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Doctoral Thesis
DOI
10.11606/T.10.2013.tde-02122013-144936
Document
Author
Full name
Daniela Fabiana Izquierdo Caquías
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2013
Supervisor
Committee
Ferrigno, Cassio Ricardo Auada (President)
Alievi, Marcelo Meller
Cunha, Olicies da
Hernandez, Arnaldo Jose
Zoppa, André Luis do Valle de
Title in Portuguese
Estudo biomecânico ex vivo da tensão do ligamento patelar à flexão do joelho com as técnicas de avanço da tuberosidade tibial (TTA) e osteotomia niveladora do platô tibial (TPLO), comparadas com tíbias não osteotomizadas
Keywords in Portuguese
Avanço da tuberosidade tibial
Biomecânica
Ligamento patelar
Osteotomia niveladora do platô tibial
Abstract in Portuguese
O reparo do ligamento cruzado cranial (LCCr) tem sido motivo de preocupação e pesquisas para desenvolver técnica cirúrgica efetiva. Recentemente novas técnicas tem se proposto a reestabelecer a biomecânica e função do joelho, chamadas de técnicas dinâmicas, entre elas Tibial Plateau Leveling Osteotomy (TPLO) e Tibial Tuberosity Advancement (TTA). Embora efetivas, várias são as complicações relatadas, e uma delas é o espessamento e desmite patelar, mais frequente com a técnica de TPLO, mas recentemente também relatada para a técnica de TTA. Vários foram os mecanismos propostos para explicar este fenômeno, embora a causa continue desconhecida. Baseado nisso é que a nossa pesquisa teve como objetivo avaliar de forma biomecânica ex vivo, as mudanças na tensão do ligamento patelar submetido às técnicas de TPLO e TTA, quando comparadas entre elas e com membros pélvicos sem osteotomia (íntegro e RLCCr). Foram testados de forma biomecânica ex vivo dez pares de membros pélvicos de cães entre dois a sete anos de idade e pesos entre 25 a 35 kg, sem predileção de raça ou sexo. As peças foram submetidas à carga de 30% do peso corporal, e testadas em três situações diferentes: a primeira com a articulação fêmoro-tíbio-patelar íntegra, numa segunda etapa com RLCCr, e por último com as técnicas de osteotomia, respeitando a regra, membros pélvicos direitos com TTA e membros pélvicos esquerdos com TPLO, e cada uma delas foi testada em duas situações de ângulos, a primeira 145 graus na articulação fêmoro-tíbio-patelar e 135 graus na articulação tíbio-társica e uma segunda situação invertendo os valores. Os dados foram submetidos a testes pareados não paramétricos de Friedman e Wilcoxon. Em quanto a força do ligamento patelar os resultados permitiram concluir que não existe diferença significativa entre o grupo íntegro e RLCCr, que existe diferença entre as técnicas de TTA e TPLO, quando comparadas com a situação íntegro e RLCCr e que existe diferença de força do ligamento patelar entre TPLO 145 versus TPLO 135 e entre TTA 145 versus TTA 135.
Title in English
Ex vivo biomechanical evaluation of the tension of the patellar ligament to stifle flexion after tibial tuberosity advancement (TTA) and tibial plateau leveling osteotomy (TPLO), compared with tibia not osteotomized
Keywords in English
Biomechanics
Patelar ligament
Tibial plateau leveling osteotomy
Tibial tuberosity advancement
Abstract in English
Cranial cruciate ligament repair (RLCCr) has been the focus of research to develop an effective surgical technique. Currently new dynamic techniques such as Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) have been proposed to restore the biomechanical knee function. Several complications have been reported despite of technique effectiveness. Patellar ligament inflammation and desmitis are usually reported as complication for TPLO but it was also reported for TTA. Several mechanisms have been proposed to explain this phenomenon but the cause remains unknown. Based on this complication, our objective was to evaluate the patellar ligament tension changes in the TPLO and TTA using an ex vivo model comparing both techniques one each other and with normal hind limbs. The sample population was ten pairs of cadaveric hind limb from dogs weighing 25 to 35 kg and with two to seven years of age without any predilection for breed or sex. The pieces were axially loaded using a material testing machine with 30% body weight in three different situations. The first test was performed with the CCL intact followed by the second test with the LCC transection and finally with osteotomy techniques for the third test. TPLO and TTA were always performed in the left and right hind limb respectively. The tests were conducted in two variations of angles joints. The first variation maintained a stifle angle of 145 degrees with the tibio-tarsal angle of 135 degrees and the second variation had inverted the values between these joints. Data were analyzed using Friedman and Wilcoxon test with repeated measures. In much the strength of the patellar ligament the results showed that there is no significant difference between the group intact and RLCCr that exists between the different techniques TTA and TPLO, when compared with the situation of integrity and RLCCr and strength that exists apart from the ligament TPLO patellar between 135 and 145 versus TPLO between TTA 145 versus 135.
 
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Publishing Date
2014-02-19
 
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  • SANTOS, JAQUELINE FRANÇA DOS, et al. Fratura proximal de tíbia após cirurgia extracapsular para correção de ruptura de ligamento cruzado cranial em cão [doi:10.1590/S0103-84782013005000001]. Ciência Rural (UFSM. Impresso) [online], 2013, vol. 43, p. CR-6130.
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