Next Article in Journal
The Pivotal Role of Stem Cells in Veterinary Regenerative Medicine and Tissue Engineering
Next Article in Special Issue
Lateral Approach and Plate Rod Sliding Humeral Osteotomy in Dogs—A Short Case Series
Previous Article in Journal
Impact of Water Sources and Shared Fence Lines on Bovine Respiratory Disease Incidence in the First 45 Days on Feed
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Communication

Determination of the Stifle Angle at Standing Position in Dogs

Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
*
Author to whom correspondence should be addressed.
Vet. Sci. 2022, 9(11), 644; https://doi.org/10.3390/vetsci9110644
Submission received: 12 October 2022 / Revised: 17 November 2022 / Accepted: 19 November 2022 / Published: 21 November 2022
(This article belongs to the Special Issue Joint Disease in Companion Animals)

Abstract

:

Simple Summary

The cranial cruciate ligament rupture is one of the most common orthopaedic diseases encountered in dogs. Surgical techniques have been developed to stabilize the stifle, with an overall accepted benefit of tibial osteotomies, among which is the tibial tuberosity advancement. Prior to surgery, the required tibial tuberosity advancement must be determined on a strict lateral radiographical view of the affected stifle with femur and tibia at an angle of 135° as initially recommended. We sought to determine if this particular stifle angle around mid-stance phase was similar among multiple dog breeds. A mean value of stifle angle of 145° was obtained. Mean stifle angle at mid-stance phase in a healthy dog is regularly higher than 135° and is likely breed and individual dependent. The pre-operative measurement of the required advancement made on stifles in 145° extension, a value close to full physiological extension, could contribute to decreasing the incidence of late post-operative meniscal lesion, consecutive to the underestimation of the tibial tuberosity advancement.

Abstract

Background: The cranial cruciate ligament rupture is one of the most common orthopaedic diseases encountered in dogs. Surgical techniques have been developed to stabilize the stifle, with an overall accepted benefit of tibial osteotomies among which is the tibial tuberosity advancement (TTA). Prior to surgery, the required TTA must be determined on a strict lateral radiographical view of the affected stifle with femur and tibia at an angle of 135° as initially recommended. This value, initially determined in only two dog breeds, has been considered the mean standard value of the canine stifle angle during the mid-stance phase. Methods: We sought to determine if this particular stifle angle around mid-stance phase was similar among multiple dog breeds. We built up a custom-made radiographic system for stifle angle measurement in standing dogs. Results: A mean value of stifle angle of 145° was obtained. Mean stifle angle at mid-stance phase in a healthy dog is regularly higher than 135° and is likely breed and individual dependent. Conclusions: The pre-operative measurement of the required TTA made on stifles in 145° extension, a value close to full physiological extension could contribute to decreasing the incidence of late post-operative meniscal lesion, consecutive to underestimation of TTA.

1. Introduction

Cranial cruciate ligament rupture (CCLR) is one of the most common orthopaedic diseases affecting the pelvic limbs in dogs [1,2]. While the definitive causes are still under debate, it is accepted that this affliction is predominately degenerative in dogs [3]. Forces exerted on the stifle and more precisely on the cranial cruciate ligament (CCL) vary throughout the stance phase. Based on the theory of Tepic, the resulting force applied on the tibia during weight bearing has a direction close to the direction of the patellar tendon [4]. The physiological cranial tibial thrust increases with the stifle joint forces, reaching a maximum at mid-stance phase [3]. The stifle angle value leading to high CCL load has been reported in the literature to be the one close to mid-stance phase (beginning of the propulsive phase) with a mean value of 135° measured in dogs of only two breeds, crosses of Labrador and German Shepherd [5].
Several treatments for incompetent CCL have been extensively investigated with tibial osteotomy techniques showing the best long term results [6,7]. TTA, based on the theory by Tepic, is one of them [3,4]. To determine the required TTA, the tibial plateau slope and its angle with the femoro-patellar tendon should be preoperatively determined on strict mediolateral stifle radiographic projections [8].
Persistent stifle instability post-TTA has been reported as a cause for postliminary meniscal tears following preoperative measurements made on stifles flexed at 135° [9]. Our hypothesis is that 135° might be an underestimation of the mid-stance phase angle in certain individuals, possibly contributing to insufficient TTA during surgery.
The purpose of this study was to measure the stifle angle on standing position in various dog breeds using a set of radiographs. Although previous studies have used reflective markers attached to the skin to determine limb axes and joint angulations, these markers introduce bias simply because the skin can move independently from bones leading to significant variations in angle measurement [10,11,12].

