions (3). These
effectswerecertainlypresent in this study
butwerenot consideredtoaffect the results
significantly, mainlybecause the differ-
ences between paired limbs were the most
important variables. We did not measure the
contactareaorits shift. Previousstudies
suggested thatpressure is amore sensitive
indicator of meniscal function (3). We chose
to describe qualitatively the apparent shift
of contactareabecause we could not find an
objective methodtoreadilyquantify this
change.Inaddition, the position of contact
between the femur andtibia would shift
caudallyduring stifle flexion, andtherefore
introducesome additional artefact.
In conclusion, our results show that
medialmeniscal release andsimilarlymedi-
al,caudalpole hemimeniscectomysignifi-
cantlyaffect the loadtransmission function
of the meniscusand consequentlythe carti-
lage pressure.The findings of our study also
suggested thatTPLOmightneutralizethe
negative effect of CCL transection on load
transmission. Theimplication of these data,
for clinical use, is thatanintactmeniscus
should be ideallypreservedinthe CCL defi-
cientstifle stabilized by TPLO.Maintaining
the load bearing function of the medialme-
niscus mayprotect the articularcartilage
fromsupra-physiological pressure andits
metabolism(50). Furtherclinical studies
areneeded to determine if medialmeniscal
release is necessaryinCCL deficient stifles
treated by TPLO.
The research wasfunded in partbygrants awarded to
ProfessorKennethJohnson by AO-Vet and the Ohio
State UniversityCanineResearch Fund Grant.The as-
sistance of TimVojt and Marc Hardman in producing
the figures is gratefully acknowledged.
1. Ahmed AM, BurkeDL. In-vitro measurement of
static pressure distribution in synovial joints--Part
I: Tibial surface of the knee. JBiomechEng 1983;
105: 216–225.
2. Ahmed A. The load-bearing role of the knee me-
nisci. In: MowVC, ArnoczkySPand Jackson DW,
eds. Knee Meniscus:Basic and clinical foun-
dations.New Yo rk: RavenPress; 1992.p.59–73.
3. Bylski-AustrowDI, Malumed J, Meade Tetal.
Kneejoint contact pressure decreases after
chronic meniscectomyrelativetothe acutelyme-
niscectomized joint: amechanical study in the
goat.JOrthop Res 1993; 11: 796–804.
4. Fukubayashi T, Kurosawa H. The contact area and
pressure distributionpatternofthe knee. Astudy
of normal and osteoarthrotic knee joints. Acta Or-
thop Scand 1980; 51: 871–879.
5. Hulse DA,Shires PK. The meniscus: Anatomy,
function and treatment. Compendium Contin
Educ Pract Vet1983; 5: 765–774.
6. Walker PS, ErkmanMJ. The role of the menisci in
force transmission across the knee. Clin Orthop
Relat Res 1975; 184–192.
7. Bennett DD,May C. Meniscaldamage associated
withcruciatedisease in the dog. JSmall Anim
Pract1991; 32: 111–117.
8. Flo GL. Meniscal injuries. VetClin North Am
Small Anim Pract1993; 23: 831–843.
9. Flo GL. Classification of meniscal lesions in
twenty-six consecutive caninemeniscectomies. J
Am AnimHosp Assoc 1983; 19: 335–340.
10. BaileyCJ, Smith BA,BlackAP. Geometric impli-
cations of the tibial wedge osteotomyfor the treat-
ment of cranialcruciateligament disease in dogs.
VetComp Orthop Traumatol 2007; 20: 169-174.
11. Ralphs SC,WhitneyWO. Arthroscopic evaluation
of menisciindogswith cranial cruciate ligament
injuries: 100 cases (1999–2000).JAm VetMed
Assoc 2002; 221:1601–1604.
VetComp OrthopTraumatol1/2008
Pozzi et al.
12.Austin B, MontgomeryRD, WrightJetal. Evalu-
ation of threeapproachestomeniscal release. Vet
Comp Orthop Traumatol 2007; 20: 92-97.
13. Bruce WJ,Rose A, Tuke et al. Evaluation of the
triple tibial osteotomy.Anewtechnoque for the
management of the caninecruciate-deficient
stifle. VetComp Orthop Traumatol 2007; 20:
14. Slocum B, SlocumTD.Tibial plateau levelling os-
teotomyfor repair of cranialcruciateligament
rupture in the canine. VetClin North Am Small
Anim Pract1993; 23: 777–795.
