Tibial Plateau Leveling Osteotomy Research Articles

Surgical site infection after 769 Tibial Plateau Leveling Osteotomies.

To report surgical site infections (SSI) after Tibial Plateau Leveling Osteotomy (TPLO), treatment course, associated risk factors, bacterial isolates and antimicrobial resistance. Retrospective clinical cohort study. Six hundred and twenty seven dogs and 769 TPLO procedures. Data from electronic medical records of dogs undergoing TPLO between 2005 and 2015 at a single institution have been retrospectively reviewed. A generalized mixed logistic regression was used to determine possible risk factors. The Chi-Square test of independence was used to examine the relationship between the isolation of multidrug-resistant (MDR) bacteria and the development of major infections undergoing additional surgical treatment. To assess the correlation between number of SSI and number MDR isolate per year, Pearson's correlation coefficient was calculated. The overall complication rate was 19.3% (n = 149). SSI was most frequent with 8.5% (n = 65). Major SSI occurred in 6.8% (n = 52) TPLO (80.0% SSI). Staphylococcus (S.) pseudintermedius (n = 37) and S. aureus (n = 10) were most frequently isolated. Multidrug-resistant bacteria were identified in 2.7% (n = 21) TPLO (32.3% SSI) but were not associated with major SSI (p = 0.426). There was a strong positive correlation between number of MDR isolates per year and number of SSI per year [r (9) = 0.79, p = 0.004]. Factors associated with SSI were previous TPLO in the contralateral stifle (p = 0.02, OR = 2.01, 95% CI = 1.11-3.64) and German Shepherd dogs (p = 0.035, OR = 4.41, 95% CI = 1.11-17.54). The use of non-locking implants was found to be protective (p = 0.02, OR = 0.179, 95% CI = 0.18-0.77). Infection with multidrug-resistant bacteria is an emerging problem in veterinary practice and treatment is challenging. The incidence of major SSI was found to be high but was not associated with the isolation of MDR bacteria.

Comparison of radiographic scoring systems for assessment of bone healing after tibial plateau leveling osteotomy in dogs.

Accurate radiographic assessment of bone healing is vital in determining both clinical treatment and for assessing interventions aimed at the promotion of bone healing. Several scoring systems have been used to evaluate osteotomy changes following tibial plateau leveling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing following TPLO over time (Aim I), and to evaluate the influence of limb positioning on TPLO osteotomy scoring (Aim II). Phase I-A randomized, blinded, prospective study was conducted using similarly positioned postoperative TPLO radiographs from seven dogs taken immediately postoperatively, 6-weeks, and 8-weeks postoperatively. Ten reviewers assessed the radiographs, and five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week postoperative were compared to 8-week postoperative. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score). Phase II-An international group of 39 reviewers was asked to score radiographs from three dogs, taken in different positions, using the VAS grading system. Scores were averaged and comparisons were made for each set. Phase I-The VAS system identified the greatest number of sets correctly (76%), with the least unchanged scores (15%), and 9% incorrect scores. Phase II-All three patients had an increase in the average difference between VAS-scores for differently positioned radiographs compared to similarly positioned radiographs. The magnitude of change between different positions far exceeded the magnitude of comparison of the similarly positioned radiographs from the 6- and 8-week time point. The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. In addition, the positioning of postoperative TPLO radiographs makes a substantial difference in the healing score that is assigned. Care must be undertaken when performing postoperative radiographs in both the clinical and research setting to ensure accurate assessment of bone healing.