2. Materials and Methods

Owned dogs were recruited for the study after owner consent. Breed, age, weight, size and sex of each animal were collected. Inclusion criteria included absence of any orthopaedic or neurologic anomaly. Orthopaedic and neurological examinations were performed on all dogs by one of the authors (M.L.).

2.1. Materials

For each dog, multiple radiographic mediolateral projections (between 1 and 4) of the entire pelvic limbs were taken while the dog was standing at rest. A wooden custom-made vertical cassette holder (162 × 61 cm) was used. This holder enabled us to vertically stack three Cr Agfa cassettes (46 × 38 cm) with an overlapping of 4.5 cm of each cassette in order to avoid any discontinuity in the final radiographical reconstruction. A portable device (Portable X-ray machine HF 80/15) attached to a custom-made metal base was used to take radiographs. The beam was centered on the stifle (Figure 1a). The distance between the X-ray device and the cassette holder was 225 cm. Using image processing software (Photoshop ND), one image containing the entire pelvic limb of each dog was obtained.

2.2. Measures

Mechanical bone axes were used in order to determine joint angulation. On lateral views, the femoral mechanical axis was defined by the line between the centre of the femoral head and the centre of the femorotibial joint. The tibial mechanical axis was defined by a line joining the tibial intercondylar eminences to the talus center. The tarsal mechanical axis was defined as a line running through the talus center parallel to the longitudinal axis of the metatarsal bones (Figure 1b).
The foot ground contact point was directly below the hip and pelvic limbs were superimposed.
Figure 1. (a) Schematic representation of the custom-made cassette holder and positioning of the dog during radiograph processing. (b) Mechanical axis on radiographs (A: femur; B: tibia; C: stifle angle).
Figure 1. (a) Schematic representation of the custom-made cassette holder and positioning of the dog during radiograph processing. (b) Mechanical axis on radiographs (A: femur; B: tibia; C: stifle angle).
Vetsci 09 00644 g001

2.3. Statistical Analysis

A Spearman correlation test was used to find a correlation between the femorotibial and tibiotarsal angles and a linear regression was used to evaluate the effect of weight on angles.

3. Results

Twenty-four dogs were included in the study. Breeds included mixed breed (n = 8), Weimaraner (n = 1), Mastiff (n = 1), Dutch Canardier (n = 1), German Shepherd dog (n = 2), White Swiss Shepherd Dog (n = 1), Belgian Shepherd (n = 3), Siberian Husky (n = 1), French bulldog (n = 2), Bouvier des Flandres (n = 1), Jack Russel Terrier (n = 2) and Border Collie (n = 1). After reviewing the radiographs, three cases were excluded from the study because of mispositioning. The femorotibial angles were between 129.5° and 156.6° (145.3°+/−7.9). Tibiotarsal angles were between 122.5° and 147.7° (134°+/−9.1) (Table 1).

