Tibial Plateau Leveling Osteotomy Procedure Research Articles

Short-term outcomes of 43 dogs treated with arthroscopic suturing for meniscal tears associated with cranial cruciate ligament disease.

To describe short-term outcomes and complications in dogs receiving meniscal suturing and concurrent tibial plateau leveling osteotomy (TPLO) with or without augmentation with an extracapsular suture. Retrospective case series. Forty-three client-owned dogs submitted for cruciate ligament disease. Dogs were included if meniscal suturing was performed during or after a TPLO procedure. Criteria included an unstable medial meniscus without evidence of a tear, a caudal vertical longitudinal tear with or without displacement, or if a bucket-handle tear was debrided and the remaining rim was unstable. Stifle stabilization was performed by either a standard TPLO or an augmented TPLO (TPLO + internal brace [IB]). Outcome measures included physical examination findings, radiographs, subjective gait examination, Liverpool Osteoarthritis in Dogs (LOAD) scores, and second-look arthroscopy. Forty-four meniscal repairs were performed in 43 dogs. Five types of meniscal tears were treated employing eight suture materials. Complications were documented in 15 cases (34%). The stabilization technique had a significant impact on the outcome (p = .049): TPLO + IB had a 93.3% success rate and the success rate was 71.4% in the TPLO-only group. Five types of meniscal pathology were addressed successfully in the study, indicating that currently accepted criteria for meniscal suturing in dogs may be overly conservative. The majority of complications were not related to the meniscal suturing itself and did not compromise the outcome. The stifle stabilization technique had an impact on outcome. The authors found arthroscopic meniscal suturing to be practical and successful in this patient population. Postoperative stifle stability had an impact on successful treatment.

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.

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.

Evaluation of a modified radiographic union scale for tibial fractures scoring system in staged bilateral tibial plateau leveling osteotomy procedures and comparison of first and second side radiographic bone healing.

To evaluate the inter- and intra-rater reliability of the tibial plateau leveling osteotomy (TPLO) modified radiographic union scale for tibial fractures (mRUST), a semiquantitative scoring system, as compared with the subjective evaluation of radiographic union for staged TPLOs. Retrospective study. Forty-eightdogs, 96 stifles. Medical records were reviewed for dogs with bilateral cranial cruciate ligament injuries diagnosed at presentation that underwent staged bilateral TPLOs within 6months and had both immediate and recheck postoperative radiographs. Radiographs were anonymized, reviewers were blinded, radiographic union was evaluated subjectively, and TPLO mRUST scores were assigned. The subjective evaluation's intra-rater reliability was 0.72 (Kappa 95% CI 0.65-0.79) and inter-rater reliability was 0.33 (Kappa 95% CI 0.28-0.39). The TPLO mRUST scoring system intra-rater reliability was 0.73 (95% CI 0.68-0.78) and inter-rater reliability was 0.56 (95% CI 0.41-0.68). There was no difference in the degree of bone healing quantified by the TPLO mRUST scoring system (95% CI - 0.1-1.2, P=.09) or subjective evaluation (P=.48) between the first and second side TPLOs. The TPLO mRUST scores were positively correlated with subjective healing (r=0.94, 95% CI 0.92-0.96, P < .0001, and for scores ≥10/12, 99%, 244/246) were subjectively assigned as radiographically healed. The TPLO mRUST scoring system improved inter-rater reliability compared to subjective evaluation of radiographic union. The TPLO mRUST scoring system should be considered as a semiquantitative supplemental tool for evaluating radiographic union.

Evaluation of the risk of patella fracture as the result of decreasing tibial plateau angle following tibial plateau leveling osteotomy.