15. Slocum B, Devine-Slocum T. Meniscalrelease. In
Bojrab MJ,editor: Current Techniques in Small
Animal Surgery, 4
ed. Philadelphia: Lea and Fe-
biger; 1998, p. 1991.
16. Dupuis J, Harari J. Cruciate ligament and meniscal
injuries in dogs. Compendium Contin Educ Pract
Vet1993; 15: 215–232.
17. Shrive NG, O'Connor JJ,GoodfellowJW. Load-
bearing in the knee joint. Clin Orthop Relat Res
1978; 279–287.
18. Roos H, Lauren M, Adalberth Tetal. Kneeos-
teoarthritis aftermeniscectomy: prevalenceof
radiographicchanges after twenty-one years,
compared withmatched controls.Arthritis Rheum
1998; 41: 687–693.
Roos H,AdalberthT, DahlbergLet al. Osteoarthri-
tis of the knee after injury to the anterior cruciate
ligament or meniscus:the influence of time and
age. Osteoarthritis Cartilage1995; 3: 261–267.
20. CoxJS, NyeCE, Schaefer WW et al. The degener-
ative effects of partial and total resection of the
medial meniscus in dogs' knees.Clin Orthop Relat
Res 1975: 178–183.
21. Lanzer WL, Komenda G. Changesinarticularcar-
tilage after meniscectomy.Clin Orthop Relat Res
1990; 41–48.
22. Johnson KA, Francis DJ,ManleyPAetal. Com-
parison of the effects of caudal pole hemi-menis-
cectomyand complete medial meniscectomyin
the canine stifle joint. Am JVet Res 2004; 65:
23. Kurosawa H, Fukubayashi T, Nakajima H. Load-
bearing mode of the knee joint: physical behavior
of the knee jointwith or without menisci. Clin Or-
thop Relat Res 1980; (149):283–290.
24. RonskyJL, HerzogW,Brown TD et al. In vivo
quantification of the cat patellofemoraljoint con-
tact stresses and areas. JBiomech1995; 28:
25. Radin EL, Ehrlich MG, Chernack Retal. Effectof
repetitiveimpulsive loadingonthe knee joints of
rabbits. Clin Orthop Relat Res 1978; 131:
26. Warzee CC,DejardinLM, Arnoczky SP et al. Ef-
fect of tibialplateau leveling on cranial and caudal
tibial thrusts in canine cranial cruciate-deficient
stifles: an in vitro experimental study.Vet Surg
2001; 30: 278–286.
27. Preston CA, Schulz KS, Kass PH. In vitro deter-
mination of contact areasinthe normal elbow
joint of dogs.Am JVet Res 2000; 61: 1315–1321.
28. Kowaleski MP,Apelt D, Mattoon JS et al. The ef-
fectoftibial plateau levelling osteotomy position
on cranialtibial subluxation: an in vitro study.Vet
Surg 2005; 34: 332–336.
29. Piermattei DL, Johnson KA. An atlas of surgical
approaches to the bones and joints of the dogand
cat. 4
ed. Philadelphia: W. B. Saunders 2004; p.
30. Liggins AB,FinlayJB. Recording contactareas
and pressures in joint interfaces. In: Little EG, edi-
tor.Experimental mechanics: Technology transfer
between high-tech engineeringand biomechanics.
Amsterdam: Elsevier 1992; p. 71–88.
Liggins AB,Surry K, FinlayJB. Sealing Fuji pre-
scale pressure-sensitivefilm against fluid damage:
the effect on its response. Strain 1995; 31: 57–62.
32. Liggins AB,FinlayJB. Calibration and manipu-
lationofdata from Fuji pressure-sensitivefilm.
In: Little EG, editor.Experimental mechanics:
Technology transfer between high-tech engineer-
ing and biomechanics. Amsterdam:Elsevier
1992; p. 61–70.
33. Pagano M, Gauvreau K. Contingencytables. In:
Pagano Meditor.Principles of Biostatistics.
Pacific Grove:Duxbury2000; p. 342–373.
