Cranial Cruciate Ligament Deficiency Research Articles

Does cranial cruciate ligament repair by tibial plateau leveling osteotomy surgery restore dog’s natural kinematics? – A case series

Tibial plateau leveling osteotomy (TPLO) serves as an effective method of functional stabilization for treating cranial cruciate ligament (CrCL) deficiency. It is not clear if TPLO could restore the natural kinematics of the stifle, hip, and tarsal joints of the affected limb during walking. The hind limb motion between TPLO cases and control groups in eight adult dogs (4 French Bulldogs and 4 Pit Bull Terrier) was recorded by a motion capture system. Three-dimensional (3D) angular motions of the hip, stifle, and tarsal joints—including flexion-extension, abduction-adduction, and rotations—were computed and compared. Significant differences in joint kinematics were observed between TPLO cases and controls. In Case 1, the TPLO case in the French Bulldog showed differences in hip, stifle, and tarsal flexion-extension, abduction-adduction, and internal-external rotation. Asymmetries between affected and unaffected limbs were also detected in hip and stifle motions (up to 43° in some cases). Similar patterns of differences were found in Pit Bull Terriers Case 2 and Case 3, with significant variations in hip, stifle, and tarsal movements. Case 3 did not show hip asymmetries, but notable stifle and tarsal asymmetries were observed. The general daily activity performance for French Bulldogs and Pit Bull Terriers that underwent TPLO procedures was positive. The general daily restricted activity performance for the French Bulldog and Pit Bull Terriers that underwent TPLO procedures was positive. Our findings suggested that natural hind limb kinematics during gait was not restored in TPLO hind limb cases in both breeds.

Double-Cut Tibial Plateau Leveling Osteotomy for the Management of Cranial Cruciate Ligament Insufficiency in Dogs with an Excessive Plateau Angle: Early Clinical Results in 16 Dogs.

To describe a modification of the tibial plateau leveling osteotomy technique wherein a double cut is made in the same plane to level the tibial plateau (double-cut tibial plateau leveling osteotomy [DCTPLO]) for treating dogs with cranial cruciate ligament (CrCL) and excessive tibial plateau angle (eTPA) diseases. The DCTPLO technique was performed on 18 stifles in dogs with CrCL and an eTPA (>34°). This study evaluated the accuracy of preoperative planning, feasibility of the technique, postoperative clinical outcomes, radiographic examinations at the postoperative follow-up for the first 120 days, evolution of the tibial plateau angle (TPA), time of union of the osteotomy, apposition of the implants, and possible complications. The described technique proved to be feasible for clinical application, with reproducibility from preoperative planning. An effective reduction in the eTPA levels was observed. The mean preoperative and postoperative TPA values were 39.4° (36°-43.5°) and 6.3° (3°-13°), respectively. Radiographic healing time was 60 days in 17/18 of stifles. Minor complications (not requiring surgical review or clinical treatment) were observed in 4/18 of stifles. The DCTPLO technique was effective for treating CrCL disease with TPA of up to 43.5° in dogs.

Ex vivo biomechanical investigations of combined extra- and intracapsular stabilization in canines with cranial cruciate ligament deficiency.

Intracapsular reconstruction (ICR) has long been recommended as a treatment for cranial cruciate ligament deficiency (CCLD) in dogs, but it has fallen out of favor due to its inferior long-term functional outcomes. These outcomes may be attributed to the poor stiffness and strength of the graft in the early period before ligamentization is completed. Additional placement of extracapsular sutures to mechanically protect the graft during the ligamentization process may be a viable method to address this problem. However, the biomechanical effect of this combined surgical approach remains unknown. This study aimed to evaluate the 3D kinematics of the CCLD stifle in dogs in response to ICR and combined extra- and intracapsular reconstruction (CEICR). Twelve hindlimbs were collected from nine cadavers of mature dogs. The limbs were tested using a custom-made testing apparatus that reproduces their sagittal plane kinematics during the stance phase. Four statuses of stifle joints were tested, namely, (a) cranial cruciate ligament (CCL) intact; (b) CCLD; (c) CCLD stifle stabilized by CEICR; and (d) CCLD stifle stabilized by ICR only. Three-dimensional stifle kinematics at the 5 instances of the stance phase were measured with an optoelectronic system. The results showed that ICR marginally corrects the increased adduction, internal rotation, and caudodistal stifle joint center displacement that occur as a result of CCLD. CEICR led to better restoration of the stifle kinematics, especially with respect to the internal rotation and cranial translation stabilities. Furthermore, CEICR only resulted in minor excessive restraints on other motion components. The findings indicated that the additional lateral fabellotibial suture offers immediate stability to the stifle, consequently lowering the risk of graft over-elongation in the short term postoperatively. Considering the propensity for the extracapsular suture to degrade over time, further in vivo studies are warranted to explore the long-term effects of the CEICR procedure.

