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Roussot, Mark. "Amputation rate following tibia fractures with associated popliteal artery injuries." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25507.
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Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
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Puma, Kari L. "A biomechanical characterization of intramedullary reaming in the human tibia." Thesis, State University of New York at Buffalo, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1594769.
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Intramedullary reaming is a technique used in orthopaedic trauma surgical procedures in which the intramedullary canal of a long bone is enlarged and prepared for the implantation of a nail to repair a fracture. Several complications of intramedullary reaming have been described in literature, including elevations in intramedullary pressure and temperature and damage to the blood vessels in the bone. However, the mechanics of intramedullary reaming in the human when performed by a surgeon have not been widely investigated. The purpose of this investigation was to characterize the mechanics of intramedullary reaming, using a novel reamer evaluation tool, performed by two operators of different experience levels. A surgical reaming system was modified with a wireless, custom sensor to measure axial force, torque and RPM of the reamer during use.
Ten cadaveric matched tibial pairs were harvested under IRB approval, and one bone of each pair was reamed by the attending orthopaedic trauma surgeon, the other by the orthopaedic surgery resident (PGY-2). Reaming began with a 9mm diameter reamer and proceeded in 0.5mm increments until the declaration of audible chatter, after which reaming proceeded to a maximum of 1.5mm beyond this point. Axial force, torque and reamer displacement were recorded, from which the time to reach the distal end and the mechanical work to reach the distal end were determined. These parameters were compared between operators at the reamer associated with chatter and the maximum reamer size beyond chatter, and also within individual operators to determine how the mechanics changed from initial chatter acknowledgement to the last, largest reamer used. Three matched pairs were excluded from analysis due to unforeseen difficulties during data collection or with the experimental procedure.
Analysis revealed that operator mechanics were not statistically different, with the exception of the application of axial load at the maximum reamer size beyond the declaration of chatter. The resident applied more axial force on the reamer than the attending surgeon for the maximum reamer size. For each operator, force, work and time increased from reaming at chatter to the last reamer used. The results of this study suggest that although the reaming procedure is not strongly operator dependent, there is likely to be a mechanical component of clinical concern associated with continued reaming after noticeable initial chatter. Additional studies with larger sample sizes and operator populations are necessary in order to draw further conclusions.
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Monaghan, Pierre. "Histological analysis of bovine bone grafting using the rat tibia model." Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=55515.
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Experimental investigations were carried out concerning the use of bovine bone (Unilab Surgibone) grafted in the tibiae of rats. The first experiment evaluated tissue response of bovine bone as an inlay graft and the second experiment as an onlay graft. Histological and morphometric analyses were performed in order to obtain baseline data on tissue response for future experiments using titanium implants with bovine bone grafts in this model. Light microscopy demonstrated rapid incorporation of the inlay graft by new bone, whereas, the onlay graft was mainly encapsulated by fibrous tissue. However, a residual increase in the thickness of the outer cortex of the tibiae was observed with onlay graft. From the results of this study it appeared that Unilab Surgibone was biocompatible and did not induce a foreign body reaction. Future investigations using titanium implants in combination with the bovine bone grafts appears to be possible especially if an inlay/onlay design is attempted.
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RIQUELME, CLAUDIA C. "Efeitos da radiação laser em baixa intensidade no processo de cicatrização óssea em defeitos enxertados com osso bovino e membrana de colágeno reabsorvível: estudo 'in vivo'." reponame:Repositório Institucional do IPEN, 2006. http://repositorio.ipen.br:8080/xmlui/handle/123456789/11701.
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Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia)
IPEN/D-MPLO
Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo
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ROSSI, MAURO C. C. "Análise comparativa da interface osso-implante, em tíbia de coelho, utilizando fresa cirúrgica e laser de Er, Cr:YSGG." reponame:Repositório Institucional do IPEN, 2006. http://repositorio.ipen.br:8080/xmlui/handle/123456789/11702.
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Dissertação (Mestrado Profissionalizante em Lasers em Odontologia)
IPEN/D-MPLO
Instituto de Pesquisas Energéticas e Nucleares - IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de São Paulo, São Paulo
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Mozes, Alon. "3D A-Mode Ultrasound Calibration and Registration of the Tibia and Femur for Computer-Assisted Robotic Surgery." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_dissertations/114.
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Registration is a key component for computer-navigated robot-assisted surgery. Invasive approaches such as fiducial-based and surface matching with mechanical probes are common but ultrasound may provide a non-invasive alternative. If an A-mode ultrasound transducer can be used to percutaneously select data points on the bones, a registration can be determined without needing any incision. This study investigates selecting an A-mode ultrasound transducer, calibrating it, analyzing the ultrasound signal, and using it to register a phantom sawbone tibia and femur as well as cadaveric specimens. This study is performed in conjunction with MAKO Surgical Corp.'s Tactile Guidance System™ (TGS™) at their headquarters and at The South Florida Spine Clinic for cadaveric experiments. The results for phantom and cadaveric ultrasound registrations compared to a mechanical probe approach demonstrate that A-mode ultrasound registration is a viable option for registration of the bones of the knee.
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Souza, Érica Siqueira de. "Estudo retrospectivo sobre a alteração do ângulo do plateau tibial durante a cicatrização óssea da TPLO em cães e execução prática da técnica de TPLO em cadáveres de cão." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2020. http://hdl.handle.net/10400.5/19838.
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Dissertação de Mestrado Integrado em Medicina VeterináriaO presente estudo avaliou a relação entre a alteração do ângulo do plateau tibial durante a cicatrização óssea e (a) o ângulo do plateau tibial (APT) pré-operatório, (b) o APT atingido no pós-operatório imediato e (c) a carga articular exercida pelo peso do paciente, em cães submetidos à Osteotomia de Nivelamento do Plateau Tibial (TPLO). Os APT foram avaliados em 32 casos e as medidas foram feitas, com auxílio de programas computacionais, através de radiografias digitais médio-laterais da tíbia. Cada um dos três observadores realizaram três medidas do APT, para cada caso, em cada momento estudado. Os dados obtidos foram analisados estatisticamente para assim avaliar a correlação entre eles bem como eliminar as possíveis interferênicas intra e interobervador. Como estudo complementar e com o objetivo de entender as dificuldades práticas da técnica de TPLO, 18 TPLOs foram executadas em cadáveres de cão. Para cada animal foram feitas radiográficas medio-laterais pré e pós operatórias para fazer o planeamento cirúrgico e avaliar os resultados finais, respetivamente. Os resultados deste estudo demonstraram que a alteração do ângulo do plateau tibial durante a cicatrização óssea, apesar de presente, não foi determinado pelos APTs pré-operatório e pós-operatório imediato bem como pelo peso do paciente, o que nos leva a concluir que a intensidade da alteração do ângulo do plateau tibial durante a cicatrização óssea não é determinada pela inclinação prévia do plateau tibial, por uma maior ou menor rotação do plateau tibial pela TPLO e que a carga exercida pelo peso do paciente sobre o joelho, após estabilização rígida por TPLO, não determina o comprometimento da rotação do plateau tibial e da estabilidade articular. A formação prática é de suma importância para a familiarização com a técnica cirúrgica e com o manuseio da serra oscilatória, antes da realização do procedimento “in vivo”.
ABSTRACT - BACKGROUND STUDY ON TPLO CHANGING OF TILT ANGLE OF THE TIBIAL PLATEAU DURING BONE HEALING IN DOGS AND PRACTICAL PERFORMANCE OF TPLO TECHNIQUE IN DOG CADAVERS - The present study evaluated the relationship between the changing of the angle of the tibial plateau during bone healing and the preoperative tibial plateau angle (TPA), the TPA achieved in the immediate postoperative period and the joint load caused by the patient's weight in dogs submitted to TPLO. The TPA were evaluated in 32 cases and the measurements were made, with the aid of computer programs, through tibial mid-lateral digital radiographs. Each of the three observers performed three TPA measurements, for each case, at every single moment. The objective data were statistically analysed in order to evaluate the correlation between them as well as to eliminate the possible intra and interobserver interferences. As a complementary study and in order to understand with the objective of understanding the practical difficulties of the TPLO technique, 18 TPLOs were performed on dog cadavers. Pre and postoperative medio-lateral radiographs were taken of each animal to make the surgical planning and to evaluate the final results, respectively. The results of this study demonstrated that, although present, the changing of the angle of the tibial plateau during bone healing was not determined by the preoperative and immediate postoperative TPAs as well as the patient's weight, which leads us to conclude that the intensity of the changing of the angle of the tibial plateau during bone healing is determined by the previous tibial plateau inclination, by a greater or lesser rotation of the tibial plateau by the TPLO and that the load exerted by the patient's weight on the knee after rigid stabilization by TPLO does not determine the impairment of tibial plateau rotation and joint stability. Practical training is very important to be comfortable with the surgical procedure and oscillating saw´s handling, before performing the procedure “in vivo”.
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Viegas, Alexandre de Christo. ""Análise das propriedades biomecânicas dos tendões dos músculos tibial anterior e tibial posterior : estudo experimental em cadáveres humanos"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-11042006-162408/.
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O autor estudou as propriedades biomecânicas dos tendões dos músculos tibial anterior e tibial posterior congelados a -20°C e a -86°C extraídos de cadáveres humanos frescos. Foram realizados ensaios mecânicos de tração até a ruptura e determinadas as seguintes propriedades: resistência máxima, coeficiente de rigidez, módulo de elasticidade e alongamento máximo relativo. Os dados obtidos foram comparados aos existentes na literatura relativos ao ligamento cruzado anterior, ligamento da patela e aos tendões dos músculos grácil e semitendíneoThe author studied the mechanical properties of the anterior and posterior tibialis muscle tendons frozen at -20°C and -86°C obtained from fresh-frozen human cadavers. The tendons were submitted to axial traction until failure and the following properties were determined: ultimate load, stiffness, modulus of elasticity and relative strain. Data obtained were compared to those from the literature related to the anterior cruciate ligament, patellar tendon, gracilis and semitendinous tendons
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Chan, Yu-wai, and 陳汝威. "Posterior tibial flap: anatomical study and clinical experience." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41290823.
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Chan, Yu-wai. "Posterior tibial flap anatomical study and clinical experience /." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41290823.
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Galloway, Francis. "Large scale, population-based finite element analysis of cementless tibial tray fixation." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/355955/.
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Joint replacements are a common treatment of osteoarthritis, rheumatoid arthritis, or fractures of both the hip and knee. The rising number of procedures being performed each year means that there is a need to assess the performance of an implant design in the general population. The majority of computational studies assessing implants do not take into account inter-patient variability and only use a single patient model. More often than not, it is then assumed that the results can be extrapolated to the general population. This thesis describes a method allowing population-based assessment of joint replacements, focussing on the tibial tray component of a total knee replacement. To generate a large population of models for finite element analysis, two statistical models were used. One was of the tibia, capturing both the variability of the morphology and bone quality, and the other was of the internal knee loads during a gait cycle. Assessment of the statistical models showed that they could adequately generate representative tibiae and gait cycle loads. An automated method was then developed to size, position, and implant the tibial tray in the generated population of tibiae in preparation for finite element analysis. The use of a population-based study, a unique approach compared to current studies, was demonstrated using three case studies assessing the performance of the tibial tray. The first case study examined the factors which might increase the risk of failure of the tibial tray and the effect of under sizing the tibial tray on primary stability. Factors such as bone quality and patient weight were seen to increase the risk of failure. It was found that under sizing the tibial tray did not significantly affect the primary stability of the tibial tray. It was also observed that the peak strain occurred during swing phase of the gait cycle, whereas peak micromotion occurred at the beginning of stance phase of the gait. The second case study investigated the effect of tibia resection depth on primary stability of the tibial tray. A more distal resection was found to increase the peak strain and micromotion of the bone-tray interface. The worsening primary stability with a more distal resection, suggest that to obtain optimal primary stability of the tibial tray it is necessary to resect as little bone as possible. The third case study compared three tibial tray designs. It was ound that the trays with pegs or flanges surrounding the stem tended to perform better, reducing the strain and the micromotion at the bone-tray interface. It was noted that the performance of the trays predicted by the analysis was similar to that observed clinically. This shows the potential use of population-based studies to help predict the clinical outcome of joint replacements.
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Carreira, Marion Almeida d'Alcântara. "Short-term complications following a TPLO surgery : retrospective study of 38 cases." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2021. http://hdl.handle.net/10400.5/21862.
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Dissertação de Mestrado Integrado em Medicina VeterináriaABSTRACT - Cranial cruciate ligament (CrCL) rupture is one of the most common causes of pelvic limb lameness in dogs and its etiopathogenesis is not yet completely established. Trauma can be a reason for the acute ligament injury, although the majority of cases may be the result of chronic degenerative change. Surgical treatment appears to be the preferable treatment, to minimize joint instability and progression of degenerative joint disease. Even though, intra- and extra-capsular techniques have good outcomes, tibial osteotomies are generally preferred. The tibial plateau levelling osteotomy (TPLO) aims to provide dynamic stability of the stifle joint during weight-bearing by neutralizing the cranial tibial thrust. This technique involves a radial osteotomy of the proximal tibia with subsequent rotation of the proximal segment to enable precise manipulation and reduction of the tibial plateau angle (TPA). TPLO surgery is associated with high short and long-term success rates in both small and large dogs, nevertheless intraoperative and postoperative complications can occur. In this retrospective study, the short-term complications after TPLO surgery were evaluated and risk factors that may influence its occurrence were analysed. Out of 38 TPLO surgeries, the overall complication rate was 56.2%, where 15.8% were major complications and 36.8% minor complications. Minor complications included delayed wound healing, patellar tendonitis, tibial tuberosity fracture, patellar osteophyte fracture with patellar tendonitis and iatrogenic fibular fracture. Major complications included three infections and one each of compartment syndrome/infection, implant failure/fracture and seroma with delayed wound healing. The more important major complication found was infection and delayed wound healing and patellar tendonitis were the more frequent minor complications. The only risk factor found was the size of implant which may be related to the patient’s body weight. In summary, although TPLO is associated with good to excellent outcomes, generally half of the cases may develop complications, more often minor and especially in the first 4 weeks after surgery.
RESUMO - COMPLICAÇÕES A CURTO PRAZO APÓS CIRURGIA TPLO: ESTUDO RETROSPECTIVO DE 38 CASOS - A rotura do ligamento cruzado cranial é uma das causas mais comuns de claudicação do membro pélvico em cães e a sua etiopatogenia não está ainda completamente conhecida. Trauma pode ser a causa para uma lesão aguda do ligamento, contudo a maioria dos casos parece resultar de alterações degenerativas crónicas no ligamento. O tratamento cirúrgico é normalmente o tratamento de eleição, para minimizar a instabilidade da articulação e a progressão da doença degenerativa articular. Apesar das técnicas intra e extra capsulares apresentarem bons resultados, as osteotomias tibiais são geralmente preferidas. A cirurgia tibial plateau levelling osteotomy (TPLO) tem como objectivo promover a estabilidade dinâmica do joelho neutralizando o avanço cranial da tibial (cranial tibial thrust). Esta técnica envolve uma osteotomia radial na tíbia proximal com subsequente rotação do segmento proximal de modo a permitir uma precisa manipulação e redução do ângulo do plateau tibial. A cirurgia TPLO está associada a uma elevada taxa de sucesso, a curto e longo prazo, tanto em cães pequenos como grandes, apesar disso complicações intra cirúrgicas e pós-cirúrgicas poderão ocorrer após esta cirurgia. Neste estudo retrospectivo, as complicações a curto prazo após a cirurgia TPLO foram avaliadas e os factores de risco que podem influenciar a sua ocorrência foram analisados. De 38 cirurgias TPLO, a taxa geral de complicações foi de 56,2%, onde 15,8% foram complicações maiores e 36,8% complicações menores. Complicações menores observadas foram atraso na cicatrização, tendinite patelar, fractura da tuberosidade tibial, fractura de osteófito patelar com tendinite patelar e fractura fíbular iatrogénica. As principais complicações maiores incluíram três infecções e uma síndrome compartimental/infecção, uma falha do implante/fractura e um seroma com atraso de cicatrização. A complicação mais importante encontrada foi infecção e atraso na cicatrização e tendinite patelar foram as complicações menores mais frequentes. O único factor de risco encontrado foi o tamanho de implante, que talvez esteja relacionado com o peso corporal do paciente. Em resumo, embora a cirurgia TPLO esteja associada a bons e excelentes resultados, geralmente metade dos casos pode desenvolver complicações, mais frequentemente, complicações menores e especialmente nas primeiras 4 semanas após a cirurgia.
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Barouni, Elyas. "Soft tissue Reconstruction of Gustilo-Anderson Grade IIIB Open Extra-Articular Tibial Fractures at a Tertiary Hospital in Cape Town, South Africa: A Retrospective Case Series." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32588.