Associations between meniscal tears and various degrees of osteoarthritis among dogs undergoing TPLO for cranial cruciate ligament rupture

ObjectiveThe aim of this study was to evaluate the association between meniscal lesions and severity of osteoarthritis (OA) among dogs that underwent Tibial Plateau Leveling Osteotomy (TPLO) for stabilization of cranial cruciate ligament rupture (CrCLR) at the University of Tennessee in 2011–2017.ResultsThere were a total of 252 meniscal tears. Factors associated with diagnosis of medial meniscal tears (MMT) in dogs were severe OA in comparison to no OA (3.8 OR, 2.0–8.0 95% CI, 0.001 p-value), sporting and mixed breed group compared to other breed (3.6 OR, 1.7–7.6 95% CI, 0.004 p-value; 3.2 OR, 1.6–6.6 95% CI, 0.019 p-value, respectively), increasing age (1.1 OR, 1.0-1.2 95% CI, 0.018 p-value), complete CrCLR compared to partial (3.3 OR, 2.1-5.0 95% CI, < 0.001 p-value), and arthrotomy compared to arthroscopy (2.2 OR, 1.4–3.1 95% CI, 0.002 p-value). The factors that did not have significance in predicting MMT were weight, sex, lameness period, and side affected.

Plasma procalcitonin kinetics in healthy dogs and dogs undergoing tibial plateau leveling osteotomy.

Procalcitonin (PCT) is a well-established biomarker for bacterial infection in human patients. We aimed to analyze the kinetics of plasma PCT (pPCT) in healthy dogs and dogs with canine cranial cruciate ligament (CCL) rupture undergoing tibial plateau leveling osteotomy (TPLO). This prospective, longitudinal study included 15 healthy dogs and 25 dogs undergoing TPLO. Hematology, pPCT, and C-reactive protein (CRP) were assessed on 3 consecutive days in healthy dogs and 1 day preoperatively and days 1, 2, 10, and 56 postoperatively. Inter- and intraindividual variability of pPCT were assessed in healthy dogs. Median pPCT concentrations of dogs with CCL rupture preoperatively were compared with healthy controls, and median pPCT concentrations, as well as percentage change postanesthesia, arthroscopy, and TPLO, were compared with baseline. For the correlation analysis, the Spearman rank correlation test was used. Inter- and intraindividual variabilities of pPCT in healthy dogs were 36% and 15%, respectively. Median baseline pPCT concentrations were not significantly different between healthy dogs (118.9pg/mL; IQR: 75.3-157.3pg/mL) and dogs undergoing TPLO (95.9pg/mL; IQR: 63.8-117.0pg/mL). Plasma PCT concentrations were significantly lower immediately post- than preoperatively (P < 0.001). CRP, WBC, and neutrophil concentrations increased significantly on post-OP day 2 and had normalized by day 10. These results indicate that CCL rupture, as well as anesthesia, arthroscopy, and TPLO combined, are not associated with increased pPCT concentrations in dogs with uncomplicated recovery. Considering the high intraindividual variability, individual serial measurements rather than a population-based reference interval should be considered.

Comparison of perioperative serum osteocrin concentrations between surgical techniques in dogs with cranial cruciate ligament rupture

The cranial cruciate ligament (CCL) rupture is a common orthopedic disease in dogs that is usually managed with tibial plateau leveling osteotomy (TPLO) or extracapsular lateral suture (ECLS). Osteotomy is generally associated with some complications, including nonunion. The periosteum plays an important role in bone growth and remodeling. Osteocrin (OSTN), which was recently identified and is involved in bone formation and differentiation, is produced in the periosteum and osteoblasts. The aimed to investigate whether the concentrations of serum OSTN change before and after stifle surgery in dogs and compare the OSTN concentrations in the two surgical techniques (TPLO: n = 20 vs. ECLS: n = 36). The postoperative serum OSTN concentration in the TPLO group was significantly lower than the preoperative value (p < 0.05), while serum OSTN concentrations differed statistically between the preoperative and suture-removal periods. In contrast, no significant differences were observed in the ECLS group. In conclusion, osteotomy affects serum OSTN concentrations during the perioperative period in dogs, which may be related to periosteal injury.

Pelvic limb anesthesia and analgesia in dogs undergoing tibial plateau leveling osteotomy (TPLO): A survey of board-certified anesthesiologists.