Evaluation of viscoelastic coagulation monitoring parameters and fibrinogen concentrations in healthy dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy.

Evaluation of viscoelastic parameters along with Hct percentages, platelet numbers, and fibrinogen concentrations in healthy dogs undergoing elective stifle arthroscopy and tibial plateau leveling osteotomy (TPLO). These results determine if dogs are in a normal, hypocoagulable, or hypercoagulable state at 4 different time points. Prospective study of 37 client-owned dogs enrolled between February 2, 2022, and November 10, 2022. All dogs received a standardized anesthetic protocol. Patients enrolled in the study underwent stifle arthroscopy using a 3-portal technique with a TPLO performed by board-certified surgeons. Viscoelastic testing, Hct percentage, fibrinogen concentration, and platelet numbers were measured preoperatively, immediately postoperatively, 24 hours postoperatively, and 14 days postoperatively. Stifle arthroscopy and TPLO surgery was not associated with significant effects on viscoelastic coagulation monitoring and fibrinogen concentrations in healthy dogs when comparing the time points. Humans have a high risk of thrombotic events when undergoing elective orthopedic surgery and are often placed on prophylactic antithrombotic medication prior to surgery. Viscoelastic coagulation monitoring in dogs undergoing similar orthopedic procedures has been evaluated in veterinary medicine, but the effects on platelets and fibrinogen concentrations from similar orthopedic procedures and uniform anesthesia protocols have not been documented. Cranial cruciate ligament insufficiency is the most common orthopedic injury in dogs. Treatment requires elective surgical correction for the best results and improved long-term prognosis. The findings of this study suggest that similar preoperative prophylactic antithrombotic intervention is not needed for canine patients.

TTA-Rapid for treating the canine cruciate deficient stifle: Medium to long-term outcome and analysis of risk factors.

This study aimed to evaluate medium to long-term outcomes following treatment of lameness associated with cranial cruciate ligament insufficiency using the tibial tuberosity advancement (TTA)-Rapid technique and to investigate risk factors associated with outcome, including tibial plateau angle (TPA). Patient records for cases treated over an 80-month period were examined retrospectively. An owner postal questionnaire using a clinical metrology instrument (Liverpool Osteoarthritis in Dogs) evaluated the outcome at least 6 months after surgery. A total of 149 procedures were carried out in 120 dogs. Questionnaires were received for 64 dogs (53.3%), with a median follow-up time of 37.5 months. Outcome was judged to be satisfactory, based on frequency of lameness, in 63 (98.4%), while satisfactory outcomes were achieved in 61 (95.3%) based on severity of lameness and in 50 (78.1%) based on mobility score. Statistical analysis showed that age, bodyweight, TPA, meniscal injury and concurrent patellar surgery did not influence outcome, but time to follow-up positively correlated with mobility score. This study involved one surgeon in one centre with outcome data based on the completion of an owner questionnaire, although this used a validated clinical metrology instrument. TTA-Rapid offers a treatment option for cranial cruciate-deficient stifles with a good medium to long-term outcome, and no risk factors were identified to suggest any limitations to its use.

Avulsion of the lateral origin of the gastrocnemius muscle mimicking cranial cruciate ligament deficiency in a dog

AbstractAvulsion of the lateral head of the gastrocnemius is an uncommon diagnosis. Nonetheless, it is a possible cause of lameness in dogs, and it could be misdiagnosed as a cranial cruciate ligament injury if a systematic approach to clinical case management is not followed. The treatment of choice for avulsion of the gastrocnemius is surgical stabilisation. The proximity to the peroneal nerve and scarcity of bone for purchase for stabilisation are surgical challenges. However, the stabilisation by a spiked washer and screw can yield an excellent outcome for return to function.