34. Anderson DR, Newman AP,DanielsAU. In vitro
load transmission in the canine knee: the effect of
medial meniscectomyand varusrotation. Knee
SurgSports Traumatol Arthrosc 1993; 1: 44–50.
35. KrauseWR, Pope MH, Johnson RJ et al. Mechan-
ical changesinthe knee after meniscectomy. J
Bone Joint SurgAm1976; 58A: 599–604.
36. FlechtenmacherJ,Borodkin SL, Hollister SJ et al.
Tibial contact pressure distribution changesinthe
canine cruciate ligament transection model of os-
teoarthrosis. In: Transactionsofthe 39
Meeting, OrthopaedicResearch Society1993; 18:
37. Smith GN,MicklerEA, Albrecht ME et al. Sever-
ity of medialmeniscus damageinthe canine knee
after anterior cruciate ligament transection. Os-
teoarthritis Cartilage 2002; 10: 321–326.
38. Boyd KT,Myers PT.Meniscus preservation;
rationale,repair techniques and results. Knee
2003; 10: 1–11.
Berthiaume MJ,Raynauld JP,Martel-PelletierJet
al. Meniscaltear and extrusion arestronglyassoci-
ated withprogression of symptomaticknee osteoar-
thritis as assessedbyquantitativemagnetic reson-
ance imaging.Ann Rheum Dis 2005; 64: 556–563.
40. Guilak F, MeyerBC, Ratcliffe Aetal.The effects
of matrix compression on proteoglycan metab-
olism in articular cartilage explants. Osteoarthri-
tis Cartilage 1994; 2: 91–101.
41. vanTienenTG, HeijkantsRG, de Groot JH et al.
Presence and mechanism of knee articular carti-
lage degeneration after meniscal reconstruction in
dogs. Osteoarthritis Cartilage 2003; 11: 78–84.
42. BurrDB, Radin EL. Microfracturesand micro-
cracks in subchondral bone: are theyrelevant to
osteoarthritis? Rheum Dis Clin North Am 2003;
29: 675–685.
43. Radin EL, Rose RM. Role of subchondral bone in
the initiation and progression of cartilage damage.
Clin OrthopRelat Res1986; 34–40.
44. ClementsKM, Bee ZC, Crossingham GV et al.
Howsevere mustrepetitive loadingbetokill
chondrocytes in articularcartilage? Osteoarthritis
Cartilage 2001; 9: 499–507.
45. HurtigMB, Akens MK. Comparison of the con-
tusive impactand ACLtransection modelsofos-
teoarthritis. In: Transactionsofthe 50
Meeting, Orthopaedic Research Society,2004;
29: 925.
46. Allen PR, Denham RA, Swan AV.Late degener-
ative changes after meniscectomy.Factors affect-
ing the knee after operation.JBone Joint Surg
1984; 66B: 666–671.
47. AppelH.Late results after meniscectomy in the
knee joint. Aclinicaland roentgenologic follow-
up investigation. Acta Orthop Scand Suppl 1970;
133: 101–111.
48. JorgensenU,Sonne-Holm S, Lauridsen Fetal.
Long-termfollow-up of meniscectomyinathlet-
es. Aprospectivelongitudinal study.JBone Joint
Surg1987; 69B: 80–83.
49. ZavatskyAB. Akinematic-freedom analysis of a
flexed-knee-stance testing rig. JBiomech1997;
30: 277–280.
50. Bolam CJ,Hurtig MB,CruzAet al. Characteriz-
ation of experimentallyinduced post-traumatic
osteoarthritis in the medial femorotibial joint of
horses. Am JVet Res 2006; 67: 433–447.
Kenneth A. Johnson MVSc,PhD
The Ohio State University
College of VeterinaryMedicine
601 VernonL.Tharp Street
Columbus, Ohio 43210, USA
Phone: +1 614 247 6757, Fax: +1 614 292 0895
... 2,30 Persistent subluxation increases shear force on the caudal horn of the medial meniscus, potentially causing meniscal injury. 3,7,[31][32][33] Underadvancement is inherent to the TTA technique and is exacerbated by a distal patella tendon insertion. 24,26 The trapezoid cage is placed proximal to the tibial tuberosity and the cage narrows distally, so the advancement at the tibial tuberosity is less than the cage size. ...
