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See detailAdaptation de la procédure de Maquet pour le traitement chirurgical de la rupture du ligament croisé crânial chez le chien
Etchepareborde, Sébastien ULg

Doctoral thesis (2013)

Cranial cruciate ligament rupture (CCLR) is the first cause of osteoarthrosis in dogs. A recent publication revealed that the economic impact of CCLR repair in States was more than one billion dollars ... [more ▼]

Cranial cruciate ligament rupture (CCLR) is the first cause of osteoarthrosis in dogs. A recent publication revealed that the economic impact of CCLR repair in States was more than one billion dollars. Although the CCLR is the most frequent cause of lameness of the hindlimb presented in referral practices, no technique has been shown to be superior to another. The amount of publications on the topic, no less than 160 papers during the last 6 years in 5 of the most important journals in veterinary surgery, reveals the lack of consensus in this field. Intracapsular techniques and physiotherapy are the most common methods used in human medicine to treat a CCLR but these techniques are unsatisfactory in veterinary medicine. The extracapsular techniques used for decades are progressively replaced by dynamic stabilisation whom TPLO and TTA are the most common. The latter technique is an adaptation of a procedure used in human and firstly described in 1976 by P. Maquet. Although the technique does not necessitate any implant in human, the surgery described in dogs uses many implants in order to stabilise the advanced tibial crest. The positioning of these implants necessitates an invasive approach of the medial face of the tibia. The goals of this work are to progressively adapt the TTA originally described in dogs in order to make it as simple as it is done in human medicine. This simplification is in agreement with the actual trend toward minimally invasive surgery. Referring to its inventor in human medicine, we named our procedure in dogs the modified Maquet Technique (MMT). In our first study, the osteotomy described for the TTA was modified in order to create a “cortical hinge” at the most distal part of the tibial crest. Following this new osteotomy, resistance to traction of the tibial tuberosity was evaluated with 3 scenari: 1) intact cortical hinge with figure of 8 wire cerclage to maintain the tibial crest, 2) intact cortical hinge without any mean to maintain the tibial crest and 3) accidentally broken cortical hinge with figure of 8 wire cerclage to maintain the crest. This biomechanical study showed that when the cortical hinge was intact, the wire cerclage did not bring much to the resistance of the montage and that the tibial crest withstood tensions above the forces encountered within the stifle of a dog at walk. However, when the cortical hinge was broken, resistance to traction is significantly lower compared to the two other groups. In a second study, we applied our technique to 20 dogs presented with CCLR. Despite the absence of a force plate to evaluate objectively the recovery, the MMT showed encouraging results and subjectively similar to other techniques of dynamic stabilisation. The mean healing time was less than 7 weeks. No major complication was experienced during the study. A prospective study with force plate would allow to compare our results with those already published on TTA. Thanks to our experience ex-vivo as well as clinical, we realised that the osteotomy, as we described it in order to create the cortical hinge, was not ideal. Indeed, the hole at the distal end of the osteotomy, supposed to prevent propagation of a potential fissure during advancement of the crest, not only did not consistently prevent the apparition of a fissure but was frequently the location of the fracture of the crest. Instead of concentrating all the stress in the bone at the level of the cortical hinge, we designed a longer incision, parallel to the cortex distally, in order to decrease the stress. This third study allowed us to study in depth this new osteotomy. The advancement was proportional to the bodyweight, to the angular deformation and to the width of the cortical hinge. Thanks to this new osteotomy, for every dog, the advancement permitted was well above the usual clinical requirement. Beside, resistance to traction of the tibial tuberosity was superior compared to our previous osteotomy. The fourth study aimed to simplify furthermore the MMT and reach our goal to perform the MMT as simple as the Maquet procedure is performed in human medicine. After a monotonic biomechanical study testing different materials (Kyon titanium cage, porous titanium block or biphasic synthetic bone (BSB) of different porosities), the ones withstanding forces encountered in vivo were submitted to cyclic testing to evaluate their subsidence within the gap of the osteotomy without any mean of fixation. The porous titanium block and the biphasic synthetic bone porosity 60% block were tested cyclically. Along the 200 000 cycles, none of them subsided, showing that the friction was enough to maintain the block within the gap. Moreover, the block of BSB withstood the 200 000 cycles. Our intensive work on tibial tuberosity advancement led us to observe an underestimation of the required advancement with the current template. Although this has never been mentioned in the literature, taking into account this underestimation is mandatory to correctly perform the surgery. We firstly studied the intra and intervariability of patellar tendon angle measurement, reflecting indirectly the measurement of the advancement. Then in a second paper, we quantified the underestimation and we provided tables in order to correct it. [less ▲]

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See detailTheoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture
Etchepareborde, Sébastien ULg; Mills; Busoni, Valeria ULg et al

in Veterinary and Comparative Orthopaedics and Traumatology (2011), 24

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See detailUse of tamoxifen in a German Sheperd dog with sclerosing encapsulating peritonitis
Etchepareborde, Sébastien ULg; Cohen-Solal, Ariel; Heimann, Marianne et al

in Journal of Small Animal Practice (2010), 51(12), 649-653

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