To evaluate the effect of postoperative tibial plateau angle (TPA) following tibial plateau leveling osteotomy (TPLO) on the risk of patella fracture during the convalescent period. Retrospective study. Fracture group: 20 stifles; reference group: 65 stifles. Medical records were reviewed for stifles with patellar fractures after a TPLO procedure (fracture group) and stifles with >180 days radiographic examination with no complications following TPLO (reference group). Stifle radiographs were masked to group and final TPA (fTPA) was measured, at the time of fracture diagnosis (fracture group) and at last follow-up (reference group), using PACS software. TPAs in the fracture and reference groups were compared using the Wilcoxon rank-sum test. Statistical significance was set at .05. Patellar fractures were diagnosed at a median of 69 days (range 31-189) after surgery. The median duration of follow-up time for the reference group was 471 days (range 180-1868). Median fTPA for the fracture group was 1.4° (range [-10.3]-7.1). Median fTPA for the reference group was 4.1° (range [-3.9]-14.1). The odds of patellar fractures increased by 21.7% (95% CI: 8.6%-35.6%) for every 1° decrease in fTPA. The risk of patella fractures increased as TPAs after TPLOs decreased. Care should be taken to avoid excessive rotation during TPLO to decrease the likelihood of postoperative patellar fractures.

Preoperative planning for tibial plateau leveling osteotomy based on proximal tibial width.

The purpose of this study was to evaluate the applicability and feasibility of a novel preoperative planning method for tibial plateau leveling osteotomy (TPLO) based on the width of the proximal tibia. All TPLO procedures were performed by the same surgeon. In preoperative planning, the width of the tibial crest to the caudal edge of the medial tibial plateau (W) was measured, and the saw blade size that was closest to the distance between the point of the cranial third W and the intercondylar tubercles was selected. The postoperative tibial plateau angle (TPA), distance of eccentricity (DOE), and minimum thickness of the tibial tuberosity remaining cranial to the osteotomy (tibial tuberosity width; TTW) were documented. Complications in the perioperative and follow-up periods were documented. Thirty-one TPLO procedures were performed in 28 dogs, including both small and large breeds. The postoperative TPA was 8.4 ± 2.0° and the DOE was 3.55 ± 2.88 mm. The ratio of the TTW to the preoperative W was 0.27 ± 0.06. There were no major complications, such as fractures of the tibial tuberosity or implant breakage. This preoperative planning method allowed appropriate planning for TPLO with a clear index that was based on the size of the tibia rather than the breed or weight of the dog. This method should be of benefit to the surgeon, whether an expert or a novice, and contribute to the success of TPLO.

Tibial Plateau Leveling Osteotomy for Cranial Cruciate Ligament Rupture in Canines: Patient Selection and Reported Outcomes.

Cranial cruciate ligament (CCL) rupture is one of the most common causes of pelvic limb lameness in dogs. In a CCL deficient stifle, joint lameness develops from cranial tibial translation in relation to the distal femoral condyles. The tibial plateau leveling osteotomy (TPLO) is a well-described surgical procedure that neutralizes tibiofemoral shear force by altering the tibial plateau via a proximal tibial osteotomy, and subsequently restores normal limb function. Current literature for the TPLO was reviewed and used to describe the optimal patient selection and to report clinical outcome with the TPLO in comparison to other surgical options for CCL rupture. The clinical outcomes reported to date, particularly those utilizing objective outcome data, support the TPLO as being able to consistently return dogs to normal limb function with a low risk for long-term morbidity. The TPLO procedure was found to be widely applicable to dogs ranging from small breed to large and giant breed, and does not appear to have some of the limitations that exist with alternative surgical options. This review concludes that the TPLO is an excellent treatment option for any dog with CCL rupture due to the excellent long-term outcome and high rate of owner satisfaction previously reported. Despite these conclusions, it is important to remember that treatment selection for CCL rupture remains dependent on multiple considerations including patient factors, surgeon experience, and costs.

Retrospective study of factors associated with surgical site infection in dogs following tibial plateau leveling osteotomy

OBJECTIVE To identify risk factors associated with surgical site infection (SSI) in dogs following tibial plateau leveling osteotomy (TPLO). DESIGN Retrospective cohort study. ANIMALS 320 dogs that underwent unilateral or bilateral TPLO (n = 405 procedures) between 2007 and 2015 and were reexamined by a veterinarian at least once ≥ 8 weeks after the procedure. PROCEDURES Data were extracted from medical records regarding signalment, TPLO procedure details, medical history of dermatitis, and SSI status. Logistic regression was performed to identify factors associated with SSI development. RESULTS An SSI developed following 34 (8.4%; 95% confidence interval [CI], 6.1% to 11.5%) procedures. Prophylactic antimicrobial administration was provided following 36.8% (n = 149) of procedures. For 71 (17.5%) procedures, the dog had dermatitis at the time of surgery; 12 of these procedures involved dermatitis at the surgical site. The incidence of SSI following the 12 procedures for dogs with dermatitis at the surgical site was 16.7% (2/12 [95% CI, 3.3% to 54.3%]) and was 10.2% (6/59 [95% CI, 4.5% to 21.3%]) for dogs with dermatitis elsewhere; however, these differences in incidence were not significant. On multivariable analysis, German Shepherd Dogs (vs other breeds), meniscectomy (vs no meniscectomy), and attending surgeon having performed ≤ 20 (vs > 20) procedures during the study period were associated with increased odds of SSI. CONCLUSIONS AND CLINICAL RELEVANCE SSI following TPLO was associated with the German Shepherd breed, meniscectomy, and surgeon. Prospective studies are needed to investigate the mechanisms underlying these associations.

Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide.

To assess the accuracy of tibial osteotomy location for tibial plateau levelling osteotomy (TPLO) in the sagittal plane and its effect on the postoperative tibial plateau angle (TPA), when performed without an alignment jig and saw guide. Also, to document the improvement gained with experience. Medical records and stifle radiographs of dogs undergoing TPLO, without the use of an alignment jig and saw guide, by one surgeon were reviewed (2010-2014). Postoperative radiographs were reviewed to record the distance and direction of eccentricity. Postoperative TPA was also recorded. In a series of 401 TPLO procedures, 231 met the inclusion criteria. The absolute distance of eccentricity (DOE) for all dogs was 3.0 ± 1.6 mm. When evaluating surgical experience, the DOE for the final 77 cases (2.72 ± 1.43 mm), the middle 77 cases (3.18 ± 1.49 mm), and the first 77 cases (3.24 ± 1.7 mm) were not significantly different (p = 0.07157). There was a very weak correlation between DOE and postoperative TPA (R = 0.029). The location of the tibial osteotomy when performing TPLO without an alignment jig and saw guide compared favourably with previously documented use of an alignment jig and saw guide. Whilst the location of the tibial osteotomy has a theoretical impact on the postoperative TPA, other factors appear to be of greater importance. Surgeon experience did not result in significant improvement in accuracy up to 231 procedures.

Novel TPLO Alignment Jig/Saw Guide Reproduces Freehand and Ideal Osteotomy Positions.

ObjectivesTo evaluate the ability of an alignment jig/saw guide to reproduce appropriate osteotomy positions in the tibial plateau leveling osteotomy (TPLO) in the dog.MethodsLateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005–Dec 2007 and Nov 2013–Nov 2015 were reviewed. The freehand osteotomy position was compared to potential osteotomy positions using the alignment jig/saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the osteotomy performed. The guide-to-osteotomy fit was categorized by the distance between the actual osteotomy and proposed saw guide osteotomy at its greatest offset (≤1 mm = excellent; ≤2 mm = good; ≤3 mm = satisfactory; >3 mm = poor).ResultsSixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3–4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-osteotomy fit (P = 0.021 and P = 0.047, respectively).Clinical SignificanceThe alignment jig/saw guide can be used to reproduce appropriate freehand osteotomy position for TPLO. Furthermore, an ideal osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.

Exame radiográfico para a avaliação do ângulo de inclinação do platô tibial em cães – critérios para aquisição da projeção radiográfica

The rupture of the cranial cruciate ligament is one of the most common orthopedic injuries in dogs. The increase in the slope of the tibial plateau has been associated with the ligament tear. The tibial plateau leveling osteotomy (TPLO) is one of the recommended surgical techniques, and aims to reestablish the tibio and patellofemoral joints. Radiographic examination is an indispensable tool for surgical planning of various orthopedic techniques that apply the use of corrective osteotomies. Measurement of the initial slope of the tibial plateau from radiographic examination is a prerequisite for the TPLO procedure. The purpose of this study is to describe the techniques for a correct radiographic projection, as well as to highlight the anatomical references used for the measurement of the tibial plateau angle.

Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates. A clinical and radiographic retrospective assessment.

To report clinical experiences with the tibial plateau levelling osteotomy (TPLO) procedure in small breed dogs with cranial cruciate ligament (CCL) disease using specific, conically coupled, 1.9/2.5 mm locking plates and evaluating short-term complications and outcome. Medical records of small breed dogs (<15 kg) that underwent TPLO using 1.9/2.5 mm locking plates were reviewed retrospectively. The preoperative, postoperative and six to eight weeks postoperative tibial plateau angle (TPA) measurements were determined from the radiographic images. Lameness evaluation was assessed subjectively preoperatively and six to eight weeks postoperatively. Sixty-nine small breed dogs (n = 79 stifles) were included in the study. Mean (± SD) preoperative TPA was 29.0 ± 3.4°, postoperative TPA was 5.8 ± 2.5°, and six to eight weeks postoperative TPA was 7.3 ± 4.1°. Sixteen complications occurred in 12 out of 79 TPLO procedures: three were intra-operative (intra-articular screw placement) and 13 were postoperative complications, of which nine were identified as minor complications not requiring surgical reintervention, and four as major complications requiring additional surgical intervention, including tibial tuberosity fracture (n = 1), osteomyelitis (n = 1), screw failure (n = 1), and plate breakage (n = 1). Lameness scores by clinical assessment reduced from a median value of 3/4 preoperatively to 1/4 at six to eight weeks postoperatively. 1.9/2.5 mm locking plates appear to be a valid choice of implant for the stabilization of unilateral TPLO in small breed dogs.

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.

A Pitfall on Postoperative Radiographs in Dogs After Tibial Plateau Leveling Osteotomy

To identify the cause of an occasional radiolucent line in the tibia on postoperative radiographs after tibial plateau leveling osteotomy (TPLO) in dogs. Retrospective case series and ex vivo experiment. Dogs (n = 80; 87 stifles) with cranial cruciate ligament (CCL) rupture that had TPLO; and 4 canine tibia specimens. Medical records (2007-2010) and radiographs of dogs that had TPLO were reviewed and examined for presence of a radiolucent line on postoperative radiographs. The TPLO procedure was reproduced ex vivo to determine the origin of this line by use of metallic wires to identify bone contours. A curvilinear radiolucent line was visible in 14 (16%) tibias and was 5.4 times more likely to be visible with lateral misalignment of the tibial diaphysis relative to the plateau and 2.6 times more likely visible on caudocranial radiographs with the stifle in outward rotation. Fracture complication rate was higher in dogs with this radiolucent line (P = .02) and with lateral misalignment of the tibial diaphysis relative to the plateau (risk ratio, 3.8). The line could be reproduced ex vivo and caused by superimposition of the craniomedial border of osteotomy with the tibial plateau. The radiolucent line was a spurious fracture line created by the medial margin of the tibial osteotomy and confounding factors such as tibial misalignment may explain the apparently associated higher complication rate.

Assessment of the medial collateral ligament as an intra-operative anatomical landmark for tibial plateau levelling osteotomy.

To determine whether the medial collateral ligament can be a reliable intra-operative anatomical landmark for rotation of the tibial plateau in the tibial plateau levelling osteotomy (TPLO) procedure, thus providing a tibial plateau rotation equal to that obtained using standard preoperative measurements. Tibial plateau levelling osteotomy procedures were performed on pelvic limbs (n = 42) from canine cadavers with or without a history of cranial cruciate ligament deficiency. The rotation of the proximal fragment was performed such that the orientation of the fibres of the medial collateral ligament were aligned parallel to the caudal tibial cortex at the location of the osteotomy. Statistical analysis was performed to evaluate the difference between calculated rotation to achieve a postoperative tibial plateau angle of five degrees and the actual rotation achieved by aligning the medial collateral ligament and caudal tibial cortex. The rotation performed by alignment of the medial collateral ligament fibres with the caudal tibial cortex resulted in a significantly greater rotation than the calculated movement required to achieve a postoperative angle of five degrees. The mean over-rotation was 2.1 ± 1.73 mm. Use of the medial collateral ligament alignment with the caudal tibial cortex will reliably result in over-rotation of the tibial plateau and should not be used as an intra-operative guideline for tibial plateau rotation during TPLO procedures.