... 3,7,8,10 Medial meniscal release and caudal horn meniscectomy result in a greater peak pressure area and magnitude during loading in vitro, and in vivo MMR has been associated with increased postoperative meniscal pathology and osteoarthritis. 32,37 Medial meniscal release in this study was performed at surgeon discretion (2.1% of TTAs) but was mostly avoided. Two stifles in the current study had postliminary meniscal injury despite MMR at the initial surgery, providing evidence that MMR is not fully protective. ...
Objective To report postoperative complications associated with forkless tibial tuberosity advancement (TTA) performed in primary care veterinary practice and to compare results with previous publications. Study design Retrospective study. Sample population Three hundred seventy‐four forkless TTAs in 329 dogs performed by six nonspecialist veterinarians. Methods Medical records of dogs treated with a standard forkless TTA (2013‐2016) and with at least 12 months of postoperative follow‐up were reviewed. Complications recorded by the referring practice or the operating veterinarian were classified as minor (medically treated) or major (surgically treated). Results Complications occurred in 57 of 374 (15.2%) TTAs; 28 (7.5%) complications were major, and 29 (7.7%) complications were minor. Postliminary meniscal injuries were documented in 12 of 374 (3.2%) TTAs (12/57 major complications) and were more common when the ratio of cage size to bodyweight was ≤0.25 (P = .019). Mean TTA (cage size) was greater in this population than what has been previously reported for a lower median bodyweight. Conclusion The incidence of major complications was low and within the range previously reported for TTA in referral practice after adjusting for study design. The magnitude of advancement was greater, and the incidence of postliminary meniscal injury was lower than what has been previously reported, after accounting for dogs that had a preliminary meniscal injury or medial meniscal release. Clinical significance Forkless TTA may be successfully performed by experienced veterinarians in primary care practice with a low rate of complications. The incidence of postliminary meniscal injury may be reduced by a greater degree of advancement of the tibial tuberosity.
... The film was cut 2 mm larger than the width and height of the patella and measured in advance. Since the film was vulnerable to humidity, it was sealed with two sheets of selfadhesive polyethylene (Tegaderm ® , 3M Health Care, USA) to prevent contamination by the damp atmosphere [10]. The film was then placed in the patellofemoral articulation by incising the suprapatellar pouch, and the beads that had been previously embedded were marked with a pen on the top of polyethylene film (Fig. 1C). ...
... Evaluation of direct contact pressure and the contact area is essential in understanding the loading environment of the joint. The Prescale pressure measuring system is useful in determining contact pressure and the contact area distribution pattern of the joint [6,10,11]. The film is suitable for measuring patellofemoral joint pressure as it can be cut into desired sizes, and it enables the selection of variable pressure ranges. ...
Full-text available
Background: An inappropriate Q angle may affect the biomechanics of the canine patellofemoral joint. Objectives: The purpose of this study was to evaluate the effects of changes in quadriceps angle (Q angle) on patellofemoral joint pressure distribution in dogs. Methods: Eight stifles were positioned at 45, 60, 75, 90, 105, and 120° of flexion in vitro, and 30% body weight was applied through the quadriceps. Patellofemoral contact pressure distribution was mapped and quantified using pressure-sensitive film. For the pressure area, mean pressure, peak pressure, medial peak pressure, and lateral peak pressure, differences between groups according to conditions for changing the Q angle were statistically compared. Results: Increases of 10° of the Q angle result in increases in the pressure area (P = 0.04), mean pressure (P = 0.003), peak pressure, and medial peak pressure (P ≤ 0.01). Increasing the Q angle by 20° increases the pressure area (P = 0.021), mean pressure (P ≤ 0.001), peak pressure (P ≤ 0.01), and medial peak pressure (P ≤ 0.01) significantly, and shows higher mean (P ≤ 0.001) and peak pressures than increasing by 10°. Decreasing the Q angle increases the mean pressure (P = 0.013), peak pressure, and lateral peak pressure (P ≤ 0.001). Conclusions: Both increases and decreases in the Q angle were associated with increased peak patellofemoral pressure, which could contribute to the overloading of the cartilage. Therefore, the abnormal Q angle should be corrected to the physiologically normal value during patellar luxation repair and overcorrection should be avoided.
