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This edition first published 2018

This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.

Edition History

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Library of Congress Cataloging-in-Publication Data

Names: Muir, Peter, BVSc, editor. | American College of Veterinary Surgeons. Foundation, issuing body.

Title: Advances in the canine cranial cruciate ligament / edited by Peter Muir.

Description: Second edition. | Hoboken, NJ : Wiley ; [United States] : American College of Veterinary Surgeons

Foundation, 2018. | Includes bibliographical references and index. |

Identifiers: LCCN 2017026733 (print) | LCCN 2017027885 (ebook) | ISBN 9781119261735 (pdf) | ISBN 9781119261742

(epub) | ISBN 9781119261711 (cloth)

Subjects: | MESH: Dog Diseases–surgery | Anterior Cruciate Ligament | Dogs–injuries | Orthopaedic

Procedures–veterinary | Rupture–veterinary | Rupture, Spontaneous–veterinary

Classification: LCC SF991 (ebook) | LCC SF991 .A38 2018 (print) | NLM SF 991 | DDC 636.7/0897582059–dc23

LC record available at https://lccn.loc.gov/2017026733

Cover Design: Wiley

Cover Images: Courtesy of Peter Muir

Contents

About the Editor

Foreword to the Second Edition

Foreword

Preface

Acknowledgements

Contributing Authors

Note

Section I Structure and Function

Introduction
1 Morphology and Function of the Cruciate Ligaments
1. Introduction
2. Morphology
3. Functional anatomy
4. References
2 Biomechanics of the Cruciate Ligaments
1. Introduction
2. Ligament composition
3. Biomechanical properties
4. Biologic factors
5. Conclusions
6. References
3 Cruciate Ligament Remodeling and Repair
1. Introduction
2. Healing potential of the extracapsular ligament
3. Healing potential of the completely ruptured CrCL
4. Healing potential of the partially ruptured CrCL
5. Healing potential of the surgically repaired CrCL
6. Healing potential of the reconstructed CrCL graft
7. Healing potential of the reconstructed graft interface tissue
8. Summary
9. References
4 Meniscal Structure and Function
1. Surgical anatomy
2. Structure and composition
3. Neurovascular anatomy
4. Biomechanical and material properties
5. Meniscal function
6. References
5 Biomechanics of the Normal and Cranial Cruciate Ligament-Deficient Stifle
1. Normal stifle
2. Cranial cruciate ligament-deficient stifle
3. References

Section II Etiopathogenesis of Cruciate Ligament Rupture

Introduction
6 Histology of Cruciate Ligament Rupture
1. Pathology of cranial cruciate ligament rupture
2. Histologic features of cruciate ligament
3. Histopathology of the canine cranial cruciate ligament
4. Cruciate ligament adaptation and repair
5. Conclusions
6. References
7 Genetics of Cruciate Ligament Rupture
1. Introduction
2. Heritability
3. Complex trait genetics
4. Candidate gene analyses
5. Genome-wide association
6. Canine and human cruciate ligament rupture
7. Summary and future recommendations
8. References
8 Cruciate Ligament Matrix Metabolism and Development of Laxity
1. Introduction
2. Cruciate ligament metabolism and laxity in human beings and other species
3. Canine cruciate ligament metabolism and laxity
4. Conclusions
5. References
9 Morphological Risk Factors for Cruciate Ligament Rupture
1. Introduction
2. Distal femur
3. Tibia
4. Patella/quadriceps mechanism and Q-angle
5. Fabella
6. Conclusion
7. References
10 Role of Nitric Oxide Production and Matrix Protease Activity in Cruciate Ligament Degeneration
1. Nitric oxide: An overview
2. Nitric oxide activity in articular tissues
3. Role of NO and reactive oxygen species in the joint
4. MMP: An overview
5. The role of MMPs in the stifle joint
6. Influence of NO and MMPs on CrCL structure
7. Conclusions
8. References
11 Role of Antibodies to Collagen Type I and II
1. Introduction
2. Antigenicity of collagen
3. Prevalence of antibodies to collagen types I and II
4. Relevance of antibodies to collagen types I and II
5. References
12 Synovitis Precedes Stifle Instability Associated with Cruciate Ligament Rupture
1. Introduction
2. Normal synovium
3. Synovitis
4. Synovial assessment
5. Synovitis in early cruciate rupture
6. Conclusions
7. References
13 Role of Synovial Immune Responses in Stifle Synovitis
1. Introduction
2. Inflammatory cell populations within the stifle joint
3. Antigen-specific immune responses within joint tissues
4. Innate immune responses within joint tissues
5. References

