ABSTRACT
Cranial cruciate ligament is the main responsible for knee stability by preventing cranial tibial displacement regarding the femur. Deficiency in this ligament (CCLD) may cause subluxation of the tibia and dysfunction of the pelvic member due to overloading. Tibial osteotomies are among the more current surgical techniques for treating CCLD in dogs and they proportionate the dynamic stability by means of modifying bone geometry and the distribution of forces acting on the articulation. The objective of this work is to describe the use of the allogeneic cortical bone graft conserved in glycerin as a spacer on the tibial tuberosity advancement (TTA) for treating the CCLD. In order to do that, 34 dogs submitted to TTA surgery correction were evaluated, being 23 males (67.35%) and 11 females (32.35%). Surgical procedures happened from May 2011 to October 2015. Regarding the surgical procedure after osteotomy of the tibial tuberosity, a disk of allogeneic cortical disk, sawn wedge-hapsed, conserved in glycerin, proportions of 2x1mm was applied as spacer, enabling TTA. Advancements from 3 to 12 mm were executed, depending on the need of the patient. For animals with patella dislocation, trochleoplasty and TTA were executed in order to correct the deviation. The mean ± SD age of animals was 6.67±3.58 and weight was 15.16±12.97 kg. Mongrel dogs, Poodles and Yorkshire terriers were the most affected ones. From the 36 evaluated knees, 11 (30.56%) were associated with some traumatic process and in 25 (69.44%) there was no relation with previous trauma. From those wounds, 20 (55.56%) happened in the right limb and 16 (44.44%) in the left limb and two animals had CCLD bilaterally. Animals had continuous support, discreet drawer movement and negative tibial compression 15 days after surgery. At 30 days, 26 cases (72.22%) had firm support (FS); at 45 days, 24 cases (66 test at 7 and 67%) had FS and eight cases (22.22%) without claudication (WC). During subsequent radiographic evaluations the progressive incorporation of the graft and osteotomy union were observed. In this study, most of the diagnosed CCLD occurred in males diverging from results obtained by other authors that found greater frequency in females. Support without claudication it was observed in most of the cases of implants at 60 days. We concluded that the conserved allogeneic cortical bone graft was able to promote bone union in TTA of dogs with CCLD. None of the animals had signs of contamination, infection of the surgical wound or rejection related with the presence of the graft, demonstrated by the complete graft-bone incorporation observed early at 45 days in some animals. The glycerin was a good conservation medium for those fragments intended for grafting because, besides being of low cost, it kept bone fragments free of contamination, reducing antigenicity and preserving the functions of osteoinduction and osteoconduction. The possibility of molding the graft to the animal need is a characteristic favorable to executing the modified technique that could be molded according to the size of the animal, allowing perfect adaptation to the osteotomized local in different breeds. Intercurrences commonly observed in TTA with patellar dislocation, meniscal lesions, tibial crest fracture and displacement were not found in the animals of this study, probably due to the better distribution of forces between the pass screw in TT and the TTA plate confirming that it has good adaptation to the technique conferring to the modified TTA advantages regarding the conventional TTA.(AU)
O ligamento cruzado cranial é o principal responsável pela estabilidade do joelho, impedindo o deslocamento da tíbia cranial em relação ao fêmur. A deficiência neste ligamento (CCLD) pode causar subluxação da tíbia e disfunção do membro pélvico devido à sobrecarga. As osteotomias tibiais estão entre as técnicas cirúrgicas mais atuais para o tratamento de CCLD em cães e proporcionam a estabilidade dinâmica por meio da modificação da geometria óssea da distribuição das forças que atuam sobre a articulação. O objetivo desse estudo é descrever o uso do enxerto ósseo cortical alogênico conservado em glicerina como espaçador no avanço da tuberosidade tibial (TTA) para o tratamento do CCLD. Para isso, 34 cães submetidos à cirurgia de TTA foram avaliados, sendo 23 machos (67,35%) e 11 fêmeas (32,35%). Os procedimentos curúrgicos aconteceram entre maio de 2011 e outubro de 2015. Com relação ao procedimento cirúrgico após a osteotomia da tuberosidade tibial, um disco alogênico cortical, em forma de cunha serrada, conservado em glicerina com proporções de 2 x 1mm foi aplicado como espaçador possibilitando a TTA. Avanços de 3 a 12mm foram executados, dependendo da necessidade do paciente. Para animais com luxação da patela, realizou-se a trocleoplastia e a TTA para a correção do desvio. A idade média dos animais foi de 6,67±3,58 anos e pesos médios de 15,16±12,97kg. Cães sem raça definida, Poodles e Yorkshire Terriers foram os mais afetados. Dos 36 joelhos avaliados, 11 (30,56%) foram associados a algum processo traumático e em 25 (69,44%) não havia nenhuma relação com um trauma prévio. Dos ferimentos, 20 (55,56%) aconteceram no membro direito e 16 (44,44%) no esquerdo, sendo que dois animais apresentavam CCLD bilateralmente. Os animais tiveram suporte contínuo, discreto movimento de gaveta e compressão tibial negativa 15 dias após a cirurgia. Aos 30 dias, 26 casos tinham suporte firme (FS); aos 45 dias, 24 casos tinham FS e oito casos sem claudicação (WC). Durante avaliações radiográficas subsequentes, observou-se a incorporação progressiva da união do enxerto e da osteotomia. Neste estudo, a maior parte do CCLD diagnosticado ocorreu em machos, divergindo dos resultados obtidos por outros autores que encontraram maior frequência em fêmeas. Suporte sem claudicação foi observado na maioria dos casos de implantes aos 60 dias. Foi concluído que o enxerto ósseo cortical alogênico conservado foi capaz de promover a união óssea na TTA de cães com CCLD. Nenhum dos animais apresentou sinais de contaminação, infecção da ferida cirúrgica ou rejeição relacionada à presença do enxerto, demonstrada pela incorporação completa do enxerto ósseo observada precocemente aos 45 dias em alguns animais. A glicerina foi um bom meio de conservação para os fragmentos destinados à enxertia porque, além do menor custo, manteve os fragmentos ósseos livres de contaminação, reduzindo a antigenicidade e preservando as funções de osteoindução e osteocondução. A possibilidade de moldagem do enxerto à necessidade do animal é uma característica favorável à execução da técnica modificada que pode ser moldada de acordo com o tamanho do animal, possibilitando perfeita adaptação ao local osteotomizado em diferentes raças. Intercorrências comumente observadas na TTA com luxação patelar, lesões meniscais, fratura da crista tibial e deslocamento não foram encontradas nos animais deste estudo, provavelmente devido à melhor distribuição de forças entre a passagem do parafuso no TT e a placa do TTA, confirmando que tem boa adaptação à técnica conferindo às vantagens da TTA modificada em relação à TTA convencional.(AU)
Subject(s)
Animals , Dogs , Stifle/surgery , Stifle/physiopathology , Stifle/injuries , Bone Transplantation/methods , Bone Transplantation/veterinary , Glycerol/pharmacologyABSTRACT
Objective To study the prognosis of the implanted xenogenic and allogenic menisci, and the implanted menisci's protection effects on articular cartilage. Methods 30 adult New Zealand white rabbits were divided equally into two groups and the medial meniscus defection models were established by medial meniscectomy. Allogenic medial menisci implantation were done in group A. Small pieces of menisci tissue were taken from pig meniscus and moulded them as the same shape and size as rabbit's medial menisci,then, xenogenic menisci implantation were done in group B with these moulded grafts. 6, 12 and 24 weeks after the operations, rabbits were sacrificed to observe the implanted menisci and the articular cartilage on medial tibial plateau, medial femoral condylus and femoral trochlea with naked eye and histological method. Results After allogenic meniscus transplantation, the state of implanted meniscus was good, and healed well around the capsula. 24 weeks post allogenic meniscus transplantation, the injury of the articular cartilage was not in evidence. In short time post xenogenic meniscus transplantation, the state of meniscus and cartilage was good and after 24 weeks the xenogenic meniscus was dissolved and absorbed, the articular cartilage also showed degeneration and injury. Conclusion With xenogenic meniscus moulded from pig meniscus tissue,the implanted meniscus was resolved and absorbed and the cartilage degeneration also appeared after half a year. Post allogenic meniscus transplantation, the meniscus structure and function were reconstructed well and the articular cartilage was also well protected.
ABSTRACT
Objective To study the type Ⅰ,Ⅱ,Ⅲ and Ⅹcollag e n expression in meniscus and articular cartilage and immunoreactions post xenoge nic and allogenic meniscus transplantation. Methods After men iscectomy,30 adult New Zealand white rabbits were divded into two groups:group A undertook allogenic medial meniscus transplantation and group B undertook xenog enic meniscus transplantation with fitted meniscus tissues harvested from swine. 6, 12 and 24 weeks post transplantation, the histological and immunohistochemical analysis of type Ⅰ ,Ⅱ,Ⅲ and Ⅹ collagens monoclonal antibody were investigated in menisci and a rticular cartilage. Peripheral blood were obtained for immunoreactions study thr o ugh the methods of CDMT (Complement Dependent Microlymphocytotoxicity Test) and RIA (Radioimmunoassay)of IL-2 and IL-6. Results The meniscu s and articular cartilage were good post allogenic meniscus transplantation, but the transplanted xenogenic meniscus appeared to be dissolved and absorbed and c art ilage lesions were observed in 24 week post operation. No significant difference was found between two groups in type Ⅰ,Ⅱ and Ⅲ collagen expression during e xperiment. From 1～12 weeks, no significant diffe rence was found among type Ⅰ,Ⅱ and Ⅲ collagen expression in articular cartil age in two groups. However,24 weeks post operation, type Ⅹ collagen's expressio n in cartilage was abnormally increased. Neither allogenic nor xenogenic meniscu s transplantation caused fatal immunoreaction during the whole experiment. Con clusion The transplantation meniscus began to be dissolved and absorbed after half a year, but allogenic meniscus transplantation achieved good results . Type Ⅰ,Ⅱ and Ⅲ collagen expression in transplanted meniscus and articular cartilage showed no difference between two groups, but the expression of type Ⅹ collagen was abnormally increased in xenogenic group 24 weeks post operation. No fatal immunoreaction was found in both groups.