4. Discussion

The main goal of this study was to determine the stifle angle at the mid-stance phase of dogs in order to allow better pre-operative planning in case of CCLR treated by TTA. The results provided evidence that the stifle angle at the mid-stance phase varies in dogs, with a mean value of 145°.
Previous studies already showed this inter-individual difference but were using retroreflective markers, leading to the introduction of a different bias as previously described [11]. Indeed, these markers are usually circular in shape and studies do not explain which part of it is used for the reference point. Furthermore, a study showed that the location of the markers on the skin itself could differ from 0.4 to 1.2 cm among repeated cycles of measurement. Such a displacement can cause significant differences in angle measurements [10], particularly in small individuals. Radiographs instead lead to more accurate measurements with clear bony reference points. It is of primary importance for the X-ray beam to be perpendicular to the limb to allow meaningful angle measurements.
A previous study reported the stifle angle during stance phase at rest in two groups of dogs, all with CCLR [13]. We chose to use healthy dogs instead, in order to better mimic the physiological situation. It is known that with CCLR or painful stifle, the limb is maintained slightly flexed in order to relieve pain [14,15]. In the previous study, the mean stifle angle was 138° against 145° in our study.
During gait, ground reaction forces increase, with speed [13] having an impact on joint angles in comparison with the standing position. It could therefore be more relevant to measure the stifle angle during the gait. Loading the back of dogs before taking radiographs at rest could have mimicked this larger force exerted on the stifle. Unfortunately, our dogs could not stand such load. Nevertheless, a study recorded the stifle angle at different gaits and showed no significant difference in stifle angle during the various gaits (walk and trot) [16].

5. Conclusions

In conclusion, our results indicate that the stifle angle at rest in a position corresponding to the mid-stance phase is regularly higher than the 135° previously published. It is close to 145° and is individual dependent. As the calculation of the required TTA on a 135° stifle angle leads to underestimation of TTA, we recommend taking the pre-operative radiographs with the stifle in full extension.

Author Contributions

All authors contributed to the conceptualization, the formal analysis of data, writing and drafting of the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived for this study due to informed consent signed by owners of the dogs, no manipulation of the dogs and radiographical studies were offered to the owners.

Informed Consent Statement

Informed consent was obtained for all subjects present in this study.

Data Availability Statement

The data presented in this study are available in: Determination of the stifle angle at standing position in dogs.