Effect of tibial plateau levelling osteotomy on patellar tendon angle: a prospective clinical study.

To evaluate the effect of the tibial plateau levelling osteotomy (TPLO) procedure on the patellar tendon angle (PTA) in dogs with naturally occurring cranial cruciate ligament rupture. Prospective observational clinical study. Dogs with naturally occurring CrCL rupture that had a TPLO performed (n = 40). Preoperative tibial plateau angle (TPA) and PTA were measured on radiographic images of affected stifle joints at 90° and standing angle (135°) respectively. The TPA and PTA were measured after TPLO was performed. Regression analysis was performed to evaluate the effect of preoperative TPA and PTA and postoperative TPA on postoperative PTA. Linear regression analysis was performed to evaluate the correlation between postoperative TPA and PTA. The mean (± SD) preoperative TPA and PTA were 26.5 ± 3.8° and 105.7 ± 3.8° respectively. The postoperative TPA and PTA values were 7.6 ± 3.3° and 91.4 ± 5.5°, respectively. Regression analysis showed that higher preoperative PTA and postoperative TPA are associated with a larger difference between the postoperative PTA and 90°. There was a positive correlation between postoperative TPA and PTA. The TPLO procedure alters the PTA to 90° in dogs with cranial cruciate ligament rupture similar to tibial tuberosity advancement (TTA). The TPLO may provide dynamic stability to the cranial cruciate deficient stifle by altering the TPA relative to the patellar tendon and creating a PTA of 90°. The biomechanical principle and mechanism of action of TPLO may be similar to TTA.

Bi-institutional retrospective cohort study evaluating the incidence of osteosarcoma following tibial plateau levelling osteotomy (2000-2009).

To evaluate the incidence and risk factors for occurrence of osteosarcoma (OSA) following tibial plateau levelling osteotomy (TPLO). Medical records of client-owned dogs that underwent consecutive TPLO procedures at two institutions were retrospectively reviewed. Referring veterinarians and owners were contacted for follow-up. Each institutional cohort was assessed separately, and the incidence density rate and median time to occurrence of OSA at the TPLO site and at other sites were calculated. Marginal Cox regression was used to calculate hazard ratios and 95% confidence intervals for potential risk factors for occurrence of OSA. There were 472 CLINIC A (Colorado State University Veterinary Teaching Hospital) and 1992 CLINIC B (SAGE Centers for Veterinary Specialty and Emergency Care) TPLO cases with over one year of follow-up available. There were five and six dogs within the cohorts that developed OSA at the site of TPLO, and seven and 22 dogs that developed OSA at other anatomical sites, respectively. The incidence density rates of OSA at the TPLO site were 30.4 and 10.2 per 10,000 dog-years at risk, and other sites were 42.6 and 37.5 per 10,000 dog-years at risk. The median time to occurrence of OSA of TPLO site OSA was 4.6 and 4.4 years, which was longer than that of other site OSA of 2.9 and 3.4 years. There is a low incidence of OSA following TPLO surgery. The longer time to occurrence for TPLO site OSA is similar to that for fracture-associated sarcoma, and could indicate a similar underlying pathophysiology rather than spontaneous OSA occurrence.

Handling of the tibial muscle envelope in tibial plateau levelling osteotomy - to elevate or not?

