Tibial Plateau Leveling Osteotomy Research Articles

Effect of tibial plateau leveling osteotomy on patellofemoral alignment: A study using canine cadavers

Tibial plateau leveling osteotomy (TPLO) has been shown to alter the biomechanics of the femorotibial joint; however, the effect of TPLO on patellofemoral (PF) joint alignment remains unknown. The purpose of this study was to evaluate PF joint kinematics before and after cranial cruciate ligament (CrCL) transection and following TPLO in a cadaveric stifle model with set patellar tendon load, tested in passive range of motion at 90°, 105°, 120°, 135° and 150° of flexion. The PF joint poses were measured on mediolateral projection radiographs using a two-dimensional computer digitization technique. In the subluxated CrCL-deficient stifle, the PF joint had an increase in patellar tilt angle. In the reduced CrCL-deficient stifle treated by TPLO, there was distal and caudal displacement of the patella relative to the femur and a decreased patellar tilt angle. The estimated patellar moment arm following TPLO was not different from the control stifle. On the basis of these results, TPLO alters PF joint kinematics. The changes in PF joint alignment induced by TPLO may be a biomechanical factor predisposing to patellar tendonitis following TPLO.

Comparison of Complication Rates and Clinical Outcome Between Tibial Plateau Leveling Osteotomy and a Modified Cranial Closing Wedge Osteotomy for Treatment of Cranial Cruciate Ligament Disease in Dogs

To report complication rates and clinical outcomes after tibial plateau leveling osteotomy (TPLO) and a modified cranial closing wedge osteotomy (mCCWO) for treatment of cranial cruciate ligament disease in dogs. Prospective cohort study. Dogs weighing 20-60 kg with unilateral cranial cruciate ligament disease treated by either TPLO (n = 97) or mCCWO (n = 74). Clinical and radiographic assessments including lameness score, morphometric measurements and tibial plateau angle (TPA) were made before surgery and 8 weeks after either TPLO or mCCWO. Long-term outcome assessment by owner questionnaire or interview was undertaken at ≥6 months postoperatively. Significant differences in lameness scores between groups were not identified at short- or long-term follow-up. Major complication and reoperation rates did not differ significantly between groups (TPLO 7.2% and 6.1%; mCCWO 9.5% and 5.4%). Median postoperative TPA did not differ significantly between groups (TPLO group 5.5°; mCCWO group 6.5°). At >6 months owner assessed lameness, disability, quality of life and satisfaction were not different between groups and were good in 90-97% of dogs. In dogs weighing 20-60 kg, TPLO and mCCWO are associated with similar complication rates and clinical outcomes when performed by surgeons experienced with the surgical techniques.

Comparison of Long‐Term Outcomes Associated With Three Surgical Techniques for Treatment of Cranial Cruciate Ligament Disease in Dogs

To evaluate long-term (>1 year) outcomes with respect to function and complications in dogs undergoing TightRope (TR), tibial plateau leveling osteotomy (TPLO), or tibial tuberosity advancement (TTA) for treatment of cranial cruciate ligament (CCL) disease. Retrospective clinical cohort study. Medical records from 2006 to 2009 were searched and cases included when all data were available and clients returned a completed questionnaire based on their assessment of their dog at least 1 year after surgery. Outcomes associated with TPLO, TTA, and TR were determined and compared based on medical records and questionnaires data regarding return to function, presence and degree of pain, and complications. Case meeting inclusion criteria were: TPLO (n = 65), TR (n = 79), and TTA (n = 18). TTA was associated with significantly (P < .03) higher rates of major complications and subsequent meniscal tears than TPLO and TR, and TPLO had significantly higher rates of major complications and meniscal tears than TR. Percent of function >1 year after surgery was 93.1% + 10.0% for TPLO, 92.7% + 19.3% for TR, and 89.2% + 11.6% for TTA. Significantly (P = 0.016) more TPLO and TR cases were classified as reaching full function than TTA. The highest levels, frequency, and severity of pain were noted in TTA cases, however, no significant differences were noted among groups. Long-term outcomes for TPLO and TR were superior to TTA based on subjective client and DVM assessments. Each technique was associated with a high long-term success rate with TR showing the highest safety-to-efficacy ratio.