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Introduction: Management of Gustilo-Anderson grade 3b tibia fractures are challenging due to the high rate of complications which includes infection, nonunion and possible amputation. Due to limited soft tissue coverage of the tibia antero-medially, open fractures remain a treatment challenge. Despite many advances, the ideal time delay to definitive soft tissue cover remains controversial. Aim: We aimed to investigate the management strategy and the outcome of soft tissue reconstruction of Gustilo-Anderson grade 3b tibia fractures at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective study was conducted on 22 patients who underwent soft tissue reconstruction for grade 3b tibia fractures from January 2014 to July 2017. Patient demographics, comorbidities, injury characteristics and management practices such as time to debridement, relook time, Negative Pressure Wound Therapy (NPWT), soft tissue coverage and complications were recorded. Results: Most patients were males (n=18; 81.8%) with an average age of 39.3 years. Pedestrian vehicle accidents accounted for 45.4%(n=10), motor-vehicle accidents (n=6; 27.3%) and gunshot wounds (n=2; 9.1%). The commonest site of injury was the middle third of the tibia (n=13; 59.1%), distal third (n=7; 31.8%) and proximal third (n=2; 9.1%). Most patients (n=18; 81.8%) were debrided within 24 hours. The mean times for NPWT prior to cover was 12.5 days and for soft tissue cover 13.7 days (range 2-35), respectively. Fasciocutaneous flaps (n=11; 50%) were predominantly used as cover, then pedicled muscle flaps (n=8; 36.4%), free flaps (n=2) and skin graft(n=1). Most patients (n=13; 59.1%) received satisfactory outcomes. Seven (31.8%) required soft tissue revisions. Three patients (13.6%) suffered complications namely, complete flap loss resulting in amputation, partial skin graft loss and soft tissue infection, respectively. Patients who underwent debridement after 24 hours reported the least complications and there appeared to be better outcomes in the relooks beyond 48 hours. Conclusion: Despite achieving outcomes which concur with other published studies, the BOAST 4 guidelines were not fully reflected in our management strategy. We will require larger numbers in future studies to formulate a standardized management protocol going forward.
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Albishi, Waleed. "Inhibition of fibroblast growth factor receptor 3 (FGFR3) signalling to accelerate bone formation during distraction osteogenesis of mice tibiae." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121465.
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Distraction osteogenesis (DO) is a surgical technique widely used for the treatment of limb length discrepancies, limb deformities, long bone nonunions, and bone loss. The technique involves performing an osteotomy and then gradually distracting the two bone segments with an external fixator. This generates new bone within the distracted gap. Although very successful, one of the limitations of this technique is the long period of time the external fixator needs to be kept on, until the newly formed bone in the distracted zone consolidates. This prolonged process may lead to numerous social, psychological, and medical complications. Recent studies from our laboratory showed that the absence of signalling through the fibroblast growth factor receptor 3 (FGFR3) in DO leads to an increase in bone formation in mice deficient for FGFR3. Thus, we hypothesize that exogenous blocking of the FGFR3 pathway in wild-type mice may be efficacious in promoting bone formation in DO. We thus planned to block this pathway using the small molecule inhibitor, PD173074 or using anti-FGFR3 antibodies. In this study, we used 2-month old wild-type C57BL/6 mice divided in 5 groups. The mice have undergone a surgical osteotomy and installation of an external fixator (distraction apparatus). Following a 5-day latency period, distraction (0.2 mm/12 hours for 12 days) was initiated. The animals were sacrificed at day 33 post-surgery (mid consolidation). Micro-computed tomography (μCT) of the wild-type control group tibiae (not treated) was compared to the tibiae of mice receiving one of three increasing doses of small molecule inhibitors and mice receiving a blocking dose of anti-FGFR3 antibodies. Our results showed a trend towards increased bone volume in mice receiving the higher doses of the small molecule inhibitor as compared to those of the untreated wild-type mice. This dose ranging experiment represents a critical study in this translational research effort to accelerate bone formation in DO.L'ostéogénèse par distraction (Distraction Osteogenesis, DO) est une technique chirurgicale largement utilisée pour le traitement des anomalies de la longueur des membres, des malformations, des fractures non-union, et de la perte osseuse suivant un traumatisme. La technique consiste à effectuer une ostéotomie puis à éloigner progressivement les deux segments osseux à l'aide d'un fixateur externe. Du nouveau tissu osseux se forme progressivement dans l'espace créé par la traction. Bien que montrant un taux de succès élevé, un des désavantages de cette technique est la longue période de temps où le fixateur externe doit être maintenu en place afin que l'os nouvellement formé se consolide. Cette période prolongée peut entraîner de nombreuses complications d'ordre social, psychologique ou médical. Des résultats récents de notre laboratoire montrent que l'absence de signalisation par le récepteur 3 des facteurs de croissance fibroblastiques (Fibroblast Growth Factor Receptor 3, FGFR3) au cours de la DO conduit à une augmentation de la formation osseuse chez les souris déficientes en FGFR3. Nous avons donc émis l'hypothèse que le blocage de la voie signalétique FGFR3 chez des souris de type sauvage pourrait être efficace afin d'augmenter la formation osseuse au cours de la DO. Afin de bloquer cette voie signalétique, nous avons utilisé un inhibiteur synthétique, PD173074, ou des anticorps anti-FGFR3. Des souris C57Bl/6 de type sauvage agée de 2 mois et divisée en 5 groupes. Les souris ont subi une ostéotomiechirurgicale et l'installation du fixateur externe (appareil de distraction). Après une période de récupération de 5 jours, la distraction a été amorcée (0,2 mm/12 heures pendant 12 jours). Les animaux ont été sacrifiés au jour 33 post-chirurgie (mi-consolidation). À l'aide de la tomographie haute résolution assistée par ordinateur (micro-computedtomography, μCT), nous avons comparé la formation osseuse dans l'espace créé par la traction entre le groupe contrôle (recevant seulement le véhicule) et les groupes traités avec une des trois doses croissantes d'inhibiteur ou avec l'anticorps anti-FGFR3. Nos résultats montrent une tendance dose-dépendante à l'augmentation de la formation osseuse chez les souris recevant l'inhibiteur, par rapport aux souris non traitées. Cette étude pilote est un jalon important dans la recherche translationnellevisant à accélérer la formation osseuse au cours de l'ostéogénèse par distraction.
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Chizari, Mahmoud. "The mechanical study of double-tunnel-double-bundle anterior cruciate ligament reconstructive surgery : graft and tibial/femoral channel performance." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=167333.
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This is an interdisciplinary research project in which the methods of biomechanical and design engineering are focused upon a problem in orthopaedics. The anterior cruciate ligament (ACL) is the major ligament in the knee and is often torn during athletic competition as well as every day activity. The ACL is made up of two functional bundles, which help to stabilize the knee. Until recently, ACL reconstruction only replaced one of these bundles; however, research shows that both bundles should be replaced to more fully restore normal knee functionality. The aim of the research was, therefore, to evaluate the mechanical aspects of the double-tunnel-double-bundle ACL reconstruction technique. The research was directed towards designing a new and improved surgical device to improve ACL reconstruction: The current study used a computational model and experimental testing to explore the mechanical parameters of the tendon graft and knee bones to investigate the effects of double tunnel drilling in tibia and femur during ACL reconstruction. The thesis presents the findings of research into three aspects of double-tunnel-double-bundle ACL reconstruction. The first aspect of the study involves clinical and computational analysis of a single-tunnel-singlebundle (SB) ACL reconstructed knee with a double-tunnel-double-bundle (DB) ACL reconstructed example. The study tried to show the advantage of the DB technique over the conventional SB technique. The anatomical geometries of both SB and DB examples were used to create a finite element model and investigate the relative merits of single and double tunnelling, the variations of graft pretension, and tunnel placement on bone stress. The experimental and computational results of both methods were compared and discussed. The second study investigated whether tripling a tendon when using suspensory fixation provides inferior graft strength and a greater cyclical elongation than a doubled tendon graft with suspensory fixation. The tensile stress was found to be lower in the third strand than in the doubled portion. The study was focussed on the mechanical assessment of two different methods of tripling tendons when using suspensory fixation. The third aspect of the study focussed on the design of a new device for fixation of the femoral tripled tendon graft in DB ACL reconstruction technique. The study describes a series of designs and prototypes that were iteratively developed and experimentally tested, leading to a novel tripled tendon graft device. The function of the new device was compared with the conventional methods and tested with a number of animal tendons and bones. The new device with a tripled tendon graft resulted in higher pull-out strength and less graft elongation than that seen using a conventional tripling method.