To compare the outcome of the tibial plateau levelling osteotomy (TPLO) procedure, using a 6-hole 3.5 mm locking TPLO plate and performed with the muscle elevation technique (ET) and placement of sponges, to the TPLO without performing these steps (non-elevation-technique [NET]). Medical records and radiographs of dogs with ET (n = 21) or NET (n = 19) were retrospectively reviewed. Signalment, TPLO procedure side, meniscal treatment, surgery time, haemorrhage, pre- and postoperative tibial plateau angle, assistant, amount of rehabilitation, bone healing (cortical, osteotomy, combined healing scores), complications, limb function, recovery time and follow-up were recorded and analysed using multivariate analysis. A value of p <0.05 was considered significant. Surgery time was significantly shorter with the NET (68.5 min ± 3.4) than with the ET (87.8 min ± 3.4) (p <0.01). No significant differences were detected for all other evaluated factors. Soft tissue trauma was minimal and none of the dogs suffered severe haemorrhage. The bone healing scores with the NET and the ET were not significantly different (p = 0.1, p = 0.2, p = 0.1). Complications were rare, minor and not significantly different between groups (p = 0.73). The results of this in vivo study indicate that NET is a feasible technique that can be considered for the clinical setting.

Tibial plateau levelling osteotomy implant removal: A retrospective analysis of 129 cases

To evaluate a cohort of dogs undergoing tibial plateau levelling osteotomy (TPLO) implant removal to determine key clinical features, prevalence, and indications for implant removal. Medical records of dogs undergoing TPLO implant removal at a private referral practice (Dallas Veterinary Surgical Center) between 2004-2008 were reviewed. Patient signalment, implant type, presence of concurrent medical disease, surgeon, antibiotic use, aerobic bacterial culture result, and operative findings were recorded. Data were analyzed using paired t-test, Fisher's exact test, and Wilcoxon-rank sum test. Statistical significance was set at p <0.05. The TPLO implants were removed from 126 dogs (n = 129, 4.8% of TPLO procedures) during the study period. Average time interval from TPLO to implant removal was 16.0 ± 17.8 months. The most common clinical signs were the presence of an open wound (n = 80), draining tract (n = 64), and lameness (n = 59). Culture of tissue or fluid from the implant bed or implants was positive for bacterial growth in 95/115 cases. A significantly greater proportion of the implants removed were Slocum TPLO plates (n = 109; 6.1%) when compared to other TPLO plate types (n = 20; 2.3%) (p <0.0001). No association was identified between a positive bacterial culture and measured variables. Local bacterial infection and clinical signs of inflammation were the most common reasons for TPLO implant removal. There may be an increased implant-associated complication rate for Slocum TPLO plates in the study population.

Kinematic Gait Analysis of the Hind Limb after Tibial Plateau Levelling Osteotomy and Cranial Tibial Wedge Osteotomy in Ten Dogs

This study identifies and compares the kinematic gait changes occurring in tibial plateau levelling osteotomy (TPLO) and cranial tibial wedge osteotomy (CTWO) limbs after transection of the cranial cruciate ligament (CrCL). Ten, healthy, adult beagle dogs were assigned to TPLO (five dogs) and CTWO (five dogs) groups. Hind limb kinematics were assessed, while dogs were trotted at speeds ranging from 2.0 to 2.3 m/s. The animals were evaluated preoperatively (prior to TPLO and CTWO surgery) and at both 8 and 12 weeks after surgery. Two-dimensional evaluation was synchronized to obtain the three-dimensional coordinates using the APAS motion analysis software. Gait patterns were assessed by measuring stifle, tibiotarsal joint angles and stifle joints angular velocity. Stifle and tibiotarsal joint functions were not affected by TPLO surgery, but stifle and tibiotarsal joint angles were changed, following CTWO surgery, compared with their preoperative values. The angular velocity patterns of CTWO were characterized by increased stifle joint extension velocity from the middle to end swing phase and decrease in the peak velocities (flexion) during swing phase. None of these changes was observed in the stance phase after the CTWO surgery. These kinematic results showed that dogs that underwent a CTWO procedure were more likely to have significantly hyperextended gait patterns of the swing phase postoperatively than the dogs that had a TPLO procedure for repair of a ruptured CrCL.