Prevalence of Dysphoria after Fentanyl in Dogs Undergoing Stifle Surgery

To describe the prevalence of dysphoria after intraoperative administration of fentanyl by infusion and identify other risk factors influencing this in dogs undergoing stifle surgery. Prospective, randomized clinical study. Dogs (n = 92) that had tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement (TTA). Dogs were anesthetized using a standardized anesthetic protocol, and randomly assigned to receive a loading dose followed by 1 of 3 infusions of fentanyl perioperatively: 2 μg/kg/h, 10 μg/kg/h, or 20 μg/kg/h. Dog characteristics and all additional medications were recorded and included as part of the statistical analysis. Dog behavior was scored before anesthesia and during recovery using a scale of 1-4 (Appendices A and B). If no improvement in behavior was seen in 3-5 minutes postextubation, dogs with a score of 3 or 4 during recovery were administered fentanyl (2 μg/kg intravenously [IV]) in the event that the behaviors associated with the higher scores were related to pain. If they did not respond favorably to the administration of additional fentanyl and wound palpation did not elicit a response, but the untoward behaviors continued, dogs were administered either a tranquilizer, sedative, or opioid antagonist, and were considered dysphoric. Of 92 dogs, 22 (23.9%) were considered dysphoric using aforementioned criteria. About one-fourth of dogs enrolled in this study were dysphoric based on study criteria.

Ruptura de menisco associada à ruptura de ligamento cruzado cranial em cães

The following study describes meniscus ruptures associated to cranial cruciate ruptures, in 34 dogs of different breeds, ages and weights. Before surgery the animals underwent clinical and radiographic examinations. All animals presented either total or partial cranial cruciate ruptures: 21 (24.14%) of the animals didn’t present any meniscus lesions, and the rest (75.86%) presented only a medial meniscus lesion. The lesions found in the medial meniscus were the following: 33 stifles (37.93%) presented with eversion of the caudal pole (Type 1), 15 (17.24%) showed a bucked handle lesion (Type 6), 3 (3.45%) presented with fibrillation lesion (Type 4), 3 (3.45%) multiple fibrillation lesion (Type 3), 3 (3.45%) longitudinal lesion (Type 2), 1 (1.15%) lesion type 7 and 10 (11.49%) presented multiple lesion. Surgical procedure for cranial cruciate rupture included: tibial tuberosity advancement (TTA) (49 stifle), tibial plateau leveling osteotomies (TPLO) (15 stifle), closing wedge osteotomy (CWO) (14 stifle), extracapsular (4 stifle) and meniscectomy alone (5 stifle), and all these techniques guaranteed weight baring and return to function in the first week after surgery, with no complications. Through this study we could demonstrate that meniscus tear is highly associated to cranial cruciate rupture and that the most common is type 1 (eversion of the caudal pole) and that cronicity of the lesion increases the probability of meniscus tear.

Outcome following removal of TPLO implants with surgical site infection

To evaluate the outcome of surgical site infection (SSI) associated with tibial plateau levelling osteotomy (TPLO) implants following treatment by medical management alone or implant removal with or without the administration of antibiotic medication. Ninety dogs (104 TPLO surgical procedures). Records of dogs that had undergone TPLO implant removal due to SSI were reviewed. Outcome following treatment with antibiotic medications without implant removal, and treatment with implant removal with and without the administration of antibiotic medications was evaluated. Treatment of SSI with antibiotic medication alone failed in 88.9% (64/72) of the dogs. The clinical signs of SSI resolved in 94.9% (74/78) of the dogs treated with implant removal (with and without the administration of antibiotic medication post-implant removal). The effect of administration of antibiotic medication on outcome of treatment of the SSI by implant removal was not significant. The rate of SSI associated with the Synthes implant was higher than with the Slocum implant, but not the New Generation implant. Implant removal with or without the administration of antibiotic medication post-implant removal for treatment of TPLO SSI provided superior outcome compared to treatment with antibiotic medications without implant removal. Implant removal should be considered for TPLO SSI that have not responded to appropriate medical management. Further investigation of the various TPLO implants and their effects on postoperative infection rate is warranted.

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.

Radiographic changes of the patellar ligament in dogs after tibial tuberosity advancement

Patellar desmopathy in dogs after tibial plateau levelling osteotomy has been described in many studies. Tibial tuberosity advancement is a biomechanically different technique. It is assumed that the patellar ligament is loaded with little force similarly as after tibial plateau levelling osteotomy. Various aspects related to secondary patellar desmopathy are not completely understood. This study deals with computed radiography measurement of patellar ligament thickness after tibial tuberosity advancement in dogs with cranial cruciate ligament rupture. The thickness of the patellar ligament in exactly predetermined locations was measured from mediolateral radiographs of stifle joints. A total of 18 dogs (20 knee joints) with cranial cruciate ligament (ligamentum cruciatum craniale) rupture underwent three radiographic examinations of the knee (preoperative examination and control examination 7 and 15 weeks after the surgery). Significant difference was found between the thickness of the patellar ligament in the first and second examinations. Some of the demographic factors possibly related to patellar ligament thickness (age, sex, body weight, type of cranial cruciate ligament rupture, arthrotomy, cage size, meniscal injury, time between surgery and radiographic examination) were analyzed. However, statistical analyses did not show any effect of these factors on the thickness of the patellar ligament, except for the time between surgery and radiographic examination. These findings can extend the surgeons’ knowledge of biomechanical aspects of tibial tuberosity advancement.

Foreign body reaction to a retained surgical sponge (gossypiboma) mimicking an implant associated sarcoma in a dog after a tibial plateau levelling osteotomy

A dog was presented with the complaint of an acute onset left pelvic limb lameness three years after a right tibial plateau levelling osteotomy had been performed. Radiographs taken at the time of presentation showed signs that were consistent with a diagnosis of an implant associated sarcoma. At revision surgery, a retained surgical sponge was identified, leading to a diagnosis of a gossypiboma. This is the first reported case of a gossypiboma as a complication of a tibial plateau levelling osteotomy surgery.

The Use and Interpretation of Tibial Plateau Leveling Osteotomy (TPLO) in Dogs in Cranial Cruciate Ligament Lesions

In this study, 7 dogs of various breed, age and sex, which were referred to the Clinics of Orthopaedics and Traumatology in Ankara University, Faculty of Veterinary Medicine, were used as study materials. Clinical radiological and arthroscopical examinations revealed 7 dogs were having unilateral CCL lesions. Tibial plato levelling Osteotomy operation was performed to stabilize the stifle joints. Operation results were evaluated clinically and radiological. According to the postoperative clinical and radiological examination. The TPLO technique with TPLO plate include locking screw mechanism was preferable for the treatment of cranial cruciate ligament ruptures of large breed dogs. Introduction The canine stifle joint is a hinge joint with two interdependent compartments; the femoropatellar joint and the femoro-tibial joint. The major motion of this joint is flexion and extention in a para-sagittal plane. However, internal rotation of the tibia and a small degree of cranial tibial translation also occurs normally. These later two motions are closely constrained by the two ligaments. In dogs rupture of the CLL seems to occur in most cases due to prior degeneration of the

Long‐Term Functional Outcome of Tibial Plateau Leveling Osteotomy Versus Extracapsular Repair in a Heterogeneous Population of Dogs