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Joshi, Shailesh Vasant. "Intra-operative shape acquisition of tibio-femoral joints using 3D laser scanning for computer assisted orthopaedic surgery : a proof of concept." Thesis, University of Strathclyde, 2015. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=24915.
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Image registration is an important aspect in all computer assisted surgeries including Neurosurgery, Cranio-maxillofacial surgery and Orthopaedics. It is a process of developing a spatial relationship between pre-operative data, such as Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans and the physical patient in the operating theatre. Current image registration techniques for Computer Assisted Orthopaedic Surgery (CAOS) in minimally invasive Unicompartmental Knee Arthroplasty (UKA) surgery are invasive, time consuming and often take 14-20 minutes and are therefore costly. The rationale for this study was to develop a new operating theatre compliant, quick, cost effective, contactless, automated technique for image registration during CAOS based on an accurate rigid body model of the ends of the exposed knee joint, produced using 3D laser scans taken intra-operatively by a Laser Displacement Sensor. Bespoke automated 3D laser scanning techniques based on the DAVID Laserscanner method were developed and were used to scan surface geometry of the knee joints in cadaveric legs. The laser scanned knee joint models were registered with the pre-operative (MRI/CT) models and the deviations were evaluated. Furthermore, trends in the deviations were studied along with a supportive validity study. Results indicated that the laser scanner can repeatedly produce accurate 3D models of the human tibio-femoral joint in the operating theatre. This study has provided a proof of concept for a new in situ automated shape acquisition and registration technique for CAOS with the potential for providing a quantitative assessment of the articular cartilage integrity during lower limb arthroplasty.
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Joss, Brendan Keith. "Clinical and biomechanical outcomes following unicondylar knee arthroplasty with Preservation fixed and mobile bearing tibial components." University of Western Australia. School of Surgery and Pathology, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0079.
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[Truncated abstract] Unicondylar knee arthroplasty (UKA) has re-emerged as a successful treatment option for isolated single compartment tibio-femoral joint osteoarthritis. However despite its increasing use, controversy still remains over fixed or mobile bearing tibial components, as there is a lack to prospective randomised studies reported in the literature. In addition, the theoretical advantages of the mobile bearing for knee kinematics, kinetics and clinical outcome have not been evaluated in vivo. The aim of this research study was to explore the clinical and biomechanical outcomes of the fixed and mobile bearing UKA. . . . When the results for the both studies were combined, utilising the Preservation and MG fixed bearing prostheses, there was a significant relationship between knee adduction moment, and a poor prognosis predicted from RSA. Those patients with translation or rotation of the tibial component in any direction above 1mm and 1.5 degrees respectively were considered to have a poor prognosis for long term fixation. Of the 28 patients, the 8 patients considered to have a poor prognosis, had increased knee adduction moments post-surgery (mean difference = 1.66Nm.kg-1, p = 0.007). There was no difference between the groups for knee flexion moment (mean difference 0.16Nm.kg-1, p = 0.844). Pre-surgery gait was unable to predict the post-surgery outcome, due to the significant changes in gait from pre- to post-surgery. Care must taken when implanting the Preservation mobile bearing prosthesis, as long term outcome is questionable. The mobile bearing prosthesis also produced the worst clinical outcome, however the theoretical advantages of the mobile bearing does not affect gait. Gait analysis is a useful tool to identify patient who are overloading their prosthesis, leading to potential early failure. Identification of these gait patterns can allow for early intervention to reduce joint load, and possible extend the longevity of the prosthesis.
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Marques, Jenifer de Santana. "Efeitos da nalbufina e do tramadol após infusão contínua com fentanil em cães submetidos a osteotomia de nivelamento de platô tibial (TPLO)." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-16112015-151300/.
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Objetivou-se comparar os efeitos de duas doses de nalbufina em relação ao tramadol após infusão contínua de fentanil durante cirurgia de osteotomia de nivelamento de platô tibial. Realizou-se estudo clínico encoberto com 28 cães (idade 5,6±1,2 anos e peso 34,7±4,2 kg), pré-medicadas com acepromazina (0,03 mg/kg, IM), induzidas com propofol (4 mg/kg, IV), mantidas com isofluorano (EtISO 1,3 V%) e fentanil (bólus de 3 µg/kg, seguido por 0,3 µg/kg/min, IV), randomizados ao final da cirurgia nos grupos: NAL 0,1: 0,1 mg/kg de nalbufina (n=9), NAL0,3: 0,3 mg/kg de nalbufina (n=9) ou TRA: 3 mg/kg de tramadol, (n=10). Avaliou-se os parâmetros fisiológicos, escores de sedação e de dor (Colorado, Glasgow e VAS) a cada 30 minutos após a administração dos tratamentos, por seis horas ou até o resgate (tramadol 4 mg/kg e dipirona 30 mg/kg, quando VAS ≥ 4, Glasgow ≥ 5 e/ ou Colorado ≥ 2). Coletas de sangue para mensuração para gasometria arterial foram realizadas. Avaliou-se ainda os tempos de extubação (TE), recuperação da respiração espontânea (TRE) e decúbito esternal (TDE). Os tempos de recuperação foram avaliados por meio de ANOVA, com pós-teste de Tukey, enquanto as escalas foram avaliadas pelos testes de Friedman e Kruskal-Wallis, seguidos por pós-teste de Dunn quando necessário, com nível de significância de 95%. Os animais que receberam tramadol apresentaram maior grau de sedação em todos os momentos avaliados (p < 0,05), além de maior TE, TRE e TDE que NAL0,1 e NAL0,3 (p<0,001). Quando comparado ao momento basal, o grupo TRA apresentou redução significativa do pH do HCO3 e elevação da PaCO2 em T 30. Na comparação entre grupos, o grupo TRA apresentou menor pH em T30 quando comparado a NAL 0,1 e NAL 0,3. Na escala de avaliação de dor de Glasgow, Colorado e na EAV, o grupo NAL 0,1 apresentou média ±DP significativamente mais alta do que NAL 0,3 (p<0,05) e TRA (p<0,001) em T60, T120 e T180. O tempo para administração do resgate foi de 133±50 minutos no grupo NAL0,1, 220±30 minutos no NAL0,3 e 360 minutos no grupo TRA. Com os dados obtidos conclui-se que a administração de nalbufina reduz o tempo de recuperação anestésica, necessitando, porém, de resgate analgésico mais precocemente que o tramadolThe aim of this study was to compare the effects of two nalbuphine doses versus tramadol after fentanyl continuous infusion during tibial plateau leveling osteotomy surgery. A clinical study with 28 dogs (5.6±1.2 years old and 34.7±4.2 kg), pre-medicated with acepromazine (0.03 mg/kg, IM), followed by propofol induction (4 mg/kg, IV), isoflurane (EtISO 1.3 V%) and fentanyl (bolus of 3 µg/kg, following 0,3 µg/kg/min, IV) maintenance; were randomized distributed in the following groups: NAL0.1: 0.1 mg/kg of nalbuphine (n=9), NAL0.3: 0.3 mg/kg of nalbuphine (n=9) or TRA: 3 mg/kg of tramadol (n=10). Physiological parameters, sedation and pain scale (Colorado, Glasgow and VAS) were evaluated every 30 minutes after treatment administration, during six hours, or until rescue medication (tramadol 4 mg/kg and dipyrone 30 mg/kg, when VAS ≥ 4, Glasgow ≥ 5 and/or Colorado ≥ 2). Arterial blood gas sampling were collected. Furthermore, time of extubation (TE), spontaneous respiration recovery (TRE) and sternal decubitus (TDE) were registered. Recovery periods were analyzed using ANOVA, followed by Tukey test, while the pain scales were evaluated using Friedman and Kruskal-Wallis, followed by Dunn's test, when necessary, with significance level of 95%. Animals that received tramadol exhibited higher sedation score in all evaluated moments (p < 0.05), and also higher TE, TRE and TDE than NAL0.1 and NAL0.3 (p<0.001). TRA group showed significate pH of HCO3 reduction when comparing to baseline and PaCO2 elevation in T30. When comparing between groups, TRA showed significate smaller pH in T30 than NAL0.1 e NAL0.3. Considering Glasgow, Colorado and EAV pain scale, NAL0.1 group produced average ±SD significant higher than NAL0.3 (p<0.05) and TRA (p<0.001) in T60, T120 and T180.Rescue pain medication time was 133±50 minutes in NAL0.1 group, 220±30 minutes in NAL0.3 group and 360 minutes in TRA group. The results of this investigation shows that nalbuphine administration decreases anesthesia recovery time, requiring, however, early rescue pain medication than tramadol
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Borges, Mariana Melo. "Complications associated with closing wedge ostectomy procedure for treatment of cranial cruciate ligament rupture in dogs : a retrospective study of 145 cases." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2016. http://hdl.handle.net/10400.5/11913.