To report the locoregional anesthesia and analgesia preferences of veterinary anesthesiologists for use in dogs undergoing a TPLO and determine any association with specialty college, time from board-certification, or employment sector. Cross sectional study. Diplomates of the American (ACVAA) and European (ECVAA) Colleges of Veterinary Anesthesia and Analgesia. An electronic survey was distributed to diplomates and responses were used to determine associations between preferred methods. The survey response rate was 28% (141/500) with 69% (97/141) of ACVAA diplomates and 31% of diplomates with ECVAA (44/141) certification. Peripheral nerve block (PNB) was preferred by 79% (111/141) of all diplomates, lumbosacral epidural (LE) by 21% (29/141), and peri-incisional infiltration (PI) by <1% (1/141). There was no association (p=.283) with specialty college. There was an association (p < .001) with time from board-certification with increased preference for LE when >10-years from certification and PI preferred by only those board-certified >20-years ago. There was an association with employment sector (p=.003) with more academic diplomates preferring LE. Anesthesiologists reported that treatment decisions were affected by various factors including time pressure and surgeon influence. Diplomates of ACVAA and ECVAA prefer PNB as the locoregional method of pelvic limb anesthesia in dogs undergoing TPLO. A greater percentage of newer and private practice diplomates prefer PNB while a larger percentage of senior and academic diplomates prefer LE. Decision making is multifactorial and includes perceived time pressure and surgeon influence. Veterinary anesthesiologists prefer and frequently use PNB in dogs undergoing TPLO and surgeon influence may affect their chosen treatment.

Effects of Angled Dynamic Compression Holes in a Tibial Plateau Levelling Osteotomy Plate on Cranially Directed Fragment Displacement.

To compare angled dynamic compression holes in a tibial plateau levelling osteotomy (TPLO) plate to a commercially available TPLO plate in an ovine cadaveric model. Ovine tibias (40 bones) were mounted on a custom-made securement device and radiopaque markers were placed to aid radiographic measurements. A standard TPLO procedure was performed on each tibia with either a custom-made six-hole 3.5 mm angled compression hole plate (APlate) or a six-hole 3.5 mm standard commercial plate (SPlate). Radiographs were obtained before and after tightening of the cortical screws and evaluated by an observer blinded to the plate. Measurements of cranio-caudal displacement (CDisplacement), proximo-distal displacement (PDisplacement) in relation to the long axis of the tibia, and change in tibial plateau angle (TPA) were determined. CDisplacement was significantly greater in APlate (median 0.85 mm, Q1-Q3: 0.575-1.325 mm) compared to SPlate (median 0.00 mm, Q1-Q3: -0.35-0.50 mm, p < 0.0001). There were no significant differences in the PDisplacement (median 0.55 mm, Q1-Q3: 0.075-1.00 mm, p = 0.5066) or TPA change (median -0.50°, Q1-Q3: -1.225-0.25°, p = 0.1846) between the two plate types. APlate increases cranially directed displacement of the osteotomy in a TPLO procedure without causing TPA change. The reduced interfragmentary distance across the whole osteotomy could improve osteotomy healing compared to standard commercial TPLO plates.

Tibial Plateau Leveling Osteotomy in small and large breed dogs: a comparative retrospective study of complications and outcomes