Cranial closing wedge ostectomies for management of canine cranial cruciate ligament insufficiency: Comparison and geometric modelling of errors

Variants of the cranial closing wedge ostectomy (CCWO) may be used to manage cranial cruciate ligament deficient stifles by reduction of the tibial plateau angle (TPA). Concerns have been raised about predictability of achieving target TPA, limb shortening, axis shift, and distalization of the tibial tuberosity.Landmarks derived from tibial radiographs (n = 50) by 5 observers, along with outlines of the cranial and caudal proximal tibial cortices, were used to simulate six CCWO variants. Tested variants were Slocum-type (n = 2), modified (n = 2), isosceles, and anatomical-mechanical axis (AMA)-based CCWO. Observer specific landmarks were used to model pre- and postoperative errors in TPA measurement. Mean landmarks were used to compare key outcome variables between the variants, as well as modelling errors in positioning the wedge apex.Variants differed markedly in TPA, axis shift, mechanical axis length changes, and tibial tuberosity distalization, with more proximally positioned wedges performing better than distally positioned wedges. Errors in TPA identification appeared partially self-correcting due to altered axis shifts. Craniocaudal shifts in wedge apex position had the most severe effects on outcome variables, especially in shorter tibiae with greater initial TPA values.Recent CCWO variants are likely to achieve a satisfactory postoperative TPA with limited axis shift. The AMA-based CCWO technique appears to influence MA length and tibial tuberosity position the least, and apart from the effect on TPA where no advantage could be discerned, it appeared more robust in the face of wedge apex positioning errors than the other techniques.

Reported accuracy of cranial closing wedge ostectomy variants for management of canine cranial cruciate ligament insufficiency: A systematic review and meta-analysis

Concerns have been raised about the predictability of achieving appropriate tibial plateau angles (TPA), the occurrence of axis shift and tibial length reduction following cranial closing wedge ostectomy (CCWO). The primary objective of this review was to quantify typical errors in achieving target TPA with CCWO, with secondary objectives of assessing axis shift and length reduction. Retrospective or prospective studies of CCWO used as the primary treatment, from any date and in English, were eligible for inclusion. Searches were performed in EMBASE, Ovid MEDLINE, Agricola, Scopus, Web of Science, and CAB abstracts. Risk of bias was assessed, and data were screened for outliers and influential cases. Extracted data from 11 included studies were tabulated and underwent meta-analysis using R. Mean errors in TPA after CCWO ranged from − 0.6–2.9°, indicating the possibility of both under- and over-correction depending on the selected technique. Errors were relatively consistent for technique subgroups. Mean axis shifts ranged from 3.4° to 5.2°, and length reduction ranged from 0.4% to 3.2% of initial length, based on 6/11 and 3/11 studies, respectively. Data had high heterogeneity, many studies had small populations, and reporting standards were inconsistent. Concerns about the predictability of postoperative TPA may be overstated. With the limited data available, limb shortening does not appear to be a clinically important consideration. Axis shift will occur to varying degrees and must be considered during CCWO planning, as it influences the postoperative TPA. Careful choice of CCWO technique may allow clinicians to reliably achieve predictable TPA values.

Blinded, randomized, placebo-controlled study of the efficacy of bupivacaine liposomal suspension using static bodyweight distribution and subjective pain scoring in dogs after tibial plateau leveling osteotomy surgery.