To compare the long-term outcome of tibial plateau leveling osteotomy (TPLO) and extracapsular repair (ECR) for treatment of a ruptured cranial cruciate ligament (RCCL). Prospective clinical trial. Normal adult dogs (control, n = 79); dogs with unilateral CCL disease (n = 38). Dogs had TPLO (n = 15) or ECR (n = 23) for treatment of RCCL. Force plate gait analysis was performed for the control group at one time point and for treatment groups at serial points: preoperatively, 2 weeks, 8 weeks, 6 and 12 months postoperatively. Symmetry indices (SIs) were calculated between operated and unoperated pelvic limb for ground reaction forces (GRFs), including peak vertical force (PVF), contact time (CT), and vertical impulse (VI). GRFs of the treatment groups and control group were compared using a general linear model and Kaplan-Meier survival analysis. At 8 weeks, for PVF and VI, the TPLO group had more symmetric limb loading than the ECR group at the walk and trot. SIs of the TPLO group were not different from the control group by 6 months to 1 year postoperatively. SIs for the ECR group were less symmetrical than the control group at all time periods. Using survival analysis, median time to normal function was no different at the walk between groups, but was shorter for the TPLO group for VI and PVF. Dogs achieved normal limb loading faster after TPLO than ECR. TPLO resulted in operated limb function that was indistinguishable from the control population by 1 year postoperatively.

Evaluation of Cut Accuracy and Cis Cortical Damage for Tibial Plateau Leveling Osteotomy Performed with and without Aid of a Novel Saw Guide: An In Vitro Study

To compare osteotomy orientation relative to the sagittal and transverse planes of the tibia, and cis cortical damage for tibial plateau leveling osteotomy (TPLO) performed with the following aids: (1) Synthes TPLO jig and saw guide, (2) Slocum TPLO jig with ancillary Kirschner wires (SlocumK), and (3) Slocum jig alone. In vitro study on Synbone(®) bone models and canine cadavers. Cadaveric pelvic limbs pairs (n = 30). TPLO was performed on 30 Synbone tibias with either the Slocum jig (n = 10), SlocumK (10), or Synthes jig (10). Synbones were analyzed to quantify osteotomy inclination, torsion, craniocaudal positioning, and medial cortical bone damage. Osteotomies were performed on cadaveric tibias and CT reconstruction used to assess the same osteotomy parameters. Significant differences in Synbone tibial osteotomy inclination (P<.001), medial cortical bone damage (P<.001) and craniocaudal osteotomy position (P<.05) were observed between the Synthes and Slocum jigs. CT analysis revealed significant differences in osteotomy inclination (P<.001) and torsion (P<.001). The use of the SlocumK resulted in osteotomies with minimal torsional malalignment however with high levels of metal debris and accelerated blunting of the TPLO blade. TPLO osteotomy inclination, torsion, and craniocaudal positioning are improved and the degree of iatrogenic medial cortical bone damage is minimal with the Synthes TPLO jig compared to the Slocum TPLO jig.

Comparison of Tibial PA, Bone Healing, and Intra‐articular Screw Placement using Conventional Nonlocked Application of Surgeon‐Contoured versus Locked Application of Precontoured TPLO Plates in Dogs

To determine the influence of conventional nonlocked application of surgeon-contoured (NL-SXc) and locked-hybrid application of precontoured (L-Pc)- TPLO plates on the tibial plateau angle (TPA) immediately postoperatively and longterm after tibial plateau leveling osteotomy (TPLO) in dogs as well as to evaluate their influence on the incidence of intra-articular screw placement and bone healing. Retrospective, cross-sectional, clinical study. Dogs (n = 101) with cruciate ligament insufficiency that had TPLO. Collected data included signalment, plate size/type, preoperative (PreTPA), postoperative (PostTPA), and recheck TPA (ReTPA). Tibial plateau rotation achieved during surgery (RotaTPA = PreTPA-PostTPA) and TPA shift during healing (ShiftTPA = ReTPA-PostTPA) were calculated. Radiographic evidence of stability and time to radiographic recheck were recorded. Variables were compared by plate type using a 2-sample t-test or χ(2) as appropriate (significance at P < .05). Median time to radiographic follow-up was 75 days (range, 43-2815 days). The remaining data are reported as means. Forty-two stifles had NL-SXc, 59 stifles had L-Pc. PreTPA of NL-SXc and L-Pc was 28.3° and 29.1°, respectively (P = .22). PostTPA (13.2° and 7.9°), RotaTPA (15.0° and 21.2°) and ReTPA (14.9° and 10.3°) for NL-SXc and L-Pc, respectively, were all significantly different (P< .0001). ShiftTPA for these constructs (1.7° and 2.4°, respectively) was not significantly different (P = .25), and 92.1% of dogs were considered to have radiographically stable osteotomies at last recheck. A higher degree of tibial plateau rotation was achieved and maintained in osteotomies with L-Pc. There was no significant difference in ShiftTPA or radiographic osteotomy stability between constructs.