To compare complication rates and outcomes of small and large breed dogs that had locking plate Tibial Plateau Leveling Osteotomy (TPLO) performed due to cranial cruciate ligament disease during the same time period at a single institution and identify potential influencing factors. 136 cases with TPLO performed at a single institution between January 2013 and December 2015 were retrospectively reviewed. Dogs were grouped by plate sizes (2.0, 2.4, 2.7, 3.5 and 3.5 broad) and by small breeds (2.0-2.7 plate sizes) and large breeds (3.5 plates). Potential influencing factors on lameness and complications were recorded from the database and measured on radiographs and statistically compared. Small dogs experienced fewer complications than large dogs (10% vs. 22%) and not a single major complication. Small dogs were significantly less lame at recheck and at long-term follow-up. Progression of bone healing had an influence on the lameness grade of dogs at recheck after TPLO. Distance of the most proximal screw from the joint was identified as a risk factor for implant failure. The width of the patella ligament correlated with body weight and uniformly increased 2.4 times after TPLO. TPLO in small breed dogs has a lower overall complication rate than in large breed dogs. The TPLO plate should always be placed as close to the joint as possible to reduce the risk of implant failure. TPLO can be recommended as treatment for cranial cruciate ligament rupture (CCLR) in dogs of all sizes.

Metal reactivity is present in dogs with tibial plateau leveling osteotomy and total hip replacement implants

Determine whether dogs with well-functioning orthopedic metal implants can develop metal reactivity. Client-owned dogs that had tibial plateau leveling osteotomy (TPLO) or total hip replacement (THR) implants for 12 months or more and control dogs with no implants. Lymphocyte transformation testing was performed by exposing peripheral blood lymphocytes to nickel (Ni), chromium (Cr), cobalt (Co), or a combination of these metals. Lymphocyte proliferation was assessed with flow cytometry. Lymphocyte stimulation indexes (SIs) were calculated. A SI > 2 was considered reactive. Median SIs of dogs in response to metal exposure were compared statistically. Samples from 10 dogs with TPLO, 12 dogs with THR, and 7 control dogs were analyzed. Six dogs out of 22 with metal implants had a reactive SI to 1 or more metals, while 2 of 7 control dogs had a SI > 2 when exposed to nickel only. When all metals were considered, no differences in metal reactivity were found between TPLO, THR, and control groups. Metal reactivity is present in dogs and can be identified using lymphocyte transformation testing. Reactivity to Ni is present in dogs with and without metal implants. Reactivity to Co and Cr occurs in some dogs with metal implants.

The Effect of Location of a Unicortical Defect on the Mechanical Properties of Rabbit Tibiae: A Model of the Distal Jig Pin Hole in Tibial Plateau Levelling Osteotomy.

The aim of this study was to determine the effect of a unicortical defect at either the mid-diaphysis (MD) or distal metaphysis (DM) on the torsional properties of tibiae in an in vitro rabbit model, and to further examine optimal distal jig pin position for the canine tibial plateau levelling osteotomy (TPLO) procedure. Thirty-eight tibiae from 19 skeletally mature female New Zealand White rabbits were assigned to one of three groups; Group 1: intact, Group 2: MD defect and Group 3: DM defect. Defects were created using a 1.6 mm Ellis pin. Pure torsion was applied to each sample and peak torque and angular displacement recorded. All tibiae fractured in a spiral configuration. Fracture lines involved the defect in 33% of the MD samples and 0% of the DM samples. No differences were detected for peak torque and stiffness between groups. However, energy (mean ± standard deviation) was significantly reduced (p = 0.028) in the MD group (0.18 ± 0.07) relative to the intact tibia group (0.31 ± 0.14). Angle was also significantly reduced (p = 0.040) in the MD group (0.17 ± 0.05) compared with the intact group (0.23 ± 0.07). Placement of a DM defect had no significant effect on mechanical properties of the rabbit tibiae. Defects placed in the MD significantly reduced energy and angle in comparison to intact samples. No significant difference in peak torque or stiffness was observed between groups. If canine tibiae were similarly affected, our findings suggest jig pin placement in the DM to have a lesser effect on the torsional properties of the tibiae.