Full textAbstract:
Dissertação de Mestrado Integrado em Medicina VeterináriaCranial cruciate ligament (CrCL) rupture is one of the most common causes of lameness in dogs and the leading cause of osteoarthritis in this species, therefore, expressing a relevant clinical and economic impact in veterinary medicine. Despite the great variety of surgical techniques available for management of this condition, the perfect treatment is yet to be found. Currently, the tibial osteotomies are preferred over the intracapsular and extracapsular techniques. The cranial closing wedge ostectomy procedure (CWO) for the tibial plateau levelling has been used for several years to provide dynamic stabilization of the stifle joint in cases of CrCL failure. In this technique, a wedge of bone is removed from the proximal tibia, aiming to reduce the tibial plateau angle (TPA) and, consequently, neutralise the cranial tibial thrust, so that the need for a CrCL is eliminated. Nevertheless, alike all the other surgical procedures, intraoperative and postoperative complications are sometimes observed following CWO surgery. In this retrospective study, complications resulting from a series of 145 cases of CWOs were evaluated. All procedures were performed by only one surgeon at Kingston Veterinary Group, in Hull, with a minimum of 6 months follow-up period. The overall complication rate was 18.6% (27/145) and the rate of complications requiring further surgical intervention, defined as major complications, was 3.4% (5/145), and included subsequent meniscal injury, implant failure and infection. Minor complications, defined as those not requiring second surgery, occurred in 15.2% (22/145) of the cases, with surgical wound infection being the most common complication encountered. The rate of major complications obtained in the present study is comparable to the ones most recently reported for TPLO procedure. In conclusion, a reasonably low rate of complications can be expected following CWO procedure when performed by experienced surgeons of the surgical technique.
RESUMO - COMPLICAÇÕES ASSOCIADAS COM A CLOSING WEDGE OSTECTOMY PROCEDURE PARA O TRATAMENTO DA RUPTURA DO LIGAMENTO CRUZADO CRANIAL EM CÃES: UM ESTUDO RETROSPECTIVO DE 145 CASOS - A rutura do ligamento cruzado cranial é uma das causas mais comuns de claudicação em cães, sendo a principal causa de osteoartrite nesta espécie, mostrando um relevante impacto clínico e económico em medicina veterinária. Apesar da grande variedade de técnicas cirúrgicas disponíveis para o tratamento desta doença não existe, até ao momento, uma técnica cirúrgica mais eficiente. No entanto, as osteotomias tibiais parecem ser preferidas em relação às técnicas intracapsulares e extracapsulares. A cirurgia closing wedge ostectomy para nivelamento do plateau tibial tem vindo a ser utilizada desde há muitos anos para promover estabilização dinâmica da articulação do joelho, em casos de insuficiência do ligamento cruzado cranial. Nesta técnica, um fragmento de osso em cunha é removido da parte proximal da tíbia, com o objetivo de reduzir o ângulo do plateau tibial e, consequentemente, neutralizar o movimento cranial da tíbia durante compressão (cranial tibial thrust), de forma a não ser necessária a existência de um ligamento cruzado cranial. No entanto, bem como todas as outras cirurgias, complicações intraoperatórias e pós-operatórias são, também, observadas nesta técnica. Neste estudo retrospetivo em 145 casos, descreve-se o procedimento cirúrgico procedendo-se ao registo e análise das complicações em um período mínimo de 6 meses pós-cirúrgico. A taxa geral de complicações foi de 18.6% (27/145) e a taxa de complicações que necessitaram uma segunda intervenção cirúrgica, designadas de complicações maiores, foi de 3.4% (5/145), sendo a lesão subsequente do menisco, a falha do implante e a infeção. As complicações menores, definidas como aquelas que não necessitaram segunda intervenção cirúrgica, ocorreram em 15.2% (22/145) dos casos, sendo a infeção da ferida cirúrgica a mais frequente. A taxa de complicações maiores obtida no presente estudo é comparável a estudos anteriores para outras técnicas cirúrgicas. É possível concluir que uma taxa significativamente baixa de complicações pode ser esperada nesta técnica quando realizada por cirurgiões com experiência na mesma.
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Rosa, Vívian Cristina [UNESP]. "Análise do exercício físico e eletroestimulção do músculo tibial cranial após neurorrafia término-lateral do nervo fibular em ratos." Universidade Estadual Paulista (UNESP), 2015. http://hdl.handle.net/11449/132683.
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000854927.pdf: 2161442 bytes, checksum: 50cc5e59721b70f8efc92d4e58851ccb (MD5)Lesões de nervos periféricos podem ser extremamente incapacitantes. Nesse contexto, a microcirurgia vem apresentando um papel fundamental no tratamento dos pacientes. Entretanto, mesmo com todo refinamento técnico obtido com a microcirurgia, ainda não se obtém total recuperação motora. Tal fato se justifica pela degeneração muscular, atrofia e perdas funcionais geradas pela desnervação. Em âmbito clínico, alguns recursos fisioterapêuticos têm sido sugeridos na tentativa de minimizar as perdas decorrentes do quadro de desnervação. Dentre esses recursos, destacam-se a eletroestimulação e o exercício físico. A utilização da eletroestimulação é justificada por esta ser capaz de minimizar a atrofia durante a desnervação. De maneira diferente, a aplicação do exercício tem como principal justificativa o estímulo na produção de fatores neurotróficos, fato este que poderia potencializar a regeneração axonal e, por seguinte, promover uma melhor reinervação. Todavia, tanto para aplicação da eletroestimulação quanto para execução do exercício físico, existem algumas controvérsias no que se refere aos parâmetros utilizados. O objetivo desse trabalho foi analisar a eficiência da eletroestimulação, do exercício de natação, e da associação entre os dois recursos, na regeneração nervosa após neurorrafia término-lateral do nervo fibular. Para a realização do experimento, os animais foram divididos em 2 grupos controles GC e GD e 4 grupos experimentais GNTL, GNTL+EE, GNTL+N e GNTL+EE+N. Os animais dos grupos experimentais passaram por cirurgia experimental de neurorrafia término-lateral, sendo que em três grupos protocolos pós-cirúrgicos de eletroestimulação, exercício de natação e de associação entre eletroestimulação e natação foram utilizados. Os resultados obtidos demonstraram que a eletroestimulação, o exercício físico e a associação dos tratamentos apresentaram resultados...
Lesions of peripheral nerves can be extremely disabling. In this context, microsurgery has presented a major role in the treatment of patients. However, even with all technical refinement achieved by microsurgery, full motor recovery has not been ensured yet. This can be explained by muscle degeneration, atrophy and functional losses generated by denervation. In the clinical setting, some physiotherapy resources have been suggested in order to minimize losses due to denervation. Among these resources, electrical stimulation and exercise are the main options. The use of electrical stimulation is justified because it is able to minimize the atrophy during denervation. Differently, the application of exercise is justified to stimulate the production of neurotrophic factors, a fact that could enhance axonal regeneration and, next, to promote better reinnervation. However, to both electrical stimulation and exercise there are some controversies regarding the parameters used. The aim of this study was to analyze the efficiency of electrical stimulation, swimming exercise and the association between these two actions, in nerve regeneration after fibular nerve end-to-side neurorraphy. For the experiment, the animals were divided into two control groups GC and GD and 4 experimental groups GNTL, GNTL + EE, GNTL + N and GNTL + EE + N. The animals of the experimental groups underwent experimental surgery of end-to-side neurorraphy and in three post surgical groups the protocols of electrostimulation, swimming exercise and the association between electrostimulation and swimming were used. The results demonstrated that electrical stimulation, physical exercise and the association of the treatments showed superior results compared to GNTL group and the group GNTL + EE + N was superior to treatment isolated groups in nerve and muscle regeneration
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Rosa, Vívian Cristina. "Análise do exercício físico e eletroestimulção do músculo tibial cranial após neurorrafia término-lateral do nervo fibular em ratos /." Botucatu, 2015. http://hdl.handle.net/11449/132683.