... Previously published studies reported 10% postoperative secondary meniscus damage after traditional tibial tuberosity advancement [57], these rates can be as high as 20% without meniscal release [58]. Although the release of the medial meniscus disturbs load transmission through the meniscus, increasing instability and cartilage loading [59]. Late meniscal tears in studies included in this review (4.28%) are lower than previously reported. ...
Full-text available
(1) Background: Several surgical techniques were described for the treatment of cranial cruciate ligament rupture in dogs. This report aims to critically review the available literature focused on preoperative planning, surgical procedure, follow-up, and complications of cranial cruciate ligament rupture treated by tibial tuberosity advancement techniques; (2) Methods: three bibliographic databases: PubMed, Google Scholar, and Scopus were used for a board search of TTAT (canine OR dog). Five GRADE recommendations according to Grading of Recommendations Assessment, Development and Evaluation and Joanna Briggs Institute Critical Appraisal Checklists were applied to the studies included. Data regarding preoperative planning (a measure of advancement), meniscal disease (meniscectomy, meniscal release, and late meniscal tears), and postoperative patellar tendon angle were recorded. Time frame, outcome, and complications were classified according to Cook’s guidelines; (3) Results: from 471 reports yielded, only 30 met the inclusion criteria. The common tangent method was the most commonly reported measurement technique for preoperative planning. The 40.21% of stifles presented meniscal tears at surgery, while 4.28% suffered late meniscal tears. In short-, mid-and long-term follow-ups examined showed a full/acceptable function was shown in >90% of cases. Among all new generation techniques, minor complications were reported in 33.5% of cases and major complications in 10.67%; (4) Conclusions: Compared to traditional TTA, new generation TTAT resulted effective in the treatment of cranial cruciate ligament failure, showing a lower rate of late meniscal injury but a higher rate of minor complications.
... 6,28,39 The integrity of the medial meniscus influences stifle stability after TPLO in vivo, with greater CTT in CCL-deficient stifles with concurrent hemimeniscectomy. 6 Both MMR and caudal hemimeniscectomy affect the joint similarly 40 and performance of either is likely to impact joint stability negatively. ...
Objective: To evaluate the effect of center of angulation of rotation (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.
... 17 In dogs, compromised function of the meniscus by either medial meniscal release or medial complete meniscectomy results in stress concentration, which may predispose to osteoarthritis. 18 Another study revealed that performing meniscal repair instead of partial meniscectomy in dogs with select meniscal tears may mitigate the development of degenerative joint disease. 19 To our knowledge, meniscal repair has not been reported in cats. ...
Full-text available
Objectives The aim of the study was to describe traumatic stifle injury in cats and report complications and long-term outcome. Methods The medical records from seven veterinary hospitals of cats treated for traumatic stifle injury were reviewed. Long-term follow-up data were collected from referring veterinarians and using the Feline Musculoskeletal Pain Index, collected from owners. Results Seventy-two cats were included in the study. The most common combination of ligament injury involved both cruciate ligaments and the lateral collateral ligament (25.4%). Medial meniscal injury was more common (66.2%) than lateral meniscal injury (59.4%). A temporary transarticular pin was used intraoperatively to aid reduction in 23/73 (31.5%) surgeries. Postoperative immobilisation was applied in 41/72 (56.9%) cats with a mean duration of 4.8 weeks. Short-term complications occurred in 40/64 (62.5%) cats. Long-term complications occurred in seven (17.5%) cats. Overall outcome was excellent in 25/61 (41%) cats, good in 13/61 (21.3%) cats, fair in 11/61 (18%) cats and poor in 12/61 (19.7%) cats. Mean length of follow-up was 29.6 months (range 0.5–204). A significantly poorer outcome was observed in cats with medial meniscal injury and those undergoing revision surgery. Use of a transarticular pin when left in situ for postoperative immobilisation was associated with a poorer outcome (P = 0.043) and a higher risk of complications (P = 0.018). Postoperative immobilisation was not related to outcome. Conclusions and relevance Traumatic stifle injury in cats can lead to rupture of multiple ligaments causing significant instability of the joint. Surgical treatment is associated with a high rate of short-term complications, although long-term outcome may still be good to excellent in the majority of cats (62.3%). In cats where follow-up was available, postoperative immobilisation had no positive effect on outcome and may not be required. Leaving a transarticular pin for postoperative immobilisation is not recommended as it was significantly associated with a poorer outcome and a higher complication rate.