Evaluation of urine specific gravity as a predictor of hypotension during anaesthesia in healthy dogs premedicated with dexmedetomidine

ObjectiveTo investigate the relationship between urine specific gravity (USG) and the risk of arterial hypotension during general anaesthesia (GA) in healthy dogs premedicated with dexmedetomidine and methadone. Study designProspective clinical cohort study. AnimalsA total of 75 healthy client-owned dogs undergoing GA for elective tibial plateau levelling osteotomy. MethodsAfter placing an intravenous catheter, dogs were premedicated with dexmedetomidine (5 μg kg–1) and methadone (0.3 mg kg–1) intravenously. After induction of GA with alfaxalone to effect, the bladder was expressed and USG measured. An arterial catheter was placed, and residual blood was used to measure packed cell volume (PCV) and total protein (TP). GA was maintained with isoflurane vaporised in oxygen and a femoral and sciatic nerve block were performed. Arterial blood pressure < 60 mmHg was defined as hypotension and recorded by the anaesthetist. Treatment for hypotension was performed in a stepwise manner following a flow chart. Frequency of hypotension, treatment and response to treatment were recorded. Logistic regression modelling was used to assess the association between USG, TP and PCV and incidence of perioperative hypotension; p < 0.05. ResultsData from 14 dogs were excluded. Of the 61 dogs, 16 (26%) were hypotensive during GA, 15 dogs needed treatment of which 12 were responsive to a decrease in inhalant vaporiser setting. The logistic regression model was not statistically significant (p = 0.8). There was no significant association between USG (p = 0.6), TP (p = 0.4), PCV (p = 0.8) and arterial hypotension during GA. Conclusions and clinical relevanceIn healthy dogs premedicated with dexmedetomidine and methadone and maintained under GA with isoflurane and a femoral and sciatic nerve block, there was no relationship between the specific gravity of urine collected after premedication and intraoperative arterial hypotension.

Evaluation of the efficacy of a cannabidiol and cannabidiolic acid rich hemp extract for pain in dogs following a tibial plateau leveling osteotomy.

To determine the impact of a cannabidiol (CBD) and cannabidiolic acid (CBDA) rich hemp product on acute post-operative pain in dogs following a tibial plateau leveling osteotomy (TPLO), and to evaluate for changes in early bone healing, serum chemistry profiles, and complete blood counts. In this randomized, placebo controlled, blinded clinical trial, 44 client-owned dogs were assigned to receive either a CBD/CBDA product dosed at 2-2.5 mg/kg PO every 12 h or a placebo for 4 weeks following a TPLO. Variables evaluated before (week 0), and at 2 and 4 weeks post-operatively included standardized veterinary assessments for pain score, weight-bearing, and lameness, the Canine Brief Pain Inventory (pain interference score-PIS, pain severity score-PSS), and serum biochemistry. Complete blood counts were performed at weeks 0 and 4. Additionally, orthogonal radiographs evaluating the degree of healing were taken at week 4. A mixed model analysis, analyzing changes of variables of interest from enrollment baseline to all other time points was utilized, with a p-value ≤ 0.05 considered significant. Of the 44 enrolled patients, 3 were lost to follow up and excluded from analysis. No significant differences were noted between placebo (n = 19) and CBD/CBDA (n = 22) groups at any point in pain score, degree of lameness, degree of weight-bearing, PIS, PSS, or radiographic healing of the osteotomy. A significant finding of elevation of ALP above normal reference range in the treatment group was identified (p = 0.02) and eosinophil count was affected by treatment (p = 0.01), increasing from baseline in placebo and decreasing in treatment groups. Finally, a significant difference (p = 0.03) was noted at 2 weeks post-operatively where 4 patients in the placebo group and no treatment patients received trazodone to facilitate activity restrictions. Use of a CBD/CBDA rich hemp product dosed at 2-2.5 mg/kg PO every 12 h did not have a significant impact on pain or delay early bone healing. A statistically significant increase in ALP, decrease in eosinophils, and reduced use of trazodone was identified in the treatment group.

Comparison of patellar position and moment arm between tibial plateau leveling osteotomy and cranial closing wedge ostectomy: An ex vivo study.