To compare the analgesic effect of surgical wound infiltration with liposomal bupivacaine (LB) to saline placebo in dogs after tibial plateau leveling osteotomy (TPLO). Blinded, randomized, placebo-controlled clinical prospective study. Fifteen client-owned dogs receiving LBand 17 dogs receiving an equivalent volume of saline placebo, all with confirmed unilateral cranial cruciate ligament insufficiency. Preoperatively and up to 48 h after surgery, Glasgow Composite Measure Short Form (CMPS-SF) pain scores were assigned and using a weight distribution platform, static bodyweight distribution (%BWdist ) to the operated limb was measured. Postoperatively, dogs also received carprofen 2.2 mg/kg subcutaneously every 12 h. Rescue analgesia was provided. Treatment success was defined as not requiring rescue analgesia over the 48-h postoperative period. There was no difference between treatment success, postoperative opioid consumption, CMPS-SF pain scores, or %BWdist in dogs that received surgical wound infiltration with LB compared with those receiving saline placebo, following TPLO. There was no linear correlation between CMPS-SF pain scores and %BWdist . For the population of dogs that underwent TPLO and received postoperative carprofen at our institution, LB did not provide an analgesic effect discernable by success/failure analysis, CMPS-SF pain scores, or %BWdist measurement using a weight distribution platform, compared with saline placebo. LB may not provide detectable analgesia during the first 48 h for dogs recovering from TPLO and receiving only postoperative carprofen.

Validation of a novel 3D printed positioning device and dynamic radiographic technique to quantify rotational laxity of the stifle in dogs.

Cranial cruciate ligament deficiency (CCLD) results in internal rotational instability of the stifle (RLS). By contrast, tibial torsion (TT) is an anatomical feature of the tibia along its longitudinal axis. The objective of this study was to validate a dynamic radiographic technique to measure internal rotational laxity of the stifle and differentiate it from TT. Models included transection of the CCL for RLS and an osteotomy for TT. One limb within eight pairs of canine cadaveric hind limbs was randomly assigned to CCLD. The contralateral limb underwent TT, followed by CCLD. Neutral and stress radiographs were taken with the limb in a custom rotating 3-D printed positioning device before and after each modification. The position of the calcaneus on neutral views and the magnitude of its displacement under standardized torque were compared within limbs and between groups. Transection of the CCL increased the magnitude of displacement of the calcaneus by 1.6 mm (0.3-3.1 mm, p < 0.05) within limbs. The lateral calcaneal displacement (dS-dN) tended to be greater when CCLD limbs were compared to limbs with intact CCL. A magnitude of calcaneal displacement of 3.45 mm differentiated limbs with RLS from intact limbs with 87.5% sensitivity and 68.7% specificity. The calcaneus was displaced further laterally by about 3 mm on neutral radiographs (dN) when limbs with experimental TT were compared to those without TT (p < 0.05). A calcaneus located at least 3.25 mm from the sulcus differentiated limbs with TT from intact limbs with 87.5% sensitivity and 87.5% specificity. The technique reported here allowed detection of RLS, especially within limbs. A calcaneus located at least 3.25 mm on neutral radiographs of large dogs should prompt a presumptive diagnosis of TT.

Stifle kinematics in 4 dogs with cranial cruciate ligament insufficiency treated by CORA-based leveling osteotomy.

The purpose of this study was to quantify three-dimensional (3D) stifle kinematics during walking in dogs with complete cranial cruciate ligament insufficiency (CCL-I) treated with a CORA-based leveling osteotomy (CBLO). Four client-owned dogs with unilateral complete CCL-I were prospectively enrolled. Custom digital 3D models of the femora and tibiae were created from pre-and postoperative computed tomographic scans for each dog. Lateral view fluoroscopic images were collected during treadmill walking preoperatively and 6 months after CBLO. Results were generated using a 3D-to-2D image registration process. Pre-and postoperative stifle kinematics (craniocaudal translation, extension angle) were compared to that of the unaffected contralateral (control) stifle. Force plate gait analysis was performed, and symmetry indices (SI) were calculated for peak vertical force (PVF) and vertical impulse (VI). After CBLO, craniocaudal femorotibial motion was reduced by a median (range) of 43.0 (17.0-52.6) % over the complete gait cycle. Median (range) PVF SI was 0.49 (0.26-0.56) preoperatively and 0.92 (0.86-1.00) postoperatively, and VI SI was 0.44 (0.20-0.48) preoperatively and 0.92 (0.82-0.99) postoperatively. CBLO mitigated but did not fully resolve abnormal craniocaudal translation; lameness was substantially improved at 6 months.