Section III Clinical Features

Introduction
14 Epidemiology of Cruciate Ligament Rupture
1. Introduction
2. Age
3. Gender
4. Obesity
5. Conformation
6. Bilateral CrCL rupture
7. Genetics
8. References
15 History and Clinical Signs of Cruciate Ligament Rupture
1. Introduction
2. History
3. Clinical signs
4. Conclusions
5. References
16 Partial Rupture of the Cranial Cruciate Ligament
1. Introduction
2. Partial cranial cruciate ligament rupture
3. Conclusions
4. References
17 Caudal Cruciate Ligament Rupture
1. Introduction
2. Clinical presentation
3. Treatment
4. Conclusions
5. References
18 Stress Imaging of the Stifle
1. Introduction
2. Measuring subluxation
3. Tibial compression radiography
4. Stress devices
5. Standing radiography
6. Stress-MRI
7. Conclusions
8. References
19 Stifle Ultrasonography
1. The normal stifle joint
2. The abnormal stifle joint
3. Conclusions
4. References
20 Computed Tomography (CT) of the Stifle
1. Introduction
2. Indications for using CT
3. Technical aspects
4. CT features of different stifle conditions
5. Conclusions
6. References
21 Magnetic Resonance Imaging of the Stifle
1. Introduction and image acquisition
2. Synovial structures
3. Meniscus
4. Tendons, ligaments, and muscles
5. Bone
6. Conclusions
7. References
22 Risk Prediction of Cruciate Ligament Rupture using Stifle Diagnostic Imaging
1. Introduction
2. Radiography
3. Magnetic resonance imaging
4. Conclusions
5. References