Tibial plateau leveling osteotomy (TPLO) and cranial closing wedge ostectomy (CCWO) are common treatments for cranial cruciate ligament disease. These two techniques mainly differ in whether the proximal tibial fragment contains the attachment site of the patellar ligament. Currently, no reports compare how these techniques affect the patellofemoral joint. This ex vivo study aimed to compare the effects of TPLO and CCWO on the patellar position and moment arm in healthy Beagles. TPLO and CCWO were performed on each stifle in six cadavers of Beagles. Pre- and postoperative mediolateral radiographs with the stifle angle at approximately 90° were obtained. The modified Blumensaat index (MBI), patellar ligament length to patella length ratio (PLL:PL), and patellar moment arm (PMA) were measured in each radiograph. Mixed-model multiple regression analyses for the MBI, PLL:PL, and PMA, with the surgical procedure as the independent variable, were then performed. The joint angle was included as an independent variable for MBI and PMA. The PLL:PL was decreased after TPLO. Additionally, the PLL:PL after TPLO was significantly lower than that after CCWO. The MBI decreased with flexion. Postoperative MBI values were reduced for both procedures, with lower values after CCWO than after TPLO. The PMA values decreased with flexion. Postoperative values for both methods were reduced in the PMA, with the values being lower after CCWO than after TPLO. Both TPLO and CCWO affect the patellofemoral joint. Compared with TPLO, CCWO produced more excellent downward traction on the patella. Therefore, CCWO may be used to correct the patellar alta and treat cranial cruciate ligament disease.

脛骨高平部水平化骨切り術実施後の脛骨前方引き出し兆候に関する検討

Although it is considered that tibial cranial drawer signs (TCDS) do not disappear with tibial plateau leveling osteotomy (TPLO), in some cases, this may occur and is presumed to be due to periarticular fibrosis; however to our knowledge, no reports have confirmed the disappearance of TCDS after TPLO. Here, we aimed to identify factors influencing the presence/absence of TCDS after TPLO. Thirty-five canine stifle joints requiring TPLO for cranial cruciate ligament rupture were assessed preoperatively, immediately postoperatively, and each month for 3 months following surgery. The cases were classified as those in which TCDS disappeared (13 stifles, disappeared group) and those in which TCDS remained (22 stifles, residual group). The osteoarthritis (OA) score at each postoperative time point was subtracted from the preoperative OA score (variation in OA score). There were no differences between the two groups, except in the preoperative OA scores (which were higher in the disappeared group). Significant increases in the variations in OA score were observed over time in both groups; these variations were significantly higher in the disappeared than in the residual group at 1, 2, and 3 months postoperatively. Disappearance of TCDS after TPLO is associated with a higher degree of OA progression, suggesting involvement of OA progression factors and periarticular fibrosis.

Pelvic limb anesthesia and analgesia in dogs undergoing tibial plateau leveling osteotomy (TPLO): a survey of board-certified anesthesiologists

Introduction: The purpose of this study was to investigate and report on the preferred pelvic limb analgesic technique of board-certified anesthesiologists when managing dogs undergoing tibial plateau leveling osteotomy (TPLO).

Evaluation of Gabapentin in the Treatment of Postoperative Pain after a Tibial Plateau Levelling Osteotomy in Dogs