Full textAbstract:
Orientador: Fausto ViterboBanca: José de Anchieta de Castro e Horta Júnior
Banca: Amilton Antunes Barreira
Resumo: Lesões de nervos periféricos podem ser extremamente incapacitantes. Nesse contexto, a microcirurgia vem apresentando um papel fundamental no tratamento dos pacientes. Entretanto, mesmo com todo refinamento técnico obtido com a microcirurgia, ainda não se obtém total recuperação motora. Tal fato se justifica pela degeneração muscular, atrofia e perdas funcionais geradas pela desnervação. Em âmbito clínico, alguns recursos fisioterapêuticos têm sido sugeridos na tentativa de minimizar as perdas decorrentes do quadro de desnervação. Dentre esses recursos, destacam-se a eletroestimulação e o exercício físico. A utilização da eletroestimulação é justificada por esta ser capaz de minimizar a atrofia durante a desnervação. De maneira diferente, a aplicação do exercício tem como principal justificativa o estímulo na produção de fatores neurotróficos, fato este que poderia potencializar a regeneração axonal e, por seguinte, promover uma melhor reinervação. Todavia, tanto para aplicação da eletroestimulação quanto para execução do exercício físico, existem algumas controvérsias no que se refere aos parâmetros utilizados. O objetivo desse trabalho foi analisar a eficiência da eletroestimulação, do exercício de natação, e da associação entre os dois recursos, na regeneração nervosa após neurorrafia término-lateral do nervo fibular. Para a realização do experimento, os animais foram divididos em 2 grupos controles GC e GD e 4 grupos experimentais GNTL, GNTL+EE, GNTL+N e GNTL+EE+N. Os animais dos grupos experimentais passaram por cirurgia experimental de neurorrafia término-lateral, sendo que em três grupos protocolos pós-cirúrgicos de eletroestimulação, exercício de natação e de associação entre eletroestimulação e natação foram utilizados. Os resultados obtidos demonstraram que a eletroestimulação, o exercício físico e a associação dos tratamentos apresentaram resultados...
Abstract: Lesions of peripheral nerves can be extremely disabling. In this context, microsurgery has presented a major role in the treatment of patients. However, even with all technical refinement achieved by microsurgery, full motor recovery has not been ensured yet. This can be explained by muscle degeneration, atrophy and functional losses generated by denervation. In the clinical setting, some physiotherapy resources have been suggested in order to minimize losses due to denervation. Among these resources, electrical stimulation and exercise are the main options. The use of electrical stimulation is justified because it is able to minimize the atrophy during denervation. Differently, the application of exercise is justified to stimulate the production of neurotrophic factors, a fact that could enhance axonal regeneration and, next, to promote better reinnervation. However, to both electrical stimulation and exercise there are some controversies regarding the parameters used. The aim of this study was to analyze the efficiency of electrical stimulation, swimming exercise and the association between these two actions, in nerve regeneration after fibular nerve end-to-side neurorraphy. For the experiment, the animals were divided into two control groups GC and GD and 4 experimental groups GNTL, GNTL + EE, GNTL + N and GNTL + EE + N. The animals of the experimental groups underwent experimental surgery of end-to-side neurorraphy and in three post surgical groups the protocols of electrostimulation, swimming exercise and the association between electrostimulation and swimming were used. The results demonstrated that electrical stimulation, physical exercise and the association of the treatments showed superior results compared to GNTL group and the group GNTL + EE + N was superior to treatment isolated groups in nerve and muscle regeneration
Mestre
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BARAÚNA, JÚNIOR Durval. "Técnica de interligação extracapsular femoro-fabelo-tibial na ruptura do ligamento cruzado cranial em cães – achados clínicos e radiográficos." Universidade Federal Rural de Pernambuco, 2006. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5337.
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Durval Barauna Junior.pdf: 734474 bytes, checksum: 741df0e4a7b2278f3858f4d6f5cb23db (MD5)Made available in DSpace on 2016-08-15T15:51:58Z (GMT). No. of bitstreams: 1 Durval Barauna Junior.pdf: 734474 bytes, checksum: 741df0e4a7b2278f3858f4d6f5cb23db (MD5) Previous issue date: 2006-02-16
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Cranial cruciate ligament rupture (CCLR) is a common disease in dogs that cause joint instability resulting in lameness and rapid development of degenerative joint disease (DJD). The aim of this work was evaluate the results of a new technique of restoration of joint femur-fabelo-tibial stability for the treatment of spontaneous CCLR in dogs, using for this purpose clinical and radiographic features. Sixteen joint of fifteen dogs were operated, six male and nine female, with weight between 2.3 to 53.0 kg (median 8.4 kg) and age between 1 year and 10 months to 11years (mean 6.1± 2.8 years), miscellaneous breed and that the interval between the suspect of lesion by the owners and the surgical procedures varied between 3 to 365 days (mean 123 ±131.5 days), were submitted to the surgical correction though the extracapsular femur-fabelo-tibial interconnection technique. The tibial compression radiographs and the distal displacement of the popliteal sesamóide were 100 per cent efficient and sensitive to the diagnostic of CCLR. In anyone of the sixteen operated joint were observed difficulty or intra-operative complication. In 3 dogs were observed discreet instability (until 2mm) in the cranial drawer test and the tibial compression test, until 180 days; however these dogs didn’t show any damage in the functional evaluation in this period. In another three operated joints a discreet degree of cranial drawer remains until the 30º day, disappearing completely at 90 days. After 30 days of the surgery all the animals showed a improvement (P≤0.05) in the evaluated parameters, with progressive improvement until the 90 days after the surgical. There was no more change statistically significant, although observed clinical improvement until 180 days, when all the animals showed complete functional recovery. The increase (90 and 180 days) in the thigh perimeter weren’t statistically significant. Among 20 joints evaluated (operated or non operated) radiographically between 0 and 180 day, the evolution of degenerative changes was seen in 90 per cent of joints. It was possible conclude that the extracapsular femur-fabelo-tibial interconnection technique evaluated in this experiment is efficient in the immediate stabilization of joint with CCLR, offering functional recovery for reduce the cranial displacement and internal rotation of the tibia, however it not arrest the osteoarthritis progression. Secondarily it can be conclude that: the nylon strands despite its elasticity and plastic deformation can produce a discreet clinical instability, it continue been a good option for joint stabilization because of its low cost, feasibility of sterilization, no production of fistulous tracts and disposability of different diameters with variable resistance adequate for the animal size. Thick strands of difficult management can be arrest through by crimp clamp system with relative facility. Another important conclusion is that like the radiographic tibial compression test, the orthopedic evaluation with tibial compression test and cranial drawer test is 100 per cent efficient in the diagnosis of CCLR, in dogs.
A ruptura do ligamento cruzado cranial (RLCC) é uma afecção comum em cães, geradora de instabilidade do joelho, resultando em claudicação e rápido desenvolvimento de doença articular degenerativa. O objetivo deste trabalho foi avaliar os resultados de uma nova técnica de reconstituição da estabilidade da articulação femoro-tíbio-patelar, como forma de tratamento da RLCC espontânea em cães, utilizando para isto avaliações clínicas e radiográficas. Foram operados 16 joelhos de 15 cães afetados, sendo seis machos e nove fêmeas, com peso variando entre 2.3 a 53.0 kg (mediana 8.4 kg), idades entre um ano e 10 meses a 11 anos (média 6.1 ± 2.8 anos), de raças variadas e onde o intervalo entre a suspeita da lesão por parte dos proprietários e os procedimentos cirúrgicos variaram entre três a 365 dias, (média 123 ± 131.5 dias), que foram submetidos à correção cirúrgica através da técnica de interligação extracapsular femoro-fabelo-tibial. O exame radiográfico sob teste de compressão tibial e a avaliação do deslocamento distal do sesamóide do poplíteo foram 100% eficientes e sensíveis, para o diagnóstico da RLCC. Em nenhum dos 16 joelhos operados foram observadas dificuldades ou complicações trans-operatórias. Em três cães foi observada instabilidade discreta (até 2mm) no movimento de gaveta cranial (MGC) e no teste de compressão tibial, até 180 dias; entretanto estes cães não apresentaram prejuízos na avaliação funcional neste mesmo período. Em outros três joelhos operados um grau discreto de MGC permaneceu até o trigésimo dia desaparecendo completamente no retorno aos 90 dias. Aos 30 dias após a cirurgia todos os animais apresentavam uma melhora (P≤ 0.05) nos parâmetros avaliados, com progressão da melhora até os 90 dias após a cirurgia, a partir daí não houve mais modificação estatisticamente significante, embora tenha sido observada melhora clínica até os 180 dias, quando todos os animais apresentaram plena recuperação funcional. Os incrementos (90 e 180 dias) no perímetro da coxa não foram estatisticamente significantes. Dos 20 joelhos avaliados (operados e não operados) radiograficamente nos dias zero e 180, a evolução das alterações degenerativas foi observada em 90% destes. Foi possível concluir que a técnica de interligação extracapsular femoro-fabelo-tibial avaliada neste experimento é eficiente na estabilização imediata da articulação com RLCC, oferecendo recuperação funcional ao reduzir o deslocamento cranial e a rotação interna da tíbia, porém que não impede a progressão da osteoartrite. Secundariamente pode-se concluir que: o fio de náilon, apesar da sua elasticidade e deformação plástica poder produzir uma discreta instabilidade clinica, este continua sendo uma boa opção para estabilização articular em virtude do seu baixo custo, facilidade de esterilização, não produzir tratos fistulosos, possuir diferentes diâmetros com resistências variadas adequadas ao tamanho do animal. Fios grossos de difícil manuseio podem ser presos através de grampos tubulares com relativa facilidade. Outra conclusão importante é que assim como o exame radiográfico sob o teste de compressão tibial, o exame ortopédico com testes de compressão tibial e de movimento de gaveta cranial é 100% eficiente no diagnóstico da RLCC, em cães.