Incidence of Transcortical Tibial Fractures with Self‐Tapping and Non‐Self‐Tapping Screws in a Canine TPLO Model

To compare the incidence of radiographically apparent transcortical diaphyseal tibial fractures between self-tapping screws (STS) and non-self-tapping screws (NSTS) in a canine tibial plateau leveling osteotomy (TPLO) model. Case series. Dogs (n = 106) that had TPLO. NSTS (n = 107), STS titanium (n = 104), or STS stainless steel (n = 105) screws were used for TPLO. Effect of STS and NSTS were compared by reviewing postoperative craniocaudal and lateral radiographic projections taken immediately after TPLO. Three screws distal to the tibial osteotomy served as the in vivo model for canine cortical bone. A transcortical fracture was defined as the presence of a saucer-shaped radiolucent defect on the periosteal surface of the trans-cortex surrounding the screw and the presence of radiopaque material (bone) separate from the transcortical periosteal surface. The effect of screw type and STS material (stainless steel or titanium) on the incidence of transcortical fractures was evaluated. STS had a significantly higher (P = .006) incidence of transcortical fractures (18.0%) compared with NSTS (0.8%). The effect of STS material on the incidence of transcortical fractures was not significant (P = .485). No cis-cortical factures were identified. We suspect the increased incidence of transcortical fractures with STS is because of the shorter cutting flutes as compared with those of a tap used with a NSTS.

Biomarkers in dogs surgically treated for ruptured cranial cruciate ligaments

Thirty-one dogs with cranial cruciate ligament rupture (CCLR) were randomly treated with tibial plateau levelling osteotomy (TPLO; TPLO group) or proximal tibial osteotomy (PTO; PTO group). Synovial fluid was collected...

Implant Removal Rate from Infection after Tibial Plateau Leveling Osteotomy in Dogs

To determine implant removal rate associated with infection after tibial plateau leveling osteotomy (TPLO) in dogs and to report antimicrobial susceptibility patterns for isolates. Retrospective case series. Dogs (n = 255; 282 TPLO). Medical records (April 2006-April 2008) for dogs that had TPLO with ≥ 18 month follow-up were reviewed. Dogs that had implant removal with confirmed bacterial isolation from the implant were studied. Cefazolin (22 mg/kg intravenously) was administered before anesthesia induction for TPLO, every 2 hours intraoperatively, and every 6 or 8 hours until the next morning. Antimicrobial susceptibility testing was performed on isolates. Twenty-one (7.4%) of 282 TPLO required implant removal because of infection. Bacterial species isolated were Actinomyces spp. (1), Corynebacterium spp. (1), Enterococcus spp. (3), hemolytic Staphylococcus coagulase negative (2), nonhemolytic Staphylococcus coagulase negative (3), Staphylococcus spp. coagulase positive (7), methicillin-oxacillin-resistant Staphylococcus coagulase positive (2), and Serratia marcesens (2). Of the antibiotics that had ≥10 isolates tested against them, gentamicin had the highest susceptibility rate (94%), followed by tribrissen (71%), and amoxicillin/clavulanic acid (67%). Staphylococcus spp. was reported in 14 of the 21 infections cultured in this study. Based on antimicrobial susceptibility testing, amoxicillin/clavulanic acid would be the best empirical treatment.