Abstract Objective Pain management is an essential component of perioperative patient care. Multimodal pain management strategies have the potential to provide more effective analgesia than a single drug. The objective of this study was to evaluate the use of gabapentin as an adjuvant to carprofen for the management of postoperative pain following tibial plateau levelling osteotomy surgery. Materials and Methods The study included 20 adult dogs with unilateral cranial cruciate ligament disease, assigned to one of two postoperative treatment groups, receiving either carprofen (4.4 mg/kg orally every 24 hours) or carprofen plus gabapentin 20 mg/kg, orally, every 8 hours beginning the night prior to surgery and continuing for 14 days postoperatively. The patients were blindly assessed postoperatively using the Short Form of the Glasgow Composite Measure Pain Scale (GCMPS-SF) and limb function measured by pressure platform gait analysis. There was no difference in body weight, age, affected hindlimb or sex between groups. Result No differences were found in (GCMPS-SF) pain assessments; after surgery, a (GCMPS-SF) more than or equal to 6 was documented in four dogs (two dogs in each group) and no dog required rescue analgesia more than once. Conclusion In this population of dogs, the addition of oral gabapentin at the dose and frequency studied did not improve subjective or objective outcome measures for perioperative pain control following tibial plateau levelling osteotomy surgery.

Effect of tibial plateau leveling osteotomy on mechanical tibial axis shift in dogs: two dimensional bone study in sagittal plane

To determine the tibial axis shift (TAS), change in tibial plateau angle (TPA), and the position of the tibial articular surface after tibial plateau leveling osteotomy (TPLO) simulation in the tibiae of dogs, tibias of 91 dogs from 23 different breeds were used. The TPA, tibial length, midshaft width, medial tibial condyle length, and distances between the tibial axis (TA) and cranial-most point of the medial condyle were measured on the tibial images. After simulated TPLO, all measurements were retaken. Paired t-tests were used to compare pre- and postoperative variables. Pearson correlation analysis was conducted to assess whether the difference between pre- and postoperative TAS was related to tibial length, tibial width, medial condyle length, and/or the degree of TPA rotation. The results showed that TPLO shifted the cranial-most point of the medial condyle caudally and distally, and the caudal-most point caudally and proximally. These shifts resulted in significant differences between pre- and postoperative distances between the TA and the cranial-most point and its percentage to the medial condyle length. It is concluded that the TPLO led to caudal TAS and altered the position of the articular surface of the medial condyle with respect to the distal part of the tibia.

Efficacy of dexmedetomidine as adjuvant to bupivacaine in femoral-sciatic nerve blocks in dogs undergoing tibial plateau levelling osteotomy (TPLO)

The aim of this randomized, prospective clinical study was to evaluate the efficacy of dexmedetomidine combined with bupivacaine on sciatic and femoral nerve blocks in dogs. Thirty dogs were selected for elective unilateral tibial plateau levelling osteotomy, and each subject was assigned randomly to receive perineural bupivacaine 0.5% (0.1 mL/kg) and intramuscular dexmedetomidine (0.5 μg/kg) in the BDs group, perineural bupivacaine 0.5% (0.1 mL/kg) plus dexmedetomidine (0.5 μg/kg) in the BDloc group, and perineural bupivacaine 0.5% (0.1 mL/kg) plus intramuscular administration of saline solution the in Bupi group. Nerve blocks were guided by electrolocation. The main intraoperative parameters were registered 10 min before the start of surgery (BASE) and during the skin incision (SKIN), the osteotomy (BONE) and the suture (SUTURE). At 2, 4, 6, 8, 10, 15, 20 and 24 h after blocks, the Glasgow Composite Pain scale (GPCs) was used to identify the degree of pain during the postoperative period. Patients with scores ≥5/20 received rescue analgesia and were excluded. Furthermore, heart rate, mean arterial pressure, footstep capacity, reaction to wound touch and femoral and sciatic skin sensitivity were registered. Parametric data were compared at each time point of the study with the one-way ANOVA for repeated measures and Fisher's test for yes/no variables analysis (p < 0.05). No subject required intraoperative rescue analgesia. In BDloc group, the GCPs score was <5/20 for all dogs at all times of the study, and 70% of dogs did not need systemic analgesia. In the Bupi and BDs groups, 100% of subjects achieved a score ≥ 5/20 between 8 and 10 h after the blocks, and 100% of subjects showed femoral and sciatic skin sensitivity and required rescue analgesia within 10 h. Our results showed that the addition of dexmedetomidine as an adjuvant to bupivacaine in SF blocks may prolong the sensory block and ensure sufficient analgesia for up to 24 h in dogs undergoing TPLO surgery.

Impacts of tibial plateau levelling osteotomy on the tibial insertion of the medial collateral ligament of the canine stifle joint – A cadaveric study

ObjectiveThe aim of this study was to assess the potential consequences of tibial plateau levelling osteotomy (TPLO) for the medial collateral ligament (MCL) tibial insertion (TI) with a particular focus on the effects of the TPLO planning technique and of the size of saw blade. Study designEighty-six stifle joints were collected from 43 canine cadavers and dissected free of soft tissue to expose the MCL. The MCL insertion sites were first identified with Chinese ink on intact stifle joints, and then marked with radio-opaque barium sulfate after removal of the MCL. Mediolateral radiographs were made of each marked stifle joint and used for TPLO digital planning. For each stifle, planning the TPLO was performed by centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia in group 1, and at the top of the intercondylar tubercles in group 2. Whenever possible, two saw blade sizes were tested in each group. Measurements were taken after TPLO simulation to assess how the procedure would alter the MCL TI. ResultsIn group 1, the integrity of the MCL TI was affected by the TPLO planning in 87.2% of the cases with the small saw blade and in 59.3% of the cases with the large blade, and in group 2, in 94.2% of the cases with the small and 77.9% with the large saw blade. In group 1, the osteotomy line was located above the TI, completely severing the MCL in four cases versus in 11 cases in group 2, while severing occurred in 14/15 cases with the small saw blade. ConclusionDuring TPLO, the osteotomy line transected the MCL TI in the majority of dogs. Centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia and using the largest saw size that preserves tibial tuberosity and patellar tendon insertion seems to be the best way to preserve the MCL TI as much as possible. Further research is needed to evaluate the clinical impact of MCL TI transection.

Vergleichende Langzeitergebnisse zwischen Tibial Plateau Leveling Osteotomy und Modified Maquet Procedure nach Ruptur des vorderen Kreuzbandes beim Hund

This study aims to compare the Modified Maquet Procedure (MMP) with the Tibial Plateau Leveling Osteotomy (TPLO) using long-term follow-up examinations over the period of more than one year (∅ 3,15 years) by clinical examination, radiographic assessment of osteoarthritis progression, and gait analysis by treadmill examination. Additional aim is to review the influence of surgeons' experience in TPLO technique. This clinical study included 67 stifle joints of 50 dogs of different breeds between 20 and 40 kilograms body weight that were treated by TPLO (n = 48) or MMP (n = 19) following the rupture of the cranial cruciate ligament. The TPLO group was further divided into a group operated by two experienced surgeons (TPLO1, n = 25) and a second group operated by several surgeons with different experience (TPLO2, n = 23). Following a post-operative time period of more than one year in the least (mean, 3.15 ± 1.21 years) orthopedic and radiographic examinations as well as separate unilateral and bilateral gait analyses were conducted. In addition, gait analysis data were compared with an orthopedically healthy control group. No significant and clinically relevant differences were observed between the 3 groups in the results of their orthopedic examination.Osteoarthritis progression showed similar values in all 3 surgical groups. On average per year this feature was slightly but statistically significantly lower in the TPLO2 group in comparison to the TPLO1 and MMP groups.Gait analysis during walking exhibited significant differences in bilateral ruptures at the Peak Vertical Force and the Vertical Impulse, especially when compared to the healthy control group. Stance phase duration did not show any significant differences. At trot, no significant differences were found between the 3 surgical groups. Both surgical techniques achieved good clinical, radiological, and gait analysis results in the 3 groups at long-term follow-up, even when compared with a healthy control group. MMP can be considered a rapid feasible alternative to the established TPLO method also bearing satisfactory results in dogs. The degree of the surgeon's experience does not seem to influence the outcome.