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Faleiro, Marta Correia da Silva Pires. "Estudo retrospetivo da relação do ângulo do plateau tibial pós-operatório, presença de efusão articular e espessura do tendão patelar com a evolução clinica em canídeos após TPLO." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2019. http://hdl.handle.net/10400.5/17282.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA rotura do ligamento cruzado cranial é a causa mais comum de claudicação dos membros posteriores do cão. O tratamento tem como objetivo restabelecer a estabilidade articular. Uma das técnicas mais utilizadas é a Tibial Plateu Leveling Osteotomy (TPLO). O presente trabalho teve como objetivo avaliar a influência do ângulo do plateau tibial (TPA) pós-operatório, da presença de efusão articular e da espessura do tendão patelar na evolução clínica em cães após TPLO. Foi realizada a análise retrospetiva 19 casos clínicos referentes a um período de cerca de dois anos e meio. Os cães foram sujeitos a TPLO no Hospital Veterinário do Restelo. Os animais foram reavaliados no primeiro e segundo mês após a cirurgia quanto ao grau de claudicação e foram realizadas radiografias para avaliação da espessura do tendão patelar e efusão articular. Para avaliar a influência do TPA pós-cirúrgico os cães foram divididos em dois grupos: TPA ≥ 6º e TPA <6º. Os resultados deste estudo demonstraram que após a cirurgia ocorre um aumento da efusão articular e da espessura do tendão patelar. Em relação ao grau de claudicação foi observada uma diminuição significativa ao longo do período pós-cirúrgico analisado. De acordo com os resultados obtidos podemos concluir que nenhuma das variáveis estudadas influencia o grau de claudicação nos primeiros dois meses após a cirurgia.
ABSTRACT - Study of the relation of the postoperative tibial plateau’s angle, presence of articulation effusion and thickness of the patellar tendon with the clinical evolution in dogs after TPLO - The cranial cruciate ligament’s rupture is the most common cause of hindlimb lameness in the dog. The treatment aims to restore joint stability. One of the most used techniques is the Tibial Plateau Leveling Osteotomy (TPLO). This work had as its purpose to test the influence of the post-op tibia plateau’s angle (TPA), of its presence of articular effusion and the patela’s tendon thickness on the clinical evaluation of post TPLO submitted dogs. Towards that goal, it was conducted a retrospective analysis of 19 clinical cases referring to a period of about two and a half years. The dogs were submitted to TPLO at the Veterinary Hospital of Restelo. The animals were reevaluated in its first and second month after the surgery, about its lameness degree and were performed radiographic exams to check the patella’s tendon thickness and articular effusion. To study the post-surgical TPA influence, the dogs were divided into two groups: TPA ≥ 6º e TPA < 6º. The results of this study demonstrated that after surgery there is an increase in joint effusion and patellar tendon thickness. Regarding the degree of lameness, a significant decrease was observed throughout the postoperative period analyzed. According to the obtained results, we can conclude that none of the studied variables influenced the degree of lameness in the first two months after the surgery.
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Iglésias, Leonor Vital. "Comparação entre técnicas cirúrgicas para a correcção da ruptura do ligamento cruzado cranial em canídeos." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2009. http://hdl.handle.net/10400.5/1508.
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Dissertação de Mestrado Integrado em Medicina VeterináriaO 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.
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Sasaki, Sandra Umeda. "Estudo comparativo entre dois métodos de tratamento da lesão do ligamento cruzado posterior por avulsão óssea na tíbia : amarrilho artroscópico e fixação com parafuso por via posterior aberta." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-19042007-115606/.
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Atualmente, os bons resultados na lesão do ligamento cruzado posterior por avulsão óssea na tíbia associam-se ao tratamento cirúrgico e precoce. A técnica convencional é a fixação com parafuso pela via de acesso posterior do joelho, com abordagem direta das estruturas vasculares e nervosas da região. Neste estudo experimental em 20 joelhos de cadáveres, buscamos apresentar uma alternativa com amarrilho por via artroscópica, comparando-o com a técnica convencional, através da inspeção direta e de testes biomecânicos. Houve falha na fixação de apenas um exemplar de cada método e medidas de deslocamento tibial posterior (p=0,23) e rigidez média (p=0,28) sem diferenças significativas entre as duas técnicas. Concluímos ser o amarrilho artroscópico viável e uma alternativa no tratamento desta lesão.Nowadays, good results on the management of posterior cruciate ligament bony avulsion of the tibia are associated with early surgical repair. The usual method of treatment is the open posterior approach with screw fixation, wich requires popliteal neurovascular bundle direct manipulation. This study presents a new arthroscopic suture and compares it with the conventional technique, using biomechanical tests and direct inspection in cadaveric specimens (20 knees). On both methods there was a fixation fail in one knee. The analisys of tibial posterior displacement (p=0,23) and stiffness (p=0,20) were similar for the two methods. The Arthroscopic suture presented is an effective reattachment method for this fracture pattern.
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Donnez, Mathias. "Planification préopératoire pour ostéotomies autour du genou : d’un modèle numérique tridimensionnel à l’industrialisation de guides patient-spécifique." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0474.
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L’Ostéotomie Tibiale de Valgisation (OTV) par ouverture médiale est un traitement conservatif efficace dans le traitement de la gonarthrose médiale chez le patient jeune et actif présentant un défaut d’alignement du membre inférieur. Ce défaut entraine un déséquilibre dans la répartition des charges transitant dans le genou et est un facteur de risque la gonarthrose. L’objectif est de corriger l’alignement en corrigeant une déformation osseuse du tibia proximal. Une coupe osseuse médiolatérale incomplète partant du bord médial de la métaphyse tibiale et orientée vers l’articulation tibio-fibulaire permet de créer une ouverture sur le bord médial par rotation autour de la charnière latérale, épaisseur d’os non-coupée sur le bord latéral. L’importance de l’ouverture dépend de la déformation osseuse et du stade d’arthrose. La réussite de l’OTV par ouverture médiale est conditionnée par une correction précise, un montage d’ostéosynthèse stable et une charnière latérale préservée pendant l’ouverture. L’objectif de cette thèse était de proposer une méthodologie de planification préopératoire à associer à une instrumentation patient-spécifique réalisée en impression 3D. Cette instrumentation devait permettre d’appliquer la correction souhaitée dans les plans frontal et sagittal mais aussi de préserver la charnière latérale pendant la chirurgie. Nos résultats ont montré, grâce aux études in-vitro et in-vivo réalisées au cours de la thèse, que le guide de coupe patient-spécifique développé permet de reproduire avec précision la planification préopératoire en apportant de la sécurité au geste opératoire tant au niveau de la précision que de la préservation de la charnière latéraleMedial Opening Wedge High Tibial Osteotomy (MOWHTO) is an efficient conservative surgical treatment for young and active patients with moderate medial gonarthrosis and varus lower limb malalignment. Varus malalignment unbalances load distribution in the knee, which is a gonarthrosis risk factor. MOWHTO aims to correct the lower limb alignment by correcting the proximal tibia bony deformity. Incomplete mediolateral cut is performed in the proximal tibia from the medial side of the tibial metaphysis towards the tibiofibular joint, and then opened by rotation around the lateral hinge which is the remaining uncut bone thickness on the lateral side. Amount of the opening depends on the importance of the proximal tibial deformity and on the medial gonarthrosis stage. MOWHTO success remains on precise correction, stable osteosynthesis system and lateral hinge preservation during the opening. Objective of this thesis was to propose a preoperative planning methodology to be associated with 3D printed patientspecific instrumentation. This instrumentation was intended to apply the correction chosen by the surgeon in the frontal and sagittal planes, but also to preserve the lateral hinge during the surgery. Our in-vitro and in-vivo results have shown that the developed patient-specific cutting guide make it possible to accurately reproduce the preoperative planning with security to the surgical gesture by bringing accuracy and lateral hinge preservation
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Skoglund, Björn. "Following the mevalonate pathway to bone heal alley." Doctoral thesis, Linköpings universitet, Ortopedi och idrottsmedicin, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11282.
