Ex Vivo Biomechanical Evaluation of the Canine Cranial Cruciate Ligament‐Deficient Stifle with Varying Angles of Stifle Joint Flexion and Axial loads after Tibial Tuberosity Advancement

OBJECTIVE: To evaluate the effect of tibial tuberosity advancement (TTA) on cranial tibial thrust (CrTT), retropatellar force (RPF), patellar tendon load (PTL), and patellar tendon angle determined by the tibial plateau angle (PTA(TPA) ) method or common tangent (PTA(CT) ) method in the canine cranial cruciate ligament (CrCL)-deficient stifle joint. STUDY DESIGN: Ex vivo cadaver study. SAMPLE POPULATION: Cadaveric canine hind limbs (n=30). METHODS: Stifle joints were subjected to 3 differing loading conditions using a constrained limb press model (Group 1: 30% body weight axial load at stifle and talocrural joint angles of 135 ± 5° and 145 ± 5°, respectively; Group 2: 30% body weight axial load at stifle and talocrural angles of 145 ± 5° and 135 ± 5°, respectively; and Group 3: 50% body weight axial load at stifle and talocrural joint angles of 135 ± 5° and 145 ± 5°, respectively). The CrCL was transected in situ under load; sensors allowed direct measurement of CrTT, RPF, and PTL. Lateral radiographic projections were used to assess PTA(TPA) and PTA(CT) . Descriptive statistics were used to report CrTT (by design this force returned to 0-point values, defined as the neutral point of advancement [NPA]). At the NPA, RPF was compared with baseline using a 2-tailed sign test. PTL within groups were compared using a paired t-test; pair-wise comparisons of PTA(TPA) and PTA(CT) were performed using a paired t-test. Comparisons between loading conditions were made with a 1-way ANOVA and Tukey's post hoc test. Equivalence tests were used to test mean PTA(TPA) and PTA(CT) for equivalence to 90°. Significance was set at a P-value of .05. RESULTS: CrTT returned to baseline values, and RPF and PTL at NPA were reduced below baseline values in all specimens in a near linear fashion with TTA. At the NPA, PTA(TPA) >PTA(CT) in 2 of the 3 loading conditions, but insufficient evidence to suggest they differed in the third. Mean PTA(TPA) and PTA(CT) varied between loading conditions. The threshold for each of the groups evaluated, at which the PTA could be significantly different from 90°, was larger for PTA(TPA) than PTA(CT) in all groups, as greater variation was observed with PTA(TPA) versus PTA(CT) . CONCLUSION: This study further supports the claim that reduction of CrTT occurs after TTA in the CrCL-deficient stifle joint through an alteration of PTA. Additionally, RPF and PTL also decrease after TTA. The PTA(CT) may be a more precise method of determining PTA.