Estudio comparativo de las técnicas quirúrgicas, TTA clásica, TTA porous TTA porous con PRP, para el tratamiento de la rotura del ligamento cruzado anterior en el perro

Abstract

One of the most common reasons for consulting in veterinary clinics is the rear canine extremity lameness, and its more frequent orthopaedic pathology, which is the ACL rupture. We all know that the ACL is the most important restraint structure and mechanism in the craniocaudal stability and the knee internal rotation, avoiding the previous tibia displacement, as well as the limitation in the internal rotation and the knee hyperextension. Most of the ruptures have no traumatic origin, considering the trauma as a violent action, but they are the consequence of a degenerative process, affecting the ACL collagen ultrastructure and the subsequent decrease in the knee functionality. For the diagnosis of this pathological process, which usually affects medium and large sized dogs, and appear in any race or sex, we base our analysis in the patient clinical exploration observing the most evident clinical signs, as well as additional evidence like the sign of the anterior drawer, and the use of radiology. With these evidences, we diagnose the ACL rupture or the modifications produced in the joint because of this condition. Later, we carry out the treatment, mainly surgical, with which we try to stabilize the knee joint avoiding the tibia cranial deviation. This doctoral thesis intends to compare the ACL rupture using two tibial tuberosity advancement techniques (TTA), with which in a first group of 15 dogs we used the classic Securos® TTA technique; with another second group of 15 dogs the TTA Porous® technique of a titanium porous wedge and a third group of 15 dogs, the TTA Porous® technique of a titanium porous wedge with PRP administered in the performed osteotomy. We assessed all the cases, before the ACL reparation, one month and three months after the surgery in order to achieve four main objectives. The first objective was to evaluate which of the three groups has clinically experienced a faster functional joint recovery. We noted that the results show that the recovery after three months is very similar in the three groups surveyed, although we discovered that in the third group in which we used the TTA Porous® technique of a titanium porous wedge with PRP administered in the performed osteotomy, slightly improves the results compared with the other groups. The second objective assesses the bony healing in the carried out osteotomies. The radiological results of the bony osseointegration after three months are adequate in the three groups to note that the osseointegration implant is positive in 95.5% of cases, although we can see a larger bony growth inside de porous wedge, in the cases of the third group (the TTA Porous® technique with PRP administered in the osteotomy). The third objective consists in assessing the osteoarthritic changes by means of clinical controls on the first and third moths after the surgical intervention. The results are very similar in the three groups, confirming that the OA does not progress in this period of time in the three groups. The fourth and final objective in this thesis, tries to evaluate and compare the complications resulting from the procedure. We have noted that the complications have been minimal (6,6 % of cases) and are very similar to the ones described in the different present surveys. That is why we can confirm that the classic Securos® TTA and the TTA Porous® techniques, are both of them suitable to solve the instability in dog knee with a ACL rupture.