Menna Nahla

Objective: To create an IA reconstruction system resembling the natural cranial cruciate ligament (CCL) to stabilize CCL-deficient stifles in dogs and to assess the stability and biomechanical properties of the intact canine stifle versus the CCL-deficient stifle stabilized with the proposed reconstruction system. Methods: The study was conducted over a 1-year period (March 2022 to March 2023) on 21 limbs from 14 skeletally mature mixed-breed cadaveric dogs with normal limbs. Cranial cruciate ligament inclination was measured in 21 stifles. Tensile strength and elongation were tested for 7 intact CCLs. Cranial cruciate ligament dimensions and volume were measured in 14 stifles. Seven CCL-severed stifles were stabilized with 3-D–braided silk/polyester (50:50), 2 H-buttons, and FiberWire and tested biomechanically. The graft was studied micromorphologically and biomechanically. Results: Mean CCL dimensions were 7.5 ± 1.3 mm wide, 2.3 ± 0.5 mm thick, and 13.14 ± 2.9 mm long, with a volume of 250.4 ± 107.8 mm ³ . Mean ± SD tensile strength of the 3-D–braided silk–polyethylene terephthalate (S-PET) before (raw S-PET; 645.8 ± 61.1 N) and after (implanted S-PET; 952.6 ± 126.2 N) reconstruction was greater than that for intact CCL (518.4 ± 97.5 N). Mean elongation at break differed among groups: implanted S-PET (90 ± 19.79%), raw S-PET (18.1 ± 2.7%), and intact CCL (49.3 ± 5.3%). Cranial cruciate ligament dogs’ age and body weight strongly correlated with CCL volume. Conclusions: IA reconstruction using 3-D–braided S-PET and H-buttons effectively stabilized CCL-deficient canine stifles ex vivo. Clinical Relevance: This technique offers an alternative to extracapsular or osteotomy-based procedures and warrants further in vivo evaluation of long-term outcomes.

Cranial cruciate ligament (CrCL) rupture is a common orthopedic disorder in dogs, leading to stifle joint instability and progressive osteoarthritis. This study aimed to develop and biomechanically evaluate a novel intra-articular reconstruction system designed to mimic the natural ligament and restore joint stability following CrCL excision. The system consisted of a 3D-printed thermoplastic polyurethane (TPU) graft, cerclage wire, and H-button fixation. Fourteen pelvic limbs from mature mixed-breed cadaveric dogs were used. The inclination angle, dimensions, volume, tensile strength, and elongation of the native CrCL were measured. Seven CrCL-deficient stifles were reconstructed using the proposed system and tested biomechanically. The native CrCL showed a significantly higher tensile strength than the TPU graft; however, the TPU demonstrated a greater flexibility. The reconstruction system successfully stabilized the joint and provided repeatable fixation. Significant correlations were found between CrCL volume and both age and body weight. These findings support the mechanical suitability of the proposed system for ex vivo stifle stabilization and highlight the potential of 3D-printed TPU in ligament reconstruction. Further in vivo studies are recommended to assess long-term performance, including implant integration, tissue remodeling, and clinical outcomes.

Canine stifle is a complex joint with the prevalence of its injuries necessitating ongoing efforts to expand our understanding of the joint. Utilizing anatomy teaching techniques fosters learning strategies and enhances the link to surgeries. The study's goal is to create a real canine pelvic limb specimen that demonstrates the anatomy and surgical approach of the stifle region using the Elnady technique to facilitate veterinary education. The study also aimed to evaluate the characteristics of Elnady-processed specimens and compare them with real and formalin-fixed samples. Normal and well-developed hind limbs of mixed-breed cadaveric dogs underwent plastination using the Elnady technique. Steps of plastination were performed at room temperature and took approximately 45 days. The criteria of the Elnady-processed specimens were then investigated and compared to the features associated with the real, formalized, and plastinated samples. Our Elnady-processed specimens were dry, odorless, durable, and non-irritating. The structures within the plastinated limb were intact with little shrinkage and change in the colors of the muscles, subcutaneous fat, ligament, and tendons. The specimen showed relatively limited flexibility, and thus, the stifle surgical approach required further dissection following the plastination to improve joint exposure. Increasing the plastination processing period (especially the impregnation step) and controlling the temperature factor can enhance the flexibility/quality of the specimen. The Elnady-processed canine pelvic limb specimen is a safe, inexpensive, and durable alternative that can be utilized as a long-term educational and training tool for teaching veterinary students and clinical practitioners the art of basic anatomy and surgical approaches.