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Prótese sintética intracapsular do ligamento cruzado cranial: estudo retrospectivo
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Orientador(es)
Resumo(s)
A ruptura do ligamento cruzado cranial (RLCC) é a condição ortopédica da articulação do
joelho mais comum, a ser diagnosticada, na espécie canina. A doença do ligamento cruzado
cranial (DLCC), no cão, tem sede num complexo etiológico multifactorial, que requer, para
sua compreensão, um conhecimento dos mecanismos biológicos e biomecânicos da
articulação femoro-tibial.
Apesar da frequência elevada de ocorrência desta condição debilitante, existe um debate e
discussão considerável acerca das opções de tratamento disponíveis actualmente.
A presente dissertação deu ênfase às opções de tratamento que consistem na utilização de
próteses sintéticas, para a correcção da instabilidade articular que se verifica
secundariamente à ruptura do ligamento cruzado cranial (LCC).
O objectivo principal do estudo aqui apresentado centra-se na comparação de técnicas
cirúrgicas intracapsulares. Foram comparados dois grupos de cães, com RLCC, nos quais
foram executadas técnicas diferentes. O grupo 1 (n=16) foi submetido a técnica
intracapsular over-the-top, enquanto no grupo 2 (n=9) foi utilizada uma âncora intracapsular
com 2 suturas grossas de poliéster que vieram reproduzir o LCC no interior da articulação.
Foi acompanhado o resultado pós-cirúrgico, a curto-médio prazo, de todos os doentes
presentes no estudo e aferida a condição actual, dos indíviduos do grupo 2, por entrevista
telefónica aos proprietários. Os resultados sugeriram que as técnicas estudadas apresentam
similaridade na eficácia do tratamento, tendo todos os doentes melhorado da apresentação
clínica referente ao período da lesão.
Devido ao facto de não existir, até à data, um método capaz de travar as alterações
degenerativas consequentes à ruptura do ligamento, nomeadamente a osteoartrite (OA),
outras prioridades de tratamento podem ser consideradas. Foi por este último factor,
intenção adicional deste trabalho averiguar a possibilidade de execução da técnica de
ancoragem por artroscopia numa fase posterior. A vertente da técnica por via artroscópica
aparentou ser sustentável após os resultados do estudo.
ABSTRACT - Cranial cruciate ligament rupture (CCLR) is the most commonly diagnosed orthopaedic condition of the stifle in dogs. The cranial cruciate ligament disease is a multifactorial complex problem, which requires a thorough understanding of the biological and biomechanical mechanisms of the femoro-tibial articulation. Despite the high frequency of occurrence of this debilitating condition, there is considerable debate and discussion about the treatment options available today. This work emphasized the options of treatment involving the use of synthetic prostheses, for the correction of joint instability that occurs secondary to cranial cruciate ligament rupture (CCL). The main objective of the study presented here focuses on the comparison of intracapsular surgical techniques. Two groups of dogs with CCLR were compared, where different techniques were performed. Group 1 (n=16) underwent intracapsular technique over-the-top, while in group 2 (n=9) an intracapsular anchor with two sutures of thick polyester was implanted in order to reproduce the function of CCL. The outcome after surgery was followed by short term evaluation for all patients in the present study and the current condition regarding the individuals belonging to the group 2 was acessed by telephone survey. The results suggested that the techniques studied showed similarity in treatment efficacy, while all patients improved the clinical presentation for the period of injury. Due to the fact that to date there is not a single surgical procedure capable of stopping the degenerative changes consequent to rupture of the ligament, including osteoarthritis (OA), other treatment priorities can be considered. It was for this latter factor, additional intent of this study to investigate the possibility of performing the anchoring technique by arthroscopy at a later stage. The aspect of an arthroscopic technique appeared to be sustainable after the study results.
ABSTRACT - Cranial cruciate ligament rupture (CCLR) is the most commonly diagnosed orthopaedic condition of the stifle in dogs. The cranial cruciate ligament disease is a multifactorial complex problem, which requires a thorough understanding of the biological and biomechanical mechanisms of the femoro-tibial articulation. Despite the high frequency of occurrence of this debilitating condition, there is considerable debate and discussion about the treatment options available today. This work emphasized the options of treatment involving the use of synthetic prostheses, for the correction of joint instability that occurs secondary to cranial cruciate ligament rupture (CCL). The main objective of the study presented here focuses on the comparison of intracapsular surgical techniques. Two groups of dogs with CCLR were compared, where different techniques were performed. Group 1 (n=16) underwent intracapsular technique over-the-top, while in group 2 (n=9) an intracapsular anchor with two sutures of thick polyester was implanted in order to reproduce the function of CCL. The outcome after surgery was followed by short term evaluation for all patients in the present study and the current condition regarding the individuals belonging to the group 2 was acessed by telephone survey. The results suggested that the techniques studied showed similarity in treatment efficacy, while all patients improved the clinical presentation for the period of injury. Due to the fact that to date there is not a single surgical procedure capable of stopping the degenerative changes consequent to rupture of the ligament, including osteoarthritis (OA), other treatment priorities can be considered. It was for this latter factor, additional intent of this study to investigate the possibility of performing the anchoring technique by arthroscopy at a later stage. The aspect of an arthroscopic technique appeared to be sustainable after the study results.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Canídeo Ruptura ligamento cruzado cranial Próteses sintéticas Técnica over-the-top Âncora intracapsular Artroscopia Dog Cranial cruciate ligament rupture Synthetic prostheses Over-the-top technique Intracapsular anchor Arthroscopy
Contexto Educativo
Citação
Cabral, C.R.S.M. (2010). Prótese sintética intracapsular do ligamento cruzado cranial: estudo retrospectivo. Dissertação de Mestrado. Universidade Técnica de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária