Tibial Plateau Leveling Osteotomy Plate Research Articles

Assessing the Effectiveness of Modified Tibial Plateau Leveling Osteotomy Plates for Treating Cranial Cruciate Ligament Rupture and Medial Patellar Luxation in Small-Breed Dogs.

In small-breed dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), correcting both disorders is are essential for restoring normal gait. However, the previously described surgical treatment, using two osteotomy technique, poses a high risk of fracture and instability. Addressing CCLR and MPL with a single osteotomy and implant was considered superior to the conventional method. Therefore, a pre-contoured modified tibial plateau leveling osteotomy (PCM-TPLO) plate facilitating medial shifting of the proximal tibia was developed. We compared postoperative alignment and strength between this novel plate group and a conventional tibial plateau leveling osteotomy (TPLO) plate group using eight small-breed dog cadavers each. Additionally, we investigated the potential of the novel plate as an alternative to tibial tuberosity transposition. Postoperative alignment and strength were assessed through radiographs and mechanical testing. Measurements including tibial plateau angle, mechanical medial proximal tibial angle, and number of screws within the joint were also analyzed. There were no significant differences in all measured parameters. For the novel plate, the medial displacement ratio of the proximal tibia was confirmed to be approximately 30%, and the result was thought to be appropriate. These findings suggest that the PCM-TPLO plate could be a promising alternative for treating concurrent CCLR and MPL in small-breed dogs.

Photobiomodulation therapy using a class 3b laser does not cause premature rupture of multivesicular liposomal bupivacaine suspensions in a cadaver model.

To determine if photobiomodulation causes a premature release of liposomal bupivacaine (LB) suspensions. A 25-kg mixed breed dog cadaver euthanized for reasons unrelated to this study. In September 2022, a proximomedial tibial incision was made in a dog cadaver, and a tibial plateau leveling osteotomy plate was implanted. A stab incision was made one-half inch distal to the incision, and a tunnel to the plate was created prior to closure of the primary wound. A 3-cc anal sac catheter was advanced through the distal incision until the bulb rested against the face of the plate. Seven treatment groups of treatment power (watts) and total energy (joules/cm2) were defined as: A, 0.5 W, 2.0 J/cm2; B, 0.5 W, 4.0 J/cm2; C, 0.5 W, 6.0 J/cm2; D, 1.0 W, 2.0 J/cm2; E, 1.0 W, 4.0 J/cm2; F, 1.0 W, 6.0 J/cm2; and sham, 0.0 W, 0.0 J/cm2. Ten samples per group of 2 mL of LB were infused into a new catheter and treated percutaneously with a class 3b laser. All samples remained in the catheter for 12 seconds to reflect the longest treatment time. Post-treatment free bupivacaine concentrations were identified with high-performance liquid chromatography. The median free bupivacaine concentration was reported as: sham, 1.89 mg/mL; A, 1.93 mg/mL; B, 2.01 mg/mL; C, 2.05 mg/mL; D, 1.92 mg/mL; E, 2.03 mg/mL; and F, 2.00 mg/mL. There were no differences in median free bupivacaine concentrations between groups (P = .988). Concurrent LB and photobiomodulation are recommended during the postoperative period. The results of this proof-of-concept study suggest that concurrent use of LB and photobiomodulation may be safe, but in vivo studies at similar and stronger photobiomodulation settings are warranted.

Silver-coated tibial plateau leveling osteotomy implants do not improve surgical site infection rates over noncoated implants in a randomized trial in 73 canines.

To evaluate the incidence of surgical site infections (SSIs) in dogs undergoing a tibial plateau leveling osteotomy (TPLO) with silver-coated (SC) and noncoated (NC) TPLO plates. 65 dogs (73 surgical procedures). Client-owned dogs undergoing a TPLO procedure between November 2021 and May 2023 were prospectively enrolled. Dogs were randomly assigned either an SC or NC TPLO plate at the time of surgery. Follow-up was performed at 2 weeks and 8 weeks postoperatively by in-person examination, client questionnaire, or telephone interview. Dogs were followed up 100 days postoperatively for any incisional or implant complications. Among 73 stifles that underwent a TPLO, the overall SSI rate was 8.2% (6/73), with an infection rate of 14.3% (5/35) in the NC group and 2.6% (1/38) in the SC group; this difference was not significant (P = .17). Five of these infections were superficial, and only 1 deep SSI was recorded within the 100-day study period (NC group). Although no significant difference was noted between the SC and NC groups, likely due to a small sample size and overall low infection rate, there was a trend showing a higher infection rate in the NC group. No conclusions can be drawn on the impact of silver coating on deep or organ/space incisional infections due to the low incidence reported in this study (n = 1). Further investigation of SC TPLO implants in a larger and more long-term clinical study is warranted.

In Vitro Assessment of Compression Patterns Using Different Methods to Achieve Interfragmentary Compression during Tibial Plateau Levelling Osteotomy.

The aim of this study was to evaluate and characterize different methods to achieve interfragmentary compression during tibial plateau levelling osteotomy (TPLO). TPLO was performed in 20 canine tibia models (Sawbones, Vashon, Washington, United States) using 3D-printed guides for standardization. Interfragmentary compression was assessed using pressure-sensitive films (Prescale, Fujifilm, Atherstone, United Kingdom). Seven compression methods were tested: (1) Kern bone holding forceps clamping the craniodistal aspect of the TPLO plate to the caudal aspect of the tibia (K); (2) using the distal TPLO plate dynamic compression hole (P); (3) pointed bone reduction forceps engaging the caudal aspect of the proximal bone fragment and the cranial aspect of the tibial crest (F); (4) K + P; (5) K + F; (6) F + P; and (7) K + F + P. Five measurements were obtained for each method, and each bone model was used for two measurements (single method, ± plate). The interfragmentary surface was digitalized and divided into quadrants for standardization and pixel density calculation: Q1, craniomedial; Q2, craniolateral; Q3, caudomedial; and Q4, caudolateral. One-way analysis of variance (ANOVA) and post hoc tests were used for statistical analysis. Mean pressures per quadrant differed significantly between methods (p < 0.001). Methods K, F, and P produced more craniomedial, craniolateral, and caudal compression, respectively. Method K resulted in loss of caudal compression (p < 0.001). Method F + P provided the most even distribution of high interfragmentary compression forces. The addition of method K to this construct (K + F + P) marginally increased cranial compression (p = 0.189 for Q1; p < 0.001 for Q2), but reduced compression caudally (p < 0.001). Method F + P provided more even interfragmentary compression. If method K were used, then combined use with method F + P would be recommended.

Use of a jumbo plate in dogs greater than 50 kg following tibial plateau leveling osteotomy does not prevent increase in tibial plateau angle through convalescence.

To investigate the use of a locking 3.5/4.0-mm jumbo tibial plateau leveling osteotomy (TPLO) plate in maintaining the postoperative tibial plateau angle (TPA) in giant-breed dogs weighing > 50 kg and to report the associated complications. Canine patients weighing > 50 kg that underwent TPLO stabilized with a locking 3.5/4.0-mm jumbo TPLO plate between January 2017 and May 2022. Retrospective case series retrieving postoperative outcomes from the medical records. Healing scores and TPAs were calculated using postoperative and recheck radiographs. Owner-perceived outcomes were obtained via questionnaire. 24 stifles in 22 dogs were included. Postoperative complications were recorded in 11 of 24 cases (45.8%) inclusive of 1 minor, 1 catastrophic, and 9 major complications. A statistically significant increase in TPA over the convalescent period was found. Grade 4 healing was present in 18 of 24 (75%) stifles, while the remainder were scored as grade 3. The use of a locking 3.5/4.0-mm jumbo TPLO plate did not prevent a statistically significant increase in TPA through convalescence. This procedure displayed an unacceptably high complication rate when compared with contemporary literature of TPLO. Despite a high complication rate in this patient population, most complications were successfully managed with medical and/or surgical treatment, and high mean and median healing scores were achieved at the radiographic recheck. Additionally, owner-perceived long-term outcomes were excellent.

Ex vivo biomechanical evaluation of a bone-screw-fastener for tibial plateau leveling osteotomy.

The objective of this study was to investigate the effect of a novel screw type on stiffness and failure characteristics of a tibial plateau leveling osteotomy (TPLO) construct under cyclic loading conditions. The authors hypothesized that bone-screw-fasteners (BSF) would result in superior biomechanical stability compared with locking buttress screws (LBS). Twelve pairs of canine cadaveric pelvic limbs were included in this ex vivo biomechanical study. A TPLO was performed using a 3.5mm locking TPLO plate and stabilized using either LBS or BSF. Cyclic loading was performed for 30,000 cycles at 4Hz with a peak-load of 1000N (50N valley). The cyclic test was then continued by stepwise incremental increase of peak-load at a rate of 75N per 500 cycles until failure. Cycles to failure for LBS (44,260 ± 5,770) and BSF (41,540 ± 7,686) were not significantly different (p = 0.36). Maximum force for LBS (3,134 ± 797N) and BSF (2,940 ± 831N) was not significantly different either (p = 0.58). Dynamic stiffness for LBS (1,778 ± 932 N/mm) and BSF (1,574 ± 677 N/mm) was not significantly different (p = 0.58). Stabilization of the TPLO with BSF provided similar biomechanical stability under cyclic axial loading conditions as the LBS. BSF may be an acceptable alternative to traditional locking screws for TPLO.

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.

Comparação biomecânica entre placa de TPLO modificada, placa bloqueada e construção placa-pino intramedular aplicadas medialmente em modelo de fratura proximal em tíbias sintéticas caninas

ABSTRACT The aim of this study was to develop a modified tibial plateau leveling osteotomy (TPLO) plate and to compare its biomechanical properties with a locking compression plate (LCP) and plate-rod constructs for the stabilization of experimentally induced gap fractures in canine synthetic tibias. The tibial models were assigned to either repair with a modified TPLO plate (Group 1), locking compression plate construct (Group 2), or plate-rod construct (Group 3). The specimens were loaded to failure in axial compression, three-point mediolateral and craniocaudal bending. There was no statistical difference between the three groups regarding stiffness (N/mm) and deformation (mm) in axial compression. The modified TPLO plate achieved load to failure similar to the plate-rod construct in craniocaudal bending. There was no significant difference between groups on mediolateral bending tests regarding load to failure and deformation. Furthermore, there was no significant difference in stiffness between groups 1 and 2. In conclusion, the modified TPLO plate had similar mechanical properties to LCP and plate-rod construct in the axial compression and bending tests. Nonetheless, clinical studies with a large population of dogs are required to determine the value of this new implant in proximal tibial fracture repair.

Long-term outcome of tibial plateau leveling osteotomy using an antimicrobial silver-based coated plate in dogs.

To evaluate long-term outcome using the BioMedtrix™ TPLO Curve® plate in dogs with cranial cruciate ligament disease (CrCLd) treated by tibial plateau leveling osteotomy (TPLO). Retrospective case study. Dogs (n = 323, 337 stifles). Medical records were searched for dogs presented with CrCLd and treated by TPLO with the BioMedtrix™ TPLO Curve® plate for 3.5 mm screws between March 2018 and December 2020. Tibial plateau angles (TPA) were measured on preoperative, postoperative, and follow-up radiographs. Changes in TPA between postoperative and follow-up radiographs (ModTPA) were calculated. Radiographic bone healing was scored. Complications were evaluated. Surgical site infections (SSI) were compared to a control group of dogs treated with the Synthes™ TPLO plate between January and December 2017. Owners of both groups were contacted by telephone at least 1 year postoperatively. The BioMedtrix™ group was composed of 237 dogs (248 stifles), the control group was composed of 86 dogs (89 stifles). In the BioMedtrix™ group, radiographic follow-up was performed at a median of 48 days. Average ModTPA was 1.2°. Bone healing was graded as complete, good, poor, and none in 18%, 62%, 20%, and 0%, respectively. At a median of 786 days postoperatively, minor and major postoperative complications were observed in 6 (2.4%) and 32 (12.9%) cases in this group, respectively. During the first year following the surgery, 23 (9.3%) and 12 (13.5%) cases suffered a SSI, of which 12 (4.8%) and 7 (7.9%) had their implant explanted in the BioMedtrix™ group and the control group, respectively. There was no significant difference between groups for SSI and implant explantations (p = 0.31 and p = 0.29, respectively). The BioMedtrix™ TPLO Curve® plate provided a reliable fixation system for osteotomy healing after TPLO. Bone healing and long-term complication rates were similar to previous studies using other implants. SSI rates were similar between the BioMedtrix™ group and the control group. The antimicrobial HyProtect® coating of the plate did not reduce SSI in this study. The BioMedtrix™ TPLO Curve® plate can be safely used for TPLO. The value of the antimicrobial HyProtect® coating of the plate may be questioned, as SSI rate was not lower in this study compared to the control group or previous reports.

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.

Timing of and risk factors for deep surgical site infection requiring implant removal following canine tibial plateau leveling osteotomy.

To identify demographic risk factors for deep surgical site infection (SSI) requiring tibial plateau leveling osteotomy (TPLO) implant removal and time to implant removal. Four hundred and thirty-three dogs that underwent a TPLO (144 that developed a deep SSI and required implant removal, 289 that did not). Retrospective case-control study. Records of dogs undergoing implant removal due to a deep SSI after TPLO between 2006 and 2018 at two referral centers were reviewed. These records were frequency-matched by date to dogs undergoing TPLO that did not require implant removal. Multivariable analyses tested associations between demographics and implant removal as well as timing of implant removal. Deep SSI and implant removal occurred in 144 of 4813 (3.0%; 95% CI: 2.5, 3.5) dogs treated with TPLO. Implant removal was performed at a median of 279 days (range 49-2394 days) postoperatively. Male dogs (OR 1.8; 95% CI: 1.2, 2.7) and German Shepherd dogs (GSDs) (OR 7.4; 95% CI: 2.6, 20.5) were associated with plate removal. Earlier TPLO plate removal was associated with GSDs only (HR 2.4; 95% CI: 1.4, 4.1). Implant removal due to SSI after TPLO was uncommon, although male dogs and GSDs seemed predisposed to this complication. These demographic risk factors can be used to educate owners regarding perioperative management.

Risk factors for short-term postoperative complications in the 8 weeks after tibial plateau leveling osteotomy in dogs weighing less than 15 kilograms: A retrospective study.

The purpose of this retrospective study was to evaluate the risk factors for short-term postoperative complications in the 8 weeks after unilateral tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament rupture in small dogs weighing less than 15 kg. Medical records were retrospectively reviewed for 90 dogs weighing <15 kg that underwent medial parapatellar arthrotomy with inspection of the meniscus and TPLO performed by the same surgeon between January 2012 and December 2017. The overall complication rate was 4.44% (4/90 dogs). There were four cases of partial incisional dehiscence, none of which required surgical revision. Complications were significantly more likely in dogs that had undergone placement of a 2.4-mm TPLO plate. Overall, the complication rate was less than that in previous studies of dogs weighing > 15kg. In this study, patients in which 2.4-mm TPLO plates were used were more likely to develop postoperative complications. Dogs weighing <15 kg that underwent TPLO had good short-term outcomes with minimal complications. In our study, the overall complication rate after TPLO in dogs weighing <15 kg is less than that historically reported in heavier dogs. Our data suggests that TPLO is a safe treatment option in small dogs with cranial cruciate ligament rupture.

Torsional comparative biomechanical test of modified tibial-plateau-leveling osteotomy plate and locking plate in canine synthetic tíbias

ABSTRACT The objective of this study was to develop a locked tibial-plateau-leveling osteotomy (TPLO) plate and to compare this implant with the conventional bone fixation method using a locked plate to determine bone stabilization against torsion forces. Maximum force, angle at peak torque, and stiffness values were determined. Ten synthetic tibias were used, divided into 2 groups. The results in Group 1 (modified TPLO plate) and Group 2 (locked plate) were assessed using analysis of variance and the means were compared using Tukey’s test at 5% probability. There were significant differences in the angle at peak torque and stiffness. The group Modified TPLO plate had higher mean values of stiffness compared with Group locked plate. Group locked plate showed a greater angle at peak torque compared with Group modified TPLO plate. All constructs failed due to tibial fractures distal to the plate. The modified TPLO plate presented higher stiffness indexes than conventional locked plate in torsion. The locked plate presented greater elasticity than modified TPLO plate having greater angle at the peak of torque.

Influence of fixation systems on complications after tibial plateau leveling osteotomy in dogs greater than 45.4 kilograms (100 lb).

To determine the influence of 3 fixation systems on complications rate after tibial plateau leveling osteotomy (TPLO) in dogs >45.4 kg. Retrospective case series. Dogs (N = 287, 342 stifles) >45.4 kg with cranial cruciate ligament tear treated with TPLO. The medical records of dogs treated with TPLO were reviewed for fixation and postoperative complications, with a follow-up of at least 6 weeks. A random effects logistic regression model was used to evaluate the association between the type of TPLO fixation system and complications. The fixation systems included a 3.5-mm broad TPLO plate alone (8P; 78.4%), a 3.5-mm broad TPLO plate with SOP (String of Pearls) plate (8AP; 14.9%), and a 3.5-mm standard TPLO plate (6P; 6.7%). Among the included stifles, 214 (62.6%) fixation systems were classified as locking, and 128 (37.4%) were classified as nonlocking. The fixation system was predictive of complications. The 8P had the lowest odds ratio for complication among the 3 fixation systems. Odds of developing complications were higher with the 8AP fixation system than with the 8P fixation system. Locking fixation eliminated the association between weight and complication rate. Fixation of a TPLO with the 8AP increased the risk of complications compared with the 8P in this population of large dogs. Locking fixation of TPLO with a 3.5-mm broad TPLO plate alone should be considered in large dogs because it may reduce complications.

Magnetic Resonance Imaging Assessment of Intra-Articular Structures in the Canine Stifle Joint after Implantation of a Titanium Tibial Plateau Levelling Osteotomy Plate.

To determine the effectiveness of magnetic resonance imaging (MRI) in the evaluation of anatomical stifle structures with respect to implant positioning after tibial plateau levelling osteotomy (TPLO) using a titanium plate. Selected sagittal and dorsal sequences of pre- and postoperative MRI (1.0 T scanner) of 13 paired (n = 26) sound cadaveric stifle joints were evaluated. The effect of susceptibility artifact on adjacent anatomical stifle structures was graded from 0 to 5. The impact of implant positioning regarding assessment score was calculated using Spearman's rank correlation coefficient. Sagittal turbo spin echo (TSE)-acquired images enabled interpretation of most soft tissue, osseous and cartilage structures without detrimental effect of susceptibility artifact distortions. In T2-weighted TSE images, the cranial cruciate ligament and caudal horn of the medial meniscus could be evaluated, independent of implant position, without any susceptibility artifact in all specimens. T2-weighted fast field echo, water selective, balanced fast field echo and short tau inversion recovery were most markedly affected by susceptibility artifact. In selected TSE sequences, MRI allows evaluation of critical intra-articular structures after titanium TPLO plate implantation. Further investigations with confirmed stifle pathologies in dogs are required, to evaluate the accuracy of MRI after TPLO in clinical cases in this context.

Protocol changes to reduce implant-associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006-2014).

To determine the influence of a stricter aseptic protocol on implant-associated infection (IAI) rates after tibial plateau leveling osteotomy (TPLO). Retrospective cohort study. Seven hundred three dogs (811 TPLO). Medical records (2006-2014) of dogs with TPLO with a ≥18-month follow-up were reviewed. An established TPLO protocol was altered to include an iodophore-impregnated adhesive drape, cefazolin administration every 90 minutes intraoperatively and then every 4 hours until hospital discharge, orthopedic surgical gloves, triclosan-coated intradermal sutures (instead of staples), soft-padded bandage with mupirocin ointment, use of single-use gloves while handling treated dogs, and placement of an Elizabethan collar. Signalment, affected limb, protocol changes, IAI, time to explant, and culture and susceptibility results were recorded. Data were analyzed by using Fisher's exact test, Wilcoxon rank-sum test, and a multivariable logistic regression model. TPLO plates were removed from 31 dogs (8.5% prechange, 1.3% postchange) because of a suspected IAI. Bacterial culture results from an explanted screw were positive in 26 dogs (7.4% prechange, 0.94% postchange). The odds ratio (OR) of IAI in the postchange cohort was decreased by 88% (OR 0.12, 95% CI 0.05-0.33) compared with the prechange cohort, after controlling for variables. Staphylococcus spp. were isolated from all implants removed from IAI-positive postchange dogs, 4/5 of which were methicillin resistant. No methicillin-resistant isolates were grown from the prechange cohort implants. The protocol tested here decreased IAI rates after TPLO, but most infections diagnosed after its implementation involved methicillin-resistant isolates. The protocol reported here may be used as a guide in clinics seeking to reduce their IAI rates after TPLO. Postoperative infections after implementation of this protocol should be monitored to evaluate its potential impact on the emergence of antibiotic resistance.

Modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angles: Technique and complications in 19 cases

To describe short-term outcomes of a modified cranial closing wedge osteotomy (CCWO) for treatment of dogs with cranial cruciate ligament disease and excessive tibial plateau angle (eTPA). Retrospective clinical study. 18 client-owned dogs (19 stifles) with cranial cruciate ligament disease and eTPA (>34°). A modified CCWO was performed with Kirschner wires as osteotomy alignment aids. A juxta-articular neutral wedge osteotomy equal in angle to the preoperative TPA was performed. Fixation was achieved with a tibial plateau leveling osteotomy (TPLO) plate and tension band wire apparatus (89%) or a TPLO plate (11%). Preoperative and postoperative, and recheck TPA, cranial tibial long axis shift, and major and minor complications were recorded. The mean preoperative TPA (49.5° ± 6.7°) was reduced postoperatively (8.3° ± 4.8°). Four of 19 joints (21%) developed 2 major and 3 minor complications during the intraoperative and follow-up period (577 day mean in-hospital recheck). Two cases were diagnosed with surgical site infections requiring implant removal for resolution. Fixation failure or implant complications were not observed in any dog during the limited radiographic follow-up period. All dogs were sound or recovering as expected, with 15/19 dogs (79%) showing complete radiographic osteotomy healing at their final in-hospital follow-up examination. Modified CCWO should be considered for the treatment of cranial cruciate ligament disease in dogs with eTPA. In this case series, the described technique was associated with uneventful osteotomy healing without implant failures in all dogs, although radiographic follow-up was limited in some cases.

Tibial Plateau Leveling Osteotomy Plate Contouring and Proximal Load Screw Angulation Affect Osteotomy Compression.

To evaluate the effect of contouring a tibial plateau leveling osteotomy (TPLO) plate, the associated angulation of the dynamic compression plate (DCP) hole relative to the long axis of the tibia, and angulation of the screw relative to the DCP hole on the osteotomy compression generated by load screws in a TPLO model. In vitro biomechanical study. Polyoxymethylene (POM) rod and synthetic cortical bone substitute model (n = 9). The distal portion of a Slocum TPLO plate was attached to a horizontally positioned POM rod that was connected to a load cell. A segment of synthetic cortical bone substitute was attached to the end mount of the testing frame and adjusted to conform to the angle of the proximal portion of the TPLO plate. A 3.5 mm cortical bone screw was inserted in the proximal DCP hole and tightened to 1.5 Nm. The peak longitudinal load (N) was recorded. Screw insertion and data collection were repeated for proximal plate angles of 0-40° at 5° increments. A significant increase in the compression generated was observed as the plate angle was increased from 0° to 10°. The compression ceased to significantly increase until the plate was bent more than 20°, after which a significant decrease in compression was noted. A marked reduction in the compression generated occurred at plate angles greater than 30°. Angulation of the DCP hole and screw insertion angle can have deleterious effects on the magnitude of osteotomy compression.

Short-term complications associated with TPLO in dogs using 2.0 and 2.7 mm plates.

The purpose of this study was to evaluate short-term complications associated with the tibial plateau leveling osteotomy (TPLO) procedure in dogs of small and medium sizes. These study findings could then be compared with similar studies in dogs of all sizes. Ninety-eight procedures (82 dogs) using 2 or 2.7 mm TPLO plates were included spanning a 6 yr period with a minimum of an 8 wk follow-up period. The overall complication rate was 36%. Complications were grouped into three categories: intraoperative (2%), those occurring up to 2 wk postoperatively (11%), and those occurring >2 wk postoperatively (30%). Radiographic evidence of delayed healing of the TPLO osteotomy site was the most common complication in the dogs (9%), none of which had clinical signs attributed to delayed healing. Other common complications included patellar tendon thickening (8%) and tibial tuberosity fracture (6%). Seven percent of the complications were considered major (requiring additional surgical intervention). Fifty-two percent of complications did not require treatment. Short-term complications should not dissuade an experienced surgeon from performing the TPLO procedure in small- and medium-sized dogs.