... Meniscal release is relatively less technically demanding than meniscectomy, is faster, and can be performed via blind or minimally invasive methods (Austin et al., 2007). Given the commonality of cranial cruciate ligament disease in the canine population (Wilke et al., 2005) with reported rates of 10-77% concurrent meniscal tears , successful meniscal treatment via the least invasive method possible may prove beneficial for patients and surgical efficiency considering the similar biomechanics reported between techniques (Pozzi et al., 2008b(Pozzi et al., , 2010a(Pozzi et al., , and 2010b. However, it is therefore important to determine if meniscal release confers the same well documented benefits to patients in lameness resolution as meniscectomy procedures before considering this an evidence based surgical technique. ...
Full-text available
PICO question In adult dogs with naturally occurring medial meniscal tears concurrent to cranial cruciate ligament disease does meniscal release confer the same benefits in lameness resolution as meniscectomy? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed A single prospective cross-sectional study was reviewed, that fulfilled the criteria Strength of evidence None Outcomes reported Meniscal release, meniscectomy (partial, hemi- or complete), or the two combined performed for concurrent medial meniscal pathology at time of surgery for naturally occurring cranial cruciate ligament (CCL) rupture resulted in an acceptable long-term outcome. Difference in outcome between the techniques was not reported Conclusion There is no evidence that meniscal release provides an equal or superior treatment option for medial meniscal injury treated at the time of surgery for CCL rupture when compared to meniscectomy. The study critically reviewed performed meniscal release via radial transection through the meniscotibial ligament, and therefore does not represent mid-body abaxial radial release. Neither is this summary appropriate for considering prophylactic meniscal release of the normal meniscus. In addition, the surgical treatments for cranial cruciate ligament rupture were either ‘Tightrope’ or tibial plateau levelling osteotomy (TPLO) procedures. Further studies are required to compare clinical outcome between meniscal release or meniscectomy for treatment of concurrent meniscal tears How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
... 123,151,154,172 Zwar vermindert der MR die Häufigkeit von späten Meniskusschäden, aber dieser Vorteil muss gegenüber seiner negativen Auswirkungen abgewogen werden. 155 So führt der MR bei intakten Menisken zum Verlust ihrer Stossdämpfer-Funktion, was Knorpelschäden und ein schnelleres Fortschreiten der Arthrose zur Folge hat. 123,153,154 Welche Behandlungsmethoden werden für grosse Hunde (>15 kg) empfohlen? ...
Cranial cruciate ligament rupture is one of the most important diseases in canine orthopedics. Despite the frequent occurrence of the disease and the extensive literature available, there is still controversy about the best treatment method. The aim of this review article is to present a new, more specific approach to treatment selection in dogs with cranial cruciate ligament rupture. Patients are divided into different groups and particular treatment methods are then recommended according to group membership. In order to develop the treatment recommendations, the patient groups were initially defined based on criteria that are important for treatment selection, such as type of cranial cruciate ligament rupture, chronicity, degree of instability, size and weight of the patient, stage of osteoarthritis, the presence of bone deformities, concurrent medial patellar luxation or rotational instability. A detailed literature search was conducted through MEDLINE/PUBMED; CAB Abstracts, Google -Scholar and in conference proceedings abstracts from 1990-2019. Based on the available literature, treatment recommendations were developed for each patient group. These patient group-specific recommendations based on best available evidence are intended to simplify the decision-making process for treatment selection in dogs with cranial cruciate ligament disease.