Fracture of the Patella after TPLO in 6 Dogs

To describe the clinical findings of dogs that sustained patellar fractures after tibial plateau leveling osteotomy (TPLO). Retrospective case series. Dogs with patellar fractures that occurred after TPLO surgery (n = 6). Medical records (November 1, 2008-October 31, 2010) were reviewed to identify dogs with patellar fracture occurring after TPLO. Six of 305 (2%) dogs had a patellar fracture after TPLO; 5 dogs were clinically lame when the fracture was diagnosed and all had radiographic evidence of patellar tendon thickening. All dogs were treated nonsurgically. In 2 dogs where follow-up radiographs were available there was no evidence of fracture union. No dog had a persistent lameness. Fracture of the patella is an uncommon complication of TPLO surgery. Nonsurgical management can provide a satisfactory functional outcome.

Evaluation of peri-operative epidural analgesia with ropivacaine, ropivacaine and sufentanil, and ropivacaine, sufentanil and epinephrine in isoflurane anesthetized dogs undergoing tibial plateau levelling osteotomy

The purpose of this study was to compare four epidural protocols for peri-operative analgesia in dogs undergoing tibial plateau levelling osteotomy. Forty client-owned dogs were randomly assigned to one of four treatments - groups R0.5 and R1 received 0.5mg/kg and 1mg/kg ropivacaine, respectively. Group SR0.5 received 1 μg/kg sufentanil plus 0.5mg/kg ropivacaine, and group SER0.5 received 1 μg/kg sufentanil, 0.5mg/kg ropivacaine plus 6 μg/kg epinephrine. Dilution, when required, was performed with saline, so that the injected volume was always 0.2 mL/kg. Intra-operatively, nociception assessment was based on the evaluation of changes in heart rate, respiratory rate and mean arterial pressure. Post-operative pain assessment was performed using the Glasgow visual analogue pain scale, and an ad hoc multifactorial pain score. Motor block was evaluated using a modified Bromage score. Intra-operatively, none of the animals was hypotensive. All groups except SER0.5 required rescue intra-operative fentanyl (40%, 30% and 40% of the animals in groups R0.5, R1 and SR0.5, respectively). Group SER0.5 showed lower post-operative pain scores, and group R1 significantly greater motor block, compared to the other treatment groups. None of the dogs had urinary retention. Epidural sufentanil-epinephrine-ropivacaine provided superior peri-operative analgesia compared to the other treatments, without producing clinically relevant side effects.

Osteosarcoma of the Tibia 6 Years After Tibial Plateau Leveling Osteotomy

A 7 yr old spayed female mastiff presented for examination of a left pelvic limb lameness of 3 mo duration. Six years previously, the dog had undergone tibial plateau leveling osteotomy (TPLO) surgery of the left pelvic limb for the treatment of cranial cruciate disease. On presentation, the dog had a painful and swollen proximal tibia. Following investigation, a diagnosis of osteosarcoma of the proximal left tibia at the site of the previous TPLO surgery was made. This is the first reported case of osteosarcoma following TPLO using an implant other than the Slocum plate.

The Effect of Shock Wave Therapy on Patellar Ligament Desmitis after Tibial Plateau Leveling Osteotomy

To determine if shock wave therapy (SWT) after tibial plateau leveling osteotomy (TPLO) has a beneficial effect on patellar ligament inflammation assessed by thickening of the ligament and ligament fiber disruption. Prospective, randomized, controlled clinical trial. Dogs (n = 30). Dogs that had TPLO (July 1, 2009 to June 1, 2010) were enrolled. The affected stifle was examined by radiographs and ultrasonography preoperatively and 4, 6, and 8 weeks after TPLO. At 4 and 6 weeks, dogs in the treatment group were briefly anesthetized and treated with SWT. Patellar ligament thickness on a lateral radiographic projection was measured at 1/4, 1/2, 3/4 of the distance from origin to insertion. Ultrasound images were evaluated for patellar ligament disruption and periligament edema. There was significant difference in thickness (P = .0264) only at the distal point; therefore, only this point was used to measure difference between the control and treatment groups. A significant difference between groups was reached at 6 and 8 weeks (P = .0059 and P = .0095, respectively) postoperatively. No significant ultrasonographic differences were found. Based on these results, SWT decreases the radiographic signs of patellar ligament desmitis.