Section IV Surgical Treatment

Introduction
23 Arthroscopy and Arthrotomy of the Stifle
1. Introduction
2. Stifle arthrotomy
3. Arthroscopy of the stifle
4. Arthroscopic-assisted arthrotomy
5. Stifle joint distraction
6. Patient morbidity
7. References
24 Joint Lavage
1. Introduction
2. Clinical studies
3. Mechanism for relief of joint pain
4. Conclusions
5. References
25 Extracapsular Stabilization
1. Introduction
2. Case selection
3. General surgical approach
4. General care after surgery
5. Biological extracapsular stabilization
6. Extracapsular stabilization with synthetic materials
7. Suture material
8. Isometry
9. Methods of securing the suture to the femur and tibia
10. Methods of securing suture ends
11. Stifle position while securing suture
12. Clinical outcome
13. Conclusions
14. References
26 Intra-Articular Repair for Cranial Cruciate Ligament Rupture in the Dog
1. Introduction
2. Current cruciate ligament rupture surgical treatment outcomes
3. Historical use of intra-articular repairs
4. Graft selection
5. Fixation
6. Biology
7. Future developments
8. Conclusions
9. References
27 Tibial Plateau Leveling Osteotomy
1. Introduction
2. TPLO technique
3. Patient selection
4. TPLO implant selection
5. Complications after TPLO
6. Outcome after TPLO
7. Conclusions
8. References
28 Tibial Tuberosity Advancement
1. Introduction
2. Stifle biomechanics
3. Implants and techniques
4. TTA pre-planning and surgery
5. TTA case selection
6. Outcome and complications with first-generation TTA
7. Outcome and complications with second-generation cage-only TTA
8. Conclusions
9. References
10. Notes
29 Closing Cranial Wedge Ostectomy and Triple Tibial Osteotomy
1. Introduction
2. Technique research
3. Patient selection
4. Implant selection
5. Complications
6. Outcome
7. Conclusions
8. Triple tibial osteotomy
9. Introduction
10. Technique: planning
11. Technique: intraoperative
12. Patient selection
13. Implant selection
14. Complications
15. Outcome
16. References
30 Treatment of Excessive Tibial Plateau Angle
1. Introduction
2. Preoperative planning
3. Surgical technique
4. Notes
5. References
31 Surgical Management of Cruciate Ligament Rupture Combined with Patella Luxation
1. Pathophysiology
2. Patient evaluation
3. Management
4. References
32 Biomechanics of the Cranial Cruciate Ligament-Deficient Stifle Treated by Tibial Osteotomies
1. Introduction
2. Biomechanics of tibial osteotomies
3. References
33 Arthroscopic Follow-Up after Surgical Stabilization of the Stifle
1. Introduction
2. Follow-up arthroscopic examination after TPLO
3. Follow-up arthroscopic examination after extracapsular stabilization
4. Follow-up arthroscopic examination after intra-articular stabilization
5. Conclusions
6. References
34 Cranial Cruciate Ligament Debridement
1. Introduction
2. Ligament debridement for complete CrCL rupture
3. Ligament debridement for partial CrCL rupture
4. References
35 Surgical Treatment of Concurrent Meniscal Injury
1. Introduction
2. Diagnosis
3. Treatment
4. Conclusion
5. References
36 Meniscal Release
1. Introduction
2. Effect of meniscal release on joint biomechanics and biology
3. Surgical technique
4. Clinical decision-making
5. References
37 Progression of Osteoarthritis after Stifle Stabilization Surgery
1. Introduction
2. Use of cranial cruciate ligament transection as a model of osteoarthritis
3. Osteoarthritis precedes stifle instability associated with cruciate ligament rupture
4. Progression of osteoarthritis after stifle stabilization procedures
5. Conclusions
6. References
38 Clinical Outcomes after Surgical Treatment of Cruciate Ligament Rupture
1. Introduction
2. Early postoperative clinical outcomes (<6 months)
3. Mid- and long-term clinical outcomes (>6 months)
4. Factors affecting clinical outcome
5. Conclusions
6. References
39 Success and Failure after Stifle Stabilization Surgery
1. Introduction
2. Balancing success and failure
3. Owner questionnaires
4. Veterinary examination
5. Pedometers and accelerometers
6. Force platform gait analysis
7. Reporting data in a clinically meaningful manner
8. Additional considerations regarding residual lameness
9. Conclusions
10. References
40 Diagnosis and Management of Orthopaedic Infection after Stifle Surgery
1. Introduction
2. Definition
3. Incidence of infection in stifle surgery
4. Pathogens
5. Diagnosis
6. Treatment
7. Prognosis and economic impact
8. Conclusions
9. References

Section V Medical Management of Cruciate Ligament Rupture

Introduction
41 Medical Therapy for Stifle Osteoarthritis
1. Introduction
2. Weight management
3. Nonsteroidal anti-inflammatory drugs
4. Additional analgesics
5. Biological products
6. Chondromodulating agents
7. Dietary supplements
8. Conclusions
9. References
42 Rehabilitation for Dogs with Cruciate Ligament Rupture
1. Introduction
2. The goals of rehabilitation for dogs with cruciate ligament rupture
3. Rehabilitation strategies
4. Scientific evidence for rehabilitation
5. Management protocols
6. Future research
7. References

Section VI Future Directions

Introduction
Reference
43 Clinical Research Design and Patient-Oriented Outcomes
1. Introduction
2. Owner assessments in orthopaedic disease
3. The stepwise development of health measurement instruments
4. Clinical trial design
5. Summary
6. References
44 Total Knee Replacement in the Dog
1. History of total knee replacement in the dog
2. Design rationale for the Biomedtrix TKR implant
3. Case selection: indications and contraindications for surgery
4. Surgical technique
5. Postoperative management
6. Clinical results with cemented canine TKR
7. Potential complications and their management
8. Laboratory testing
9. Summary and conclusions
10. References
45 Regenerative Medicine and Cranial Cruciate Ligament Repair
1. Introduction
2. Current surgical treatments and their comparative effectiveness
3. Why cruciate ligaments do not heal
4. Can arthritic degeneration be stopped?
5. Additional factors affecting CrCL healing
6. Preclinical studies for CrCL repair
7. Summary
8. References
46 Disease-Modifying Medical and Cell-Based Therapy
1. Introduction
2. Synovial inflammation
3. Tetracyclines
4. T-cell inhibitors
5. Nonsteroidal anti-inflammatory drugs
6. Glucocorticoids
7. Mesenchymal stem cells
8. Future directions
9. References

Index

EULA

Dedication