Full-text available
Objectives The objective of this study was to use for the first time proton nuclear magnetic resonance spectroscopy (1H NMR) to examine the metabolomic profile of stifle joint synovial fluid from dogs with cranial cruciate ligament rupture with and without meniscal injuries. We hypothesised this would identify biomarkers of meniscal injury. Methods Stifle joint synovial fluid was collected from dogs undergoing stifle joint surgery or arthrocentesis for lameness investigations at three veterinary hospitals in the North-West of England. Samples underwent 1H NMR spectroscopy and metabolite identification. We used multivariate and univariate statistical analysis to identify differences in the metabolomic profile between dogs with cranial cruciate ligament rupture and meniscal injury, cranial cruciate ligament rupture without meniscal injury, and neither cranial cruciate ligament rupture nor meniscal injury, taking into consideration specific clinical variables. Results 154 samples of canine synovial fluid were included in the study. 64 metabolites were annotated to the 1H NMR spectra. Six spectral regions were found to be significantly altered between groups with cranial cruciate ligament rupture with and without meniscal injury, including three attributed to NMR mobile lipids (mobile lipid -CH3 [p=0.016], mobile lipid -n(CH3)3 [p=0.017], mobile unsaturated lipid [p=0.031]). Clinical Significance We identified an increase in NMR mobile lipids in the synovial fluid of dogs with meniscal injury which are of interest as potential biomarkers of meniscal injury, as well as understanding the metabolic processes that occur with meniscal injury.
Objective: To evaluate the short- and mid-term effects of tibial tuberosity advancement (TTA) and tibial plateau leveling osteotomy (TPLO) on subsequent meniscal tears. Study design: Experimental in vivo study. Animals: Purpose-bred beagle dogs (n = 15). Methods: For each dog, the cranial cruciate ligaments were transected; one limb underwent TTA and the other limb underwent TPLO. Orthopedic and radiographic examinations were performed preoperatively and at 12 and 32 weeks postoperatively. Gross evaluation of the stifle joint was performed after euthanasia at 12 (n = 10) and 32 (n = 5) weeks. Results: Lameness scores were not different between TTA and TPLO limbs at any time point. Radiographic osteoarthritis scores of TTA stifles (1.33 ± 0.49) were higher than TPLO stifles (0.67 ± 0.49) (p = .002) at 12 weeks postoperatively, but there was no difference between groups at 32 weeks postoperatively. Subsequent medial meniscal tears occurred in 6/10 TTA stifles, and 0/10 TPLO stifles at 12 weeks postoperatively and in 5/5 TTA stifles, and 1/5 TPLO stifles at 32 weeks postoperatively. Subsequent lateral meniscal tears occurred in 4/5 TTA stifles at 32 weeks postoperatively. Medial meniscal total gross pathology score was higher in TTA than TPLO stifles. TTA stifles had more articular cartilage damage when compared with TPLO stifles at 32 weeks postoperatively. Conclusion: In this within-dog experimental comparison, subsequent medial meniscal tears and cartilage injury was more prevalent following TTA when compared to TPLO. Clinical significance: In an experimental model, TPLO protects the medial meniscus and articular cartilage better than TTA in stifles with complete cranial cruciate ligament deficiency.
Full-text available
La rupture de ligament croisé antérieur est une cause extrêmement fréquente de consultation en orthopédievétérinaire. Avec une prévalence de 4,87% chez les chiens, c’est l'atteinte orthopédique la plus courante desmembres pelviens. C’est une affection qui doit être prise en charge chirurgicalement. De nombreuses méthodesont été décrites et l’ostéotomie de nivellement du plateau tibial est aujourd’hui la technique de référence chez lechien. Toutefois, l’avènement récent de matériaux hautement résistants et biocompatibles relance l’intérêt duremplacement de ces ligaments par des prothèses ligamentaires en médecine humaine mais également enmédecine vétérinaire.Cette étude biomécanique, réalisée sur modèle cadavérique de genou de chien (n=14), doit permettre decomparer deux systèmes d’ancrage d’un ligament artificiel par des vis d’interférence. Dans le premier groupe(n=7), les deux vis sont placées dans le tunnel osseux de l’espace articulaire vers la métaphyse (système In-Out)tandis que dans le second groupe (n=7), elles sont placées dans le sens opposé (système Out-In). Les paramètresétudiés lors de la traction sur le montage sont le mode de rupture du montage, la force maximale à laquelle lemontage résiste et le déplacement associé, la force associée à un déplacement de 3mm et la rigidité du système.L’étude montre la Force associée à 3mm de déplacement est environ deux fois supérieure dans le groupe In-Outdonc deux vis d’interférence disposées en In-Out permettent une meilleure résistance initiale en traction qu’unmontage Out-In pour des valeurs compatibles à une stabilisation du grasset acceptable.
Full-text available
The triple tibial osteotomy (TTO) is a technique which combines the features of tibial tuberosity advancement and wedge osteotomy for the treatment of complete and partial cruciate ligament injuries in dogs. In this paper, the technique is described and the results of a prospective study of 64 consecutive cases are presented. TTO provided a satisfactory clinical outcome in a very high percentage of cases. The technique is relatively easy to learn and has a low post-operative complication rate.
Fuji Prescale pressure-sensitive film is a readily available medium which can be used for investigating both pressure and contact area distributions in normal and prosthetic joints. The appJication of pressure produces a pink stain for which the optical density at any point is determined by the pressure level at that point. This paper describes a system developed for calibrating this film from a series of standard stains and then using these data for digitally processing test stains and rendering them as false-colour pressure maps.
Pathology of the menisci was evaluated in 87 consecutive cases of cruciate disease in the dog. Lesions were recorded in 43 cases (49 per cent) and only the medial meniscus was affected. The commonest lesion was a folding of the caudal horn of the medial meniscus with its displacement between the medial femoral and tibial condyles (19 cases). Other lesions were single or multiple longitudinal tears (14 cases) in which four showed the classical ‘bucket handle’ appearance, fibrillation/tearing of the femoral surface (four cases), axial fringe tears (three cases) and transverse tears (three cases). The meniscal lesions were treated by a partial meniscectomy at the time of the cruciate surgery. Meniscectomy had no untoward effect on the postoperative recovery and overall the postoperative recovery of the dogs in this study has been superior to the author's previous cases where the menisci were not properly evaluated.
Fuji Prescale pressure sensitive film will record pressures as a characteristic pink stain; the optical density response of these stains can be calibrated to allow subsequent conversion into full field pressure data. Due to its ease of use, Fujifilm has been employed extensively within animal joints. For this application, the potential disruption to the stain producing mechanism posed by the presence of joint fluids has led to the widespread use of fluid proof materials, within which the Fujifilm is protected; however, little data have been presented on the effect of protective materials on the subsequent stain response. This paper presents a quantitative assessment of the mean optical density responses of both protected film and a control group of unprotected film; the first group consisted of Fujifilm sealed between two layers of a readily available self-adhesive material, forming sealed packets. The results indicated significant differences between groups (p<0.05); however, the effect of these differences is dependent on the method used to produce pressure data. Qualitative observations indicated that sealing reduced stain uniformity; preliminary qualitative observations regarding data manipulation methods to overcome this phenomenon are presented. Consequently, this work indicates the importance of validating methods for protecting Fuji film from fluid damage and their associated methods of data manipulation.
The effects of compressive stress on the rate of proteoglycan synthesis and release were determined in bovine articular cartilage from 4–5-month-old animals. Full depth cartilage explants were compressed in an unconfined configuration at various stresses ranging up to 1.0 MPa. At mechanical equilibrium (after 24 h), no significant changes were detected in the rate of [35S]-sulfate (35SO4) incorporation at the low level of compressive stresses used (less than 0.057 MPa). At an intermediate level of compressive stress (0.057, 0.1, 0.5 MPa), 35SO4 incorporation rates were reduced to ∼60% of control values. At the highest level compressive stress (1.0 MPa) studied, 35SO4 incorporation rates were further reduced to ∼20% that of controls. Recovery experiments at intermediate stress levels showed increased rates of 35SO4 incorporation at 24 h after compression. In explants loaded for 24 h at stresses of 0.1 MPa or higher, there was a stress-dose dependent inhibition of proteoglycan release into the media (up to 61% at 1.0 MPa), and proteoglycan release rates did not return to control values following a 24 h recovery period. While cartilage composition and biosynthetic activity were found to vary significantly with depth in control cartilage, the observed suppression (% change) in biosynthetic activity was relatively uniform with depth in both loading and recovery experiments. The study indicates that compression of the tissue to physiological strain magnitudes serves as a signal to modulate chondrocyte biosynthetic and catabolic responses through the depth of cartilage, while prolonged compression at higher strains may be responsible for tissue and cell damage.