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Comparação entre técnicas cirúrgicas para a correcção da ruptura do ligamento cruzado cranial em canídeos
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Resumo(s)
O objectivo do presente trabalho centra-se na comparação entre técnicas cirúrgicas para a
resolução da ruptura do ligamento cruzado cranial em canídeos. Foi baseado numa pesquisa
bibliográfica e num estudo estatístico retrospectivo de 11 casos intervencionados no Hospital
Escolar, seguidos durante o estágio curricular. Nesse estudo foram incluídos três grupos de
técnicas: tibial tuberosity advancement (TTA), técnicas extra-capsulares e técnicas intracapsulares.
As técnicas intra-capsulares visam essencialmente substituir o ligamento
rupturado, através do uso de enxertos que vão ficar localizados numa posição semelhante à
posição anatómica do ligamento cruzado cranial (LCCr). As técnicas extra-capsulares, por
outro lado, diminuem temporariamente a laxitude articular, pelo que em última instância a
estabilização definitiva do joelho é alcançada pela exacerbação da fibrose peri-articular. O
mecanismo de acção deste tipo de técnicas é portanto fornecer uma restrição passiva aos
movimentos do joelho. Outro grupo de técnicas atinge a estabilidade articular por meio da
alteração da geometria óssea, e portanto da biomecânica do joelho, de modo a que as
restrições passivas deixem de ser necessárias. Estas técnicas são as osteotomias tibiais, e o
tipo de estabilidade que providenciam designa-se por estabilidade dinâmica. Existem dois
modelos biomecânicos da articulação femoro-tibio-patelar mais aceites, nos quais se baseiam
estas técnicas. Essencialmente vai-se atingir a estabilidade dinâmica pelo nivelamento do
ângulo de inclinação do plateau tibial, ou pela alteração do alinhamento do tendão patelar, ou
ainda pelos dois em simultâneo. Actualmente nenhuma técnica se destaca de todas as outras
como a mais vantajosa. Apesar disso, verifica-se uma crescente aposta nas osteotomias tibiais,
por resultarem de um conhecimento mais aprofundado da biomecânica do joelho, e por
aparentemente diminuírem o tempo de recuperação, a progressão da doença degenerativa
articular (DDA), e resultarem numa função final do membro afectado mais satisfatória.
Contudo, estas vantagens reportadas até à data baseiam-se em impressões clínicas subjectivas
dos autores, não havendo estudos objectivos com reavaliações a longo prazo que as suportem.
ABSTRACT - Comparison of surgical techniques for Cranial Cruciate Ligament Rupture management in dogs -- This thesis’ objective was to evaluate the differences between several techniques used to repair cranial cruciate ligament rupture in the dog. It was based on a literature review and a retrospective study including 11 surgical cases from the Teaching Hospital, followed during the curricular training in this institution. Three groups of techniques were represented in this study: intra-capsular techniques, extra-capsular techniques and tibial tuberosity advancement (TTA). Intra-capsular techniques aim to substitute the ruptured ligament by implanting a graft in a similar position of the cranial cruciate ligament’s original anatomical position. On the other hand, the extra-capsular techniques use extra-articular implants to achieve a temporary stabilization, which will prevent meniscal damage, as the peri-articular fibrosis responsible for the permanent stability develops. The stability provided by these traditional techniques is based on a passive restraint to the stifle’s movements. Another type of joint stability can be achieved by bone geometry and stifle’s biomechanics alteration. This dynamic stability, where passive restraints are no longer required, is the aim of the tibial osteotomy techniques, such as TPLO and TTA, which are based in two different biomechanical models of the stifle joint. These techniques aim either to level the tibial plateau slope angle, or to alter the alignment of the patelar tendon, or simultaneously both (TTO). Because the development of the tibial osteotomy techniques result from a deeper knowledge of stifle’s biomechanics, there has been an increased popularity of these procedures in the past years, over the traditional ones, supported by a subjective clinical impression of shorter recovery time, slower progression of degenerative joint disease (DJD), and better function of the affected limb. Currently available data remains insufficient to support these advantages, and to date no procedure has proven to be superior. Carefully designed long-term objective studies and further biomechanical studies are required to determine the optimal cranial cruciate ligament repair technique.
ABSTRACT - Comparison of surgical techniques for Cranial Cruciate Ligament Rupture management in dogs -- This thesis’ objective was to evaluate the differences between several techniques used to repair cranial cruciate ligament rupture in the dog. It was based on a literature review and a retrospective study including 11 surgical cases from the Teaching Hospital, followed during the curricular training in this institution. Three groups of techniques were represented in this study: intra-capsular techniques, extra-capsular techniques and tibial tuberosity advancement (TTA). Intra-capsular techniques aim to substitute the ruptured ligament by implanting a graft in a similar position of the cranial cruciate ligament’s original anatomical position. On the other hand, the extra-capsular techniques use extra-articular implants to achieve a temporary stabilization, which will prevent meniscal damage, as the peri-articular fibrosis responsible for the permanent stability develops. The stability provided by these traditional techniques is based on a passive restraint to the stifle’s movements. Another type of joint stability can be achieved by bone geometry and stifle’s biomechanics alteration. This dynamic stability, where passive restraints are no longer required, is the aim of the tibial osteotomy techniques, such as TPLO and TTA, which are based in two different biomechanical models of the stifle joint. These techniques aim either to level the tibial plateau slope angle, or to alter the alignment of the patelar tendon, or simultaneously both (TTO). Because the development of the tibial osteotomy techniques result from a deeper knowledge of stifle’s biomechanics, there has been an increased popularity of these procedures in the past years, over the traditional ones, supported by a subjective clinical impression of shorter recovery time, slower progression of degenerative joint disease (DJD), and better function of the affected limb. Currently available data remains insufficient to support these advantages, and to date no procedure has proven to be superior. Carefully designed long-term objective studies and further biomechanical studies are required to determine the optimal cranial cruciate ligament repair technique.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Ruptura ligamento cruzado cranial LCCr Canídeo Cirurgia Tibial tuberosity advancement Técnica extra-capsular Técnica intra-capsular Estabilidade dinâmica DDA Cranial cruciate ligament rupture CrCLR Dog Surgery Tibial tuberosity advancement Extracapsular technique Intra-capsular technique Dynamic stability DJD
Contexto Educativo
Citação
Iglésias, L.V. (2009). Comparação entre técnicas cirúrgicas para a correcção da ruptura do ligamento cruzado cranial em canídeos. Dissertação de Mestrado, Universidade Técnica de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária