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- Title
Epifisiodese tibial proximal em cão imaturo com ruptura de ligamento cruzado cranial.
- Authors
Casagrande, André Jayr; Callado de Oliveira, Débora Maria Marques; Schmaedecke, Alexandre
- Abstract
Background: Cranial cruciate ligament (CCL) rupture is one of the most common causes of lameness in dogs. It is usually reported to be of traumatic origin in juvenile dogs, associated with hyperextension and excessive internal rotation of the knee joint. Treatment of immature dogs poses a therapeutic dilemma, because various stabilization techniques could prove inadequate for growing animals. Proximal tibial epiphysiodesis has been proposed for the correction of CCL rupture in immature dogs and involves reducing the tibial plateau angle via partial fusion of the proximal tibia. This report aimed to describe the successful treatment of a juvenile dog with CCL rupture using proximal tibial epiphysiodesis. Case: A 5-month-old dog of the American Staffordshire breed presented with a history of claudication in the left pelvic limb since a week after trauma. During physical examination, the dog exhibited a non-weight-bearing lameness and pain on hyperextension of the knee joint; there were no signs of joint effusion. The drawer and cranial tibial thrust tests were positive only with the knee flex, which was confirmed under sedation. The radiograph showed no change in the affected joint and the tibial plateau angle (TPA) was 22°. The patient was suggested exploratory arthrotomy. Proximal tibial epiphysiodesis was performed on confirming partial rupture of the CCL. A 3.5 × 30-mm cortical screw was inserted into the proximal-most portion of the tibial plateau in the mediolateral plane, in the direction of the tibial axis. An immediate postoperative-radiograph confirmed the correct position of the implant. The patient underwent monthly follow-ups and re-examinations. Thirty days after the surgical procedure, the TPA reduced to 13° and the lameness was less severe. However, the dog was still sensitive to palpation of the joint. Sixty days postoperatively, orthopedic examination did not reveal any claudication or painful joint movement. The radiograph revealed a reduction in the TPA to 6° and closure of the tibial epiphyseal growth plate. One year after surgical intervention, the patient showed normal locomotion with no complications. Discussion: Proximal tibial epiphysiodesis has been suggested as a therapy for immature dogs with CCL injury. In a study conducted by Vezonni et al., 14 juvenile patients with CCL rupture were assessed; 22 knees were operated using proximal tibial epiphysiodesis. During assessment, 1 year after the surgical procedure, all patients regained normal gait. Reduction in TPA suggests that fusion of the central proximal tibial epiphysis by proximal tibial epiphysiodesis blocks central while allowing continuous growth of the caudal region of the tibial plateau. Thus, the TPA is reduced when the dog attains maturity. This technique is minimally invasive and confirming the correct insertion of the screw by radiography or fluoroscopy avoids complications. If the desired final TPA is not achieved, additional corrective osteotomy techniques may be performed. In very young dogs, it is necessary to remove the screw to avoid excessive correction of the tibial plateau rotation, which could increase the burden on the caudal cruciate ligament. It has been shown that partial epiphysiodesis performed on immature dogs with partial CCL rupture avoided ligament damage and required further invasive surgical interventions. Proximal tibial epiphysiodesis can be used for TPA reduction during the growing-phase; thus, stabilizing the joint with partial CCL rupture and reestablishing limb function.
- Publication
Acta Scientiae Veterinariae, 2015, Vol 43, p1
- ISSN
1678-0345
- Publication type
Article