Intercondylar width index of the tibia in the dogs: A morphological study

Morphological characteristics of the proximal tibia affect the orthopedic balance of the knee region. Such as the width of the condyles, tibial plateau angle, position of the patella; Intercondylar width is one of these features as well. The objectives of this study are to calculate the intercondylar width index of the tibia (ICWI) in dogs, to determine if there are gender-related differences in ICWI, and to compare the ICWI among the six breeds of dog. For these aims, the tibial bones of 84 dogs from 26 different breeds were used. The radiographs of tibias were taken, and the tibial plateau and intercondylar widths were measured. The intercondylar width index was calculated using the following formula: (intercondylar width/tibial plateau width) *100. The mean intercondylar width index of the dogs was 19.2±2.72. The index values of male and female dogs were 19.1±3.32 and 19.3±2.02, respectively. The significant differences in the index were not determined between male and female dogs, but the significant difference was determined among dogs’ breeds. The dogs in the high-risk breeds had significantly smaller eminence width index value than the dogs in the low-risk breeds related with the non-traumatic cranial cruciate ligament rupture. The results of this study suggested performing further clinical studies to evaluate whether the difference in intercondylar width index among breeds in dogs is associated with cranial cruciate ligament deficiency.

Use of Blumensaat's line for assessment of cranial tibial subluxation in dogs with cranial cruciate ligament deficiency.

This study aimed to determine whether Blumensaat's line, a consistently present radiographic feature delineating the peak of the femoral intercondylar fossa, could be used to assess for cranial tibial subluxation in canine stifles with cranial cruciate ligament disease. Thirty sequential, neutrally positioned, standing-angle stifle radiographs were taken from dogs presenting to a specialist referral centre for treatment of cruciate ligament disease. Thirty similarly positioned radiographs of healthy canine stifles were used as a control group. The radiographs were anonymised and submitted to blinded observers for measurement of the tibial plateau angle, patella tendon angle, Blumensaat's line length and the length of Blumensaat's line cranial to the tibial mechanical axis. Finding that the tibial mechanical axis intersects Blumensaat's line cranial to its midpoint, as a marker of cranial tibial subluxation, had a positive predictive value of 76% for subsequent surgical identification of cruciate ligament disease. Tibial cranial subluxation is detectable and quantifiable radiographically using the intersection of the tibial mechanical axis and Blumensaat's line. Once quantified, this measurement could be used both as a radiographic marker of cruciate ligament disease and to adjust tibial osteotomy procedures to minimise the risk of under advancement of the tibial tuberosity resulting in a persistently unstable stifle.

Treatment of cranial cruciate ligament insufficiency and medial patellar luxation in a small‐breed dog with a true spherical osteotomy

AbstractA 9‐year‐old, neutered, male, Cairn Terrier dog presented with a 3‐year history of progressive pain and lameness of the right hindlimb. After an acute episode of severe pain and non‐weight‐bearing lameness, the dog was referred to our clinic for evaluation. The physical examination was unremarkable; the orthopaedic examination revealed a positive cranial drawer sign and medial patellar luxation grade 3/4. Orthogonal radiographs were taken. Chronic degenerative changes consistent with cranial cruciate ligament insufficiency and medial patellar luxation were noted. Preoperative planning was performed using veterinary preoperative planning software. A spherical osteotomy was performed to level the tibial plateau, correct the medial patellar luxation and improve a valgus deformity. The osteotomy was stabilised using a polyaxial 2.0 tibial plateau levelling osteotomy plate. At the 8‐week postoperative follow‐up examination, the dog had normal weight‐bearing ability without evidence of lameness or pain.

Orthosis in the Conservative Treatment of Cranial Cruciate Ligament Rupture in Dogs – Clinical Observations

Abstract Orthoses are increasingly frequently applied orthopedic devices in veterinary medicine. Injury to the knee joint with a rupture of the cranial cruciate ligament is one of the main indications for the use of orthoses in dogs. This study aimed to present the results of treatment of 30 dogs with injured cranial cruciate ligaments using a knee orthosis and describe the reasons for the conservative treatment of cranial cruciate ligament deficiency. The study was conducted between 2017 and 2019 and involved 30 dogs of various breeds aged 7 to 15, weighing from 2.5 kg to 45 kg, diagnosed with cranial cruciate ligament rupture. In the study, a stifle knee orthosis by the Polish manufacturer Admirał (Pl) was used in 29 dogs and, in one case, an orthosis by Balto (USA) was applied. In each case, the orthosis was selected individually, based on the measurements taken. In the twelfth week of treatment using orthoses, the owners of 25 dogs were satisfied with the results of conservative treatment with the application of orthoses. The caretakers of four dogs observed difficulties in the form of slight lameness at rest after prolonged exertion on the previous day. Running difficulty was observed in one dog. In the conducted study, the knee orthosis demonstrated good therapeutic effects in dogs up to 25 kg. In the majority of dogs, a slight increase in the flexion angle of the treated knee joints was observed, X-ray examinations did not show the degenerative disease progress during the studied period.

Long-term clinical and goniometric follow-up of lateral suture surgery in dogs with cranial cruciate ligament rupture

The aim of this study was to evaluate the complications and the short-, medium-, and long-term outcomes following treatment of cranial cruciate ligament (CCL) rupture in dogs using the lateral fabello-tibial suture technique. The patients were ten dogs of various breeds, 62.5 ± 18.8 months of age, weighing 30.2 ± 3.3 kg, with unilateral CCL rupture. At 2, 6, 12, 24, and 52 weeks after surgery, the dogs were re-evaluated with clinical examination, gait and pain analysis, and radiography. A major complication was identified in one dog (10%), requiring second surgery due to implant failure and destabilisation of stifle joint. Minor complications occurred in two dogs postoperatively (one late meniscal injury and one case of seroma formation). The short-term outcome at two and six weeks postoperatively was considered good in six dogs and satisfactory in four dogs, while the mid-term outcome (between 12 and 24 weeks) was good to excellent in eight dogs and satisfactory in two dogs. All ten dogs had a good to excellent outcome 52 weeks after surgery. The lateral suture technique is generally safe and given the major benefits, such as lower costs, lower technical difficulty, and minimal requirement for specialised equipment, will probably remain a popular and alternative method for treatment of CCL insufficiency in dogs with good degree of owner satisfaction.

Double-cut center of rotation of angulation–based leveling osteotomy for treatment of cranial cruciate ligament deficiency and excessive tibial plateau angle secondary to growth anomaly in two dogs

A 4-year-old female Staffordshire Bull Terrier (dog 1) and a 6-year-old male Yorkshire Terrier (dog 2) were evaluated because of left pelvic limb lameness. Both dogs had a partial rupture of the left cranial cruciate ligament associated with a unilateral excessive tibial plateau angle (51° in dog 1 and 41° in dog 2) secondary to a growth anomaly. Both dogs underwent a double-cut center of rotation of angulation-based leveling osteotomy combining rotation of the proximal fragment with a cranial closing wedge ostectomy. The procedure allowed leveling of the tibial plateau to a final angle of 11° in one dog and 10° in the other without perioperative complications. Both dogs had excellent functional outcomes ≤ 4 months after the surgery. No postoperative complications were reported during follow-up (12 months and 9 months for dogs 1 and 2, respectively). Results for these dogs suggested that double-cut center of rotation of angulation-based leveling osteotomy can be considered as a viable treatment option for cranial cruciate ligament deficiency associated with excessive tibial plateau angle.

Effect of tibial plateau levelling osteotomy and rehabilitation on muscle function in cruciate-deficient dogs evaluated with acoustic myography

The objective of the study was to determine the function of the biceps femoris, quadriceps, gastrocnemius and semitendinosus muscles at the walk in dogs with unilateral clinical cruciate disease and palpable joint instability. To compare function before and after a tibial plateau levelling osteotomy (TPLO) procedure, and after six weeks of subsequent rehabilitation therapy. Fourteen adult client-owned dogs with cranial cruciate ligament deficiency (CCLD). Orthopaedic examination, temporospatial gait analysis and acoustic myography (AMG) recordings were made at three time points: before TPLO, and post-operatively at two and eight weeks. A rehabilitation program started 2 weeks after surgery and was either in-clinic along with in-home rehabilitation or in-home only. Statistics included: repeated measures ANOVA and paired t-tests. Significance was set atP&lt;0.05. When comparing the affected versus the unaffected limb in the CCLD dogs, there were no significant differences found in AMG values between baseline and other time points for the quadriceps and semitendinosus muscles. The gastrocnemius and biceps femoris muscles had a significant change in spatial summation (S) score over time. The gastrocnemius (S) score was not significantly different to the unaffected limb by 8 weeks post TPLO. There was no significant effect of rehabilitation method on S score. Dogs with in-clinic rehabilitation regained more symmetry in thigh circumference versus in-home only. Lameness parameters improved but did not completely resolve in all dogs by week 8 post TPLO. The function of the gastrocnemius muscles in affected limbs was significantly different to normal limbs at baseline and 2 weeks post TPLO but not at 8 weeks. Thigh symmetry, but no other parameters, was improved with the addition of in-clinic rehabilitation.

