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

Authors

  • Tomás G. Guerrero Dr. Med Vet, Diplomate ECVS,

    Corresponding author
    • Clinic for Small Animal Surgery, Vetsuisse-Faculty University of Zurich, Zurich, Switzerland
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    • Contributed equally.

  • Antonio Pozzi DMV, MS, Diplomate ACVS,

    1. Department of Small Animal Clinical Sciences and the Collaborative Orthopaedic Biomechanical Laboratory, University of Florida, Gainesville, FL
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    • Contributed equally.

  • Nicholas Dunbar BS,

    1. Department of Mechanical and Aerospace Engineering and the Collaborative Orthopaedic Biomechanical Laboratory, University of Florida, Gainesville, FL
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  • Nicolas Kipfer Dr. Med Vet,

    1. Clinic for Small Animal Surgery, Vetsuisse-Faculty University of Zurich, Zurich, Switzerland
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  • Michael Haessig Dr. Med Vet, Diplomate ECVPH & ECBHM,

    1. Department of Herd Health Management, Vetsuisse-Faculty University of Zurich, Zurich, Switzerland
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  • Mary Beth Horodyski ATC,

    1. Department of Orthopedics and Rehabilitation and the Collaborative Orthopaedic Biomechanical Laboratory, University of Florida, Gainesville, FL
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  • Pierre M. Montavon Dr. Med Vet

    1. Clinic for Small Animal Surgery, Vetsuisse-Faculty University of Zurich, Zurich, Switzerland
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  • Presented at the 37th Annual Conference Veterinary Orthopedic Society, Breckenrigde, CO, 2010, February 20–27, 2010 and at the 19th ECVS Annual Scientific Meeting. Helsinki, Finland, July 1–3, 2010.

  • This work was performed at the Vetsuisse-Faculty University of Zurich, and at the University of Florida Comparative Orthopaedics and Biomechanics Laboratory.

Corresponding Author

Dr. Tomás G. Guerrero, Dr. Med Vet, Diplomate ECVS, Small Animal Medicine & Surgery Academic Program, St. George's University, School of Veterinary Medicine, True Blue, Grenada, West Indies

E-mail: tguerrero@sgu.edu

Abstract

Objective

To evaluate the effect of tibial tuberosity advancement (TTA) on patellofemoral (PF) contact mechanics, and alignment of the PF and femorotibial (FT) joints in cranial cruciate ligament (CrCL)-deficient stifles of dogs.

Study Design

Ex vivo biomechanical study.

Animals

Unpaired cadaveric hind limbs (n=9).

Methods

Digital pressure sensors placed in the PF joint were used to measure contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. The FT and PF poses were obtained using a 2-dimensional computer digitization technique. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Data was normalized and analyzed, after testing for normality by Wilk–Shapiro, using 1 sample T-test, paired T-test, and ANOVA; P≤.05 was considered significant. Bonferroni's correction was used when needed.

Results

A significant cranioproximal tibial displacement and increase in patellar tilt were found in the CrCL-deficient joints. Both FT and PF alignments were restored after TTA. Contact areas and peak pressure did not vary between conditions. Peak pressure location displaced proximally from intact to CrCL-deficient condition and returned to normal after TTA. Total force measured in the CrCL-deficient stifle and TTA conditions were significantly lower than in the control.

Conclusion

TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%.

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