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The mevalonate pathway is an important biosynthetic pathway, found in all cells of virtually all known pro- as well as eukaryotic organisms. This thesis is an investigation into the use of two drugs, originally developed for different applications, but both affecting the mevalonate pathway, in to models of fracture repair. Using two different rodent models of fracture repair, a commonly used cholesterol lowering drug (statin) and two drugs used to treat osteoporosis (bisphosphonate) were applied both systemically as well as locally in order to enhance fracture repair. Papers I and II investigate the potential of simvastatin to improve the healing of femoral fractures in mice. Papers III and IV explore the use of two bisphosphonates to improve early fixation of stainless steel screws into rat bone. The statin simvastatin lead to an increased strength of the healing cellus. The application of bisphosphonates increased early screw fixation. It seems clear that both drugs have uses in orthopaedic applications. One interesting avenue of further research would be to combine the two classes of drugs and see if we can get the benefits while at the same time diminishing the drawbacks.
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Wilson, Megan L. "Interday and intraday stance analysis variability in dogs with hindlimb lameness and comparison of the effect of dog, surgeon, and TPLO surgical procedure variables on improvement of eight-week post-operative static weight-bearing." Thesis, 2018. http://hdl.handle.net/2097/38827.
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Master of Science in Biomedical SciencesDepartment of Clinical Sciences
James K. Roush
Interday and intraday stance analysis variability in dogs with hindlimb lameness Objective: The purpose of this study was to assess the same day and next-day repeatability of data collected with a Pet Safe Stance Analyzer on animals with naturally-occurring lameness presented for veterinary orthopedic examination. Our hypothesis was that dogs would show consistent repeatability with regards to body weight distribution on the Pet Safe Stance analyzer. Materials and Methods: Interday Variability Trial: Thirty-one consecutive dogs presenting for hindlimb lameness were included. The PetSafe Stance Analyzer was used with the dog standing in their natural standing position with each foot placed in its respective quadrant on the Stance Analyzer. A minimum of 5 valid measurements were collected and averaged to find the mean distribution of weight on each limb. This process was repeated the following day with the same handler and recorder. Intraday Variability Trial: Fifteen consecutive dogs were placed on the Pet Safe Stance analyzer and measurements were collected for each of 5 trials identical to the interday group. Four additional assessment trials followed with reintroduction of the animal to the room at each assessment. Results: Interday Variability Trial: There were no significant differences between Day 1 and Day 2 measured variables except for a significant increase in the Forelimb Symmetry index on Day 2 compared to Day 1. Lin’s Correlation Coefficients % body weight measured on Day 1 compared to Day 2 were significantly correlated on the lame hindlimb (0.524) and contralateral hindlimb (0.733). Intraday Variability Trial: There were no significant differences across trials for measured variables of % weight on the lame hindlimb, contralateral hindlimb, ipsilateral forelimb, or contralateral forelimb. Lin’s Correlation coefficients showed strong correlation between trials for the lame hindlimb (0.682), contralateral hindlimb (0.817), body weight (0.863), and hindlimb symmetry index (0.726). Clinical Significance: A commercial stance analyzer is a repeatable method of measurement of weight-bearing on lame hindlimbs of dogs between days and in repeated trials over one day. Day-to-day forelimb weight-bearing in dogs who are lame on a hindlimb is more variable, likely because of trial to trial changes in weight redistribution from lameness. Comparison of the effect of dog, surgeon, and TPLO surgical procedure variables on improvement of eight-week post-operative static weight-bearing Objective: To compare the effect of surgeon and tibial plateau leveling osteotomy (TPLO) procedure variations on the outcome of TPLO in naturally-occurring cranial cruciate-deficient stifles. Materials and methods: Records from 142 dogs receiving a TPLO were reviewed for information regarding surgical procedure, status of meniscus at the time of surgery, surgeon identity, ACVS diplomate or resident, meniscal release, progression of healing at the progress evaluation based on radiographic interpretation, and complications encountered. The primary outcome measure was static force on the operated limb at recheck on a PetSafe Stance Analyzer ͣ. Results: Recheck tibial plateau angle (TPA) was negatively and significantly correlated with improvement (r=-0.2132, p=0.013). Post-operative, and Recheck TPA’s were all significantly correlated with one another. The amount of TPA change from initial to immediate post-operative values was significantly correlated with the Initial TPA (r=0.628, p<0.001). Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, post-operative TPA, and initial TPA had no significant effect on weight-bearing at recheck. Clinical Significance: TPLO’s show improvement of 4.58% BW on the operated limb at 6-12 week rechecks on a stance analyzer. Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, post-operative TPA, and initial TPA have no effect on surgical outcome.
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Serras, Francisco Maria Pinhão Mateus Lorga. "Abordagem cirúrgica à rotura do ligamento cruzado cranial do cão: relato de casos clínicos." Master's thesis, 2018. http://hdl.handle.net/10437/8552.
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Orientação: Sónia Campos ; co-orientação: Rui OnçaO presente trabalho consistiu em avaliar a utilização de duas técnicas cirúrgicas diferentes (Sutura fabelo tibial lateral e Osteotomia de nivelamento da meseta tibial) no tratamento da rotura do ligamento cruzado cranial em cães, mediante a descrição de quatro casos clínico-cirúrgicos. A rotura do ligamento cruzado cranial é uma das doenças ortopédicas de maior prevalência em cães. O seu quadro evolutivo leva a uma série de alterações articulares que culminam num decréscimo acentuado da sua função e consequente diminuição da qualidade de vida dos animais. Existem várias técnicas cirúrgicas para corrigir esta lesão e limitar a evolução das alterações articulares instaladas. As duas técnicas utilizadas no presente trabalho, assentam em diferentes princípios, sendo que uma é extracapsular e através de um implante tem a finalidade de mimetizar a função do ligamento cruzado cranial. A outra técnica, visa através de uma osteotomia, alterar a biomecânica do joelho, tendo como objetivo abdicar da necessidade funcional deste mesmo ligamento tornando-o redundante. A eleição da técnica consiste na ponderação de diferentes fatores como o elevado ângulo da meseta tibial, o peso corporal e estilo de vida do doente, assim como a disponibilidade financeira do tutor. Nos casos clínicos descritos no presente trabalho, ambas as técnicas utilizadas revelaram resultados satisfatórios, ainda que todos os doentes tenham demonstrado um período de recuperação pós-cirúrgico variável. Fatores como hiperatividade, cuidados como reabilitação física e intervenções cirúrgicas a ambos os joelhos, contribuíram para essa variação, assim como a cronicidade da doença.
The present work consisted in the evaluation of two distinct surgical techniques (Lateral suture system and Tibial plateau levelling osteotomy) for the treatment of the cranial cruciate ligament rupture in the dog, by using the description of four clinical study cases. The cranial cruciate ligament rupture is one of the most common orthopedic diseases in dogs. Its clinical panel leads to a series of joint changes that culminate in the lost of function and, consequently, in lower quality of life for the animals. There are several surgical techniques described in the literature that can be applied in the correction of this injury and limit the progression of the changes in the joints affected. Two of these techniques were used in the present work and rely on different principals. One is an extracapsular technique that by using one implant, acquires the ability to mimic the function of the cranial cruciate ligament. The other technique, demands a change on the biomechanics of the stifle joint and is achieved by an osteotomy. This last technique intends to waver the functional need of the ligament turning it redundant. The selection of one or other technique takes in consideration several factors as the high opening of the tibial plateau angle, the animal weigh, the life style of the dog and the financial possibility of the owner. In the clinical cases presented in this work, both techniques showed positive results, although the patients showed different recuperation times after surgery. Factors like hyperactivity, a physical rehabilitation programm or the intervention on both stifles, contributed for the different outcomes or to the chronicity of the primary problem.