Locking compression plates versus locking plates for tibial plateau levelling osteotomy in dogs: progression of osteoarthritis, bone healing score and lameness degree

BackgroundThe partial or complete cranial cruciate ligament rupture is a common skeletal disease affecting the stifle joint in dogs. The tibial plateau levelling osteotomy, performed with several synthesis systems, changed the approach to its treatment in dogs. The aim of this study was to compare two types of fixation implants, locking compression system and locking system, evaluating radiographically the progression of osteoarthritis of the stifle joint in dogs with complete cranial cruciate ligament deficiency treated surgically with tibial plateau levelling osteotomy. Moreover, we evaluated bone healing and lameness scores to show biomechanical effects by the implant used. Twenty-eight dogs, who met the inclusion criteria, were divided into two groups. Group A: 14 dogs treated using locking compression plates; Group B: 14 dogs treated using locking plates. Radiographic osteoarthritis scores were evaluated up to 1 year following tibial plateau levelling osteotomy. At each visit, animals were clinically and radiographically assessed. Each dog was evaluated before (T0) and after two (T2) and twelve (T12) months after the surgery. At T2 the stage of bone healing was evaluated. The clinical follow up was performed before the surgery and at 10, 15 and 20 days after the surgery, grading the lameness at walk and trot.ResultsAn increase in osteoarthritis score at T12 versus T0 in both groups was detected. A decrease of the lameness score was observed in Group A versus Group B. The healing score system at T2 showed a lower score in Group A versus Group B.ConclusionsThe osteoarthritis score following tibial plateau levelling osteotomy did not differ when comparing the two different fixation systems. The locking compression system allowed a more rapid functional recovery of the limb and a quicker bone healing than the locking system. Locking compression system should be carefully considered for dogs subjected to tibial plateau levelling osteotomy surgery, because it may reduce the recovery time.

Subsequent meniscal tears following tibial tuberosity advancement and tibial plateau leveling osteotomy in dogs with cranial cruciate ligament deficiency: An in vivo experimental study.

To evaluate the short- and mid-term effects of tibial tuberosity advancement (TTA) and tibial plateau leveling osteotomy (TPLO) on subsequent meniscal tears. Experimental in vivo study. Purpose-bred beagle dogs (n=15). For each dog, the cranial cruciate ligaments were transected; one limb underwent TTA and the other limb underwent TPLO. Orthopedic and radiographic examinations were performed preoperatively and at 12 and 32 weeks postoperatively. Gross evaluation of the stifle joint was performed after euthanasia at 12 (n=10) and 32 (n=5) weeks. Lameness scores were not different between TTA and TPLO limbs at any time point. Radiographic osteoarthritis scores of TTA stifles (1.33 ± 0.49) were higher than TPLO stifles (0.67 ± 0.49) (p=.002) at 12 weeks postoperatively, but there was no difference between groups at 32 weeks postoperatively. Subsequent medial meniscal tears occurred in 6/10 TTA stifles, and 0/10 TPLO stifles at 12 weeks postoperatively and in 5/5 TTA stifles, and 1/5 TPLO stifles at 32 weeks postoperatively. Subsequent lateral meniscal tears occurred in 4/5 TTA stifles at 32 weeks postoperatively. Medial meniscal total gross pathology score was higher in TTA than TPLO stifles. TTA stifles had more articular cartilage damage when compared with TPLO stifles at 32 weeks postoperatively. In this within-dog experimental comparison, subsequent medial meniscal tears and cartilage injury was more prevalent following TTA when compared to TPLO. In an experimental model, TPLO protects the medial meniscus and articular cartilage better than TTA in stifles with complete cranial cruciate ligament deficiency.