Comparison of three imaging modalities used to evaluate bone healing after tibial tuberosity advancement in cranial cruciate ligament-deficient dogs and comparison of the effect of a gelatinous matrix and a demineralized bone matrix mix on bone healing - A pilot study

Abstract

Background: Bone healing and assessment of the state of bone bridging is an important part of clinical orthopedics, whether for fracture healing or for follow up of osteotomy procedures. Tibial tuberosity advancement (TTA) is designed to restore stability in cruciate deficient stifle joints by advancing the tuberosity while creating an osteotomy gap. The current study aims to: 1) compare three different imaging modalities to assess bone healing: ultrasound, radiographs and computed tomography (CT) and, to 2) compare the effect of a gelatinous matrix (GM) versus a demineralized bone matrix mix (DBM mix) on bone healing and bridging of this osteotomy gap in 10 otherwise healthy client-owned dogs with cranial cruciate ligament insufficiency. Osseous union of the osteotomy gap was evaluated with ultrasound, radiographs and CT at one, two, and 3 months postoperatively. Dogs were randomly selected to receive GM or DBM mix to fill the osteotomy gap created during the TTA procedure. Bone healing was assessed subjectively on all modalities as well as scored on radiographs and measured using Hounsfield units (HUs) on CT. Time to heal based on ultrasound, radiographs and CT were statistically compared between groups with significance set at p<0.05. Results: All osteotomy gaps were bridged with bone within 3 months for all modalities. Bridging bone was diagnosed in 5.6 weeks, 10.4 weeks and 9.6 weeks based on ultrasound, radiographs, and CT, respectively, in dogs treated with DBM mix. In dogs treated with GM osseous union was diagnosed in a mean of 4.0 weeks, 9.6 weeks and 7.2 weeks based on ultrasound, radiographs and CT. Ultrasound diagnosed osseous union significantly faster than both CT and radiographs (p<0.001). The dimensions of the newly formed bone differed between treatment groups with the central portion of the bone only providing a small bridge in GM cases. Although bridging of the osteotomy gap occurred earlier in the group that received GM, no significant statistical difference was found between the two groups. Conclusions: Radiographs overestimate the time needed for osseous union of the osteotomy gap. All osteotomy sites healed radiographically within 3 months.