Acknowledgments

The authors thank Pierre-Marie Lefebvre for his help in collecting the raw data.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Johnson, J.A.; Austin, C.; Breur, G.J. Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989. Vet. Comp. Orthop. Traumatol. 1994, 7, 56–69. [Google Scholar] [CrossRef]
  2. Boge, G.S.; Engdahl, K.; Bergström, A.; Emanuelson, U.; Hanson, J.; Höglund, O.; Moldal, E.R.; Skjerve, E.; Krontveit, R. Disease-related and overall survival in dogs with cranial cruciate ligament disease, a historical cohort study. Prev. Vet. Med. 2020, 181, 105057. [Google Scholar] [CrossRef] [PubMed]
  3. Kowaleski, M.P.; Boudrieau, R.J.; Pozzi, A.; Tobias, K.M.; Johnston, S.A. Stifle joint. In Veterinary Surgery: Small Animal; Elsevier: St. Louis, MO, USA, 2017; pp. 1071–1167. [Google Scholar]
  4. Montavon, P.; Damur, D.; Tepic, S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. In Proceedings of the 1st World Orthopaedic Veterinary Congress, Munich, Germany, 5–8 September 2002. [Google Scholar]
  5. Allen, K.; DeCamp, C.E.; Braden, T.D.; Balms, M. Kinematic Gait Analysis of the Trot in Healthy Mixed Breed Dogs. Vet. Comp. Orthop. Traumatol. 1994, 7, 148–153. [Google Scholar]
  6. Innes, J.F.; Bacon, D.; Lynch, C.; Pollard, A. Long-term outcome of surgery for dogs with cranial cruciate ligament deficiency. Vet. Rec. 2000, 147, 325–328. [Google Scholar] [CrossRef] [PubMed]
  7. Brioschi, V.; Arthurs, G.I. Cranial cruciate ligament rupture in small dogs (<15 kg): A narrative literature review. J. Small Anim. Pract. 2021, 62, 1037–1050. [Google Scholar] [PubMed]
  8. Cadmus, J.; Palmer, R.H.; Duncan, C. The Effect of Preoperative Planning Method on Recommended Tibial Tuberosity Advancement Cage Size. Vet. Surg. 2014, 43, 995–1000. [Google Scholar] [CrossRef] [PubMed]
  9. Barnhart, M.D. Complications Associated with Tibial Tuberosity Advancement. In Complications in Canine Cranial Cruciate Ligament Surgery [Internet]; John Wiley & Sons, Ltd.: Hoboken, NJ, USA, 2021. [Google Scholar]
  10. Schwenke, M.; Smolders, L.; Bergknut, N.; Gustas, P.; Meij, B.; Hazewinkel, H. Soft Tissue Artifact in Canine Kinematic Gait Analysis. Vet. Surg. 2012, 41, 829–837. [Google Scholar] [CrossRef] [PubMed]
  11. Bush, M.A.; Bowlt, K.; Gines, J.A.; Owen, M.R. Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement. Vet. Comp. Orthop. Traumatol. 2011, 24, 205–210. [Google Scholar] [PubMed]
  12. Langley, B.; Page, R.; Greig, M. The influence of different pelvic technical marker sets upon hip kinematics during gait. Gait Posture 2019, 71, 74–78. [Google Scholar] [CrossRef] [PubMed]
  13. Slocum, B.; Devine, T. Cranial tibial thrust: A primary force in the canine stifle. J. Am. Vet. Med. Assoc. 1983, 183, 456–459. [Google Scholar] [PubMed]
  14. Vezzoni, A.; Demaria, M.; Corbari, A.; Cirla, A. Non-traumatic cranial cruciate ligament injuries. In Proceedings of the 1th World Orthopedic Congress, Munich, Germany, 5–8 September 2002. [Google Scholar]
  15. Sanchez-Bustinduy, M.; de Medeiros, M.A.; Radke, H.; Langley-Hobbs, S.; McKinley, T.; Jeffery, N. Comparison of Kinematic Variables in Defining Lameness Caused by Naturally Occurring Rupture of the Cranial Cruciate Ligament in Dogs-Sanchez-Bustinduy. Vet. Surg. 2010, 39, 523–530. [Google Scholar] [CrossRef] [PubMed]
  16. Fu, Y.C.; Torres, B.T.; Budsberg, S.C. Evaluation of a three-dimensional kinematic model for canine gait analysis. Am. J. Vet. Res. 2010, 71, 1118–1122. [Google Scholar] [CrossRef] [PubMed]
Table 1. Breed, weight, femorotibial angles, tibiotarsal angles and tibial plateau angles.
Table 1. Breed, weight, femorotibial angles, tibiotarsal angles and tibial plateau angles.
AnimalBreedWeight (kg)Mean Femorotibial Angle (°)Mean Tibiotarsal Angle (°)TPA Angle (°)
1Dutch canardier11132.9136.921.4
2Mixed breed27.9133.6128.624.4
3Berger Blanc Suisse41.5136.9125.418.8
4Mixed Breed18142.4128.619.5
5Siberian Husky20.9142.5113.815.4
6Belgian Shepherd28143131.917.8
7Mixed breed8.5144.3127.523.9
8Mixed breed20.4145.3121.435.7
9Belgian Shepherd31.7146.7134.714.3
10Weimaraner37.5147.313733.9
11Belgian Shepherd22150140.530.2
12Border Collie24.5150.8147.718.7
13Mastiff62151.8145.819.1
14Bouvier des Flandres31.2155.6135.224.1
15French Bulldog7156.6127.228.9
Mean value 26.1145.3132.123.1
No significant correlation between the femorotibial and tibiotarsal joint angles was noted (r = 0.38 and p = 0.15). No significant effect of weight on femorotibial, tibial plateau and tibiotarsal angles was detected by linear regression (p = 0.68, p = 0.46 and p = 0.14, respectively).
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Giansetto, T.; Picavet, P.P.; Lefebvre, M.; Balligand, M. Determination of the Stifle Angle at Standing Position in Dogs. Vet. Sci. 2022, 9, 644. https://doi.org/10.3390/vetsci9110644

AMA Style

Giansetto T, Picavet PP, Lefebvre M, Balligand M. Determination of the Stifle Angle at Standing Position in Dogs. Veterinary Sciences. 2022; 9(11):644. https://doi.org/10.3390/vetsci9110644

Chicago/Turabian Style

Giansetto, Thomas, Pierre P. Picavet, Michaël Lefebvre, and Marc Balligand. 2022. "Determination of the Stifle Angle at Standing Position in Dogs" Veterinary Sciences 9, no. 11: 644. https://doi.org/10.3390/vetsci9110644

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop