Triple tibial osteotomy partially restores instantaneous centre of rotation position in cruciate deficient stifle joints ex vivo

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Purpose of the work The canine femorotibial joint exhibits a combination of sagittal plane rotation and translation during flexion and extension, resulting in a constantly moving instantaneous centre of rotation (ICR). The ICR is defined as the point about which a movement can be described as pure rotation. Deficiency of the cranial cruciate ligament (CCL) has been shown to result in a change in ICR position (1,2): assessment of ICR patterns might be a useful research tool for evaluating surgical strategies for CCL-deficient joints. Previous analysis of ICR position relative to joint angle ex vivo resulted in large variation between test constructs (2). While error size is dependent on number of points analysed and amount of rotation about the ICR (larger is better for both), variation between joint angle and tibial plateau orientation was hypothesised to be an additional contributing factor. Materials and used methods Fluoroscopic data were obtained from a previous study (3). Briefly, hindlimb constructs from donated cadavers were fixed by the femur to a radiolucent support, and instrumented to mimic quadriceps and gastrocnemius loads of 15kg and 5kg, respectively. The constructs were slowly moved from full flexion to extension under fluoroscopic video recording. Coordinate data for 5 radio-opaque tibial markers were retrieved for multiple joint angles from still images. Monotonic cubic splines were used to smooth and interpolate data to pre-selected angles (10°-100°) between the femoral diaphyseal axis and the tibial plateau. A least-squares approach (4) was used to obtain ICR data for each construct under intact, cruciate ligament transection, medial meniscal release and triple tibial osteotomy (TTO) conditions. Curves based on mean ICR locations were found, and error ellipses derived from covariate matrix eigenvalues for each point. Outcomes The intact ICR curve was short and located mid-condyle during flexion-extension. Transection of the CCL moved the starting point of the ICR curve to the distal metaphysis and the end-point to the cranial condyle: the medial meniscal release ICR curve overlapped and extended this curve. The TTO ICR curve started near the intact ICR curve but deviated towards the distal metaphysis. Curve positions were similar for joint angle and tibial plateau referenced calculations, but error ellipse areas were smaller for all test conditions except TTO when the tibial plateau reference was used compared to bone axes (60-85% vs 134%). Conclusions CCL transection and subsequent medial meniscal release result in markedly abnormal ICR curves, which may contribute to ongoing joint pathology. Normal curve position and initial deviation was consistent with previous reports analysing normal joints and the over-the-top repair (1,5). TTO restored the starting point of the ICR curve but did not normalise joint rotation/translation in this model, in contrast to reports for the over-the-top repair (1). This may reflect initial caudal subluxation in the flexed joint followed by cranial subluxation at terminal extension. Whether other osteotomy techniques produce better ICR curves and thus more normal joint movement should be the focus of further research. Tibial plateau referenced curves generally reduced errors, supporting our hypothesis: the exception after TTO may reflect variability in final tibial plateau angle (mean 7°±3°) achieved in this study. Bibliography 1. Mitton GR, Ireland WP, Runyon CL. Evaluation of the instantaneous centers of rotation of the stifle before and after repair of torn cruciate ligament by use of the over-the-top technique in dogs. Am J Vet Res. 1991 Oct;52(10):1731–7. 2. Gundersen RS, Miles JE. Instantaneous centre of rotation in the canine stifle following cranial cruciate ligament transection and stabilising surgery. In: World Small Animal Veterinary Association Congress Proceedings [Internet]. Copenhagen, Denmark; 2017. Available from: https://www.vin.com/apputil/content/defaultadv1.aspx?pId=20539&catId=113406&id=8506148&ind=235&objTypeID=17 3. Jensen TV, Kristiansen SS, Buelund LE, Miles JE. Modelling the Effects of Cranial Cruciate Ligament Transection, Medial Meniscal Release and Triple Tibial Osteotomy on Stability of the Canine Stifle Joint. Vet Comp Orthop Traumatol. 2020 Jan 30;s-0039-1700989. 4. Challis JH. Estimation of the finite center of rotation in planar movements. Med Eng Phys. 2001 Apr;23(3):227–33. 5. Ireland WP, Rogers J, Myers RK. Location of the instantaneous center of joint rotation in the normal canine stifle. Am J Vet Res. 1986 Apr;47(4):837–40. Address for Correspondence Dr. James Miles - Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark - E-mail jami@sund.ku.dk
Original languageEnglish
Publication dateMay 2021
Publication statusPublished - May 2021
EventEuropean Society of Veterinary Orthopaedics and Traumatology: Congress 2021 - Online
Duration: 5 May 20218 May 2021

Conference

ConferenceEuropean Society of Veterinary Orthopaedics and Traumatology
LocationOnline
Period05/05/202108/05/2021

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