Tibial Plateau Leveling Osteotomy Research Articles

Opioid requirements after locoregional anaesthesia in dogs undergoing tibial plateau levelling osteotomy: a pilot study

ObjectiveTo determine the intraoperative and early postoperative opioid requirement after ultrasound-guided sciatic and/or femoral nerve block or epidural anaesthesia in dogs undergoing tibial plateau levelling osteotomy (TPLO). Study designProspective, masked, pilot, randomized, clinical trial. AnimalsA total of 40 client-owned dogs undergoing TPLO. MethodsEach dog was randomly assigned to group SF (combined sciatic and femoral nerve block), group S (sciatic nerve block), group F (femoral nerve block) or group E (epidural anaesthesia). A total of 0.3 mL kg–1 of ropivacaine 0.5% was administered to each nerve or in the epidural space. Intraoperatively, fentanyl (2 μg kg–1) was administered intravenously when heart rate, mean arterial pressure or respiratory rate increased by >30% compared with baseline values. Postoperatively, a visual analogue scale (VAS) and a modified German version of the French pain scale (4AVet) were used to assess pain every 30 minutes for 150 minutes and again once the morning after surgery. Methadone (0.1 mg kg–1) was administered intravenously if the VAS was ≥ 4 cm [maximal value 10 cm; median (interquartile range)] or the composite pain score was ≥5 [maximal value 15; median (interquartile range)]. Significance was defined as p ≤ 0.05. ResultsGroups SF and E required less total intraoperative and early postoperative opioid doses compared with groups S and F (p = 0.031). No dogs in group SF had a block failure or required postoperative methadone. A reduced methadone requirement was found in group SF compared with all the other groups up to 150 minutes after recovery (p = 0.041). Conclusions and clinical relevanceCombined sciatic and femoral nerve block and epidural anaesthesia lead to less cumulative consumption of perioperative opioids than single nerve blockade. Sciatic or femoral nerve block alone might be insufficient to control nociception and early postoperative pain in dogs undergoing TPLO.

Rock back phenomenon in 32 dogs that underwent tibial plateau levelling osteotomy

The aim of this study was to evaluate the postoperative temporal changes in the tibial plateau angle (TPA) after a tibial plateau levelling osteotomy (TPLO) in dogs. The TPA of thirty-two dogs were measured before surgery (TPA<sub>1</sub>), immediately after the TPLO (TPA<sub>2</sub>), and later at the healing of the osteotomy site (TPA<sub>3</sub>). Three observers carried out three TPA measurements for each patient at the time of the evaluation. TPA changes were observed over the bone healing (2.05 ± 3.05°); however, no statistical significance was noted when comparing TPA<sub>3</sub> and TPA<sub>1</sub>. There were no statistical differences in the inter-observer measurements among TPA<sub>1</sub>, TPA<sub>2</sub>, and TPA<sub>3</sub> (P > 0.05). The comparison between the preoperative TPA<sub>1</sub> and the rock back showed a low positive correlation (S = 4 735.9, P = 0.471 5, r = 0.131 976 9). There was also a low positive correlation between the body weight (kg) and the change in the TPA during the bone healing (S = 4 581.8, P = 0.381, r = 0.160 234 7). Although changes in the TPA have been observed over the time of the bone healing, they were not influenced by the preoperative and postoperative TPA, or by the body weight. The magnitude of the variation in the TPA is not determined by the previous inclination or by the degree of rotation in the plateau.

Osteosarcoma in a dog eight years after tibial plateau leveling osteotomy with an angle stable implant

An 11-year-old, 41-kg female spayed mixed-breed dog was examined for a chronic left hind limb lameness, with swelling of the proximal left tibia. A tibial plateau leveling osteotomy (TPLO) using an angle stable implant had been performed 8 years earlier at the site. Initial radiography showed mild degenerative signs in the stifle joint and osteolytic lesions in the proximal tibial metaphysis. Three weeks later, the clinical and radiographic changes had worsened. A transition from a moth-eaten pattern to permeative bone lysis was radiographically evident, along with an extensive increase of soft tissue swelling. Ultrasonographically-guided fine needle aspiration of the epiperiosteal tissue and lymph nodes, CT with pre-and post-contrast scans, and an incisional biopsy were performed. The radiographic and CT findings were consistent with an aggressive and monostotic bone lesion at the site of previous TPLO. The cytology and histology confirmed the diagnosis of an osteosarcoma (OSA) with a chondroid differentiation. Three months after a palliative hind limb amputation, the dog was euthanased. CONCLUSION We believe that this is the first report of implant-related OSA at the site of a previous TPLO with a new generation angle stable implant

Does meniscal release confer similar clinical benefits to meniscal tear treatment when compared to meniscectomy?

PICO question
 In adult dogs with naturally occurring medial meniscal tears concurrent to cranial cruciate ligament disease does meniscal release confer the same benefits in lameness resolution as meniscectomy?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 A single prospective cross-sectional study was reviewed, that fulfilled the criteria
 Strength of evidence
 None
 Outcomes reported
 Meniscal release, meniscectomy (partial, hemi- or complete), or the two combined performed for concurrent medial meniscal pathology at time of surgery for naturally occurring cranial cruciate ligament (CCL) rupture resulted in an acceptable long-term outcome. Difference in outcome between the techniques was not reported
 Conclusion
 There is no evidence that meniscal release provides an equal or superior treatment option for medial meniscal injury treated at the time of surgery for CCL rupture when compared to meniscectomy. The study critically reviewed performed meniscal release via radial transection through the meniscotibial ligament, and therefore does not represent mid-body abaxial radial release. Neither is this summary appropriate for considering prophylactic meniscal release of the normal meniscus. In addition, the surgical treatments for cranial cruciate ligament rupture were either ‘Tightrope’ or tibial plateau levelling osteotomy (TPLO) procedures. Further studies are required to compare clinical outcome between meniscal release or meniscectomy for treatment of concurrent meniscal tears
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

English

Because of plate development, it is now possible to perform tibial plateau leveling osteotomy (TPLO) in small-breed dogs with cranial cruciate ligament rupture. Compared with conventional treatment, faster walking and better function are reported post-TPLO. However, TPLO can be more difficult in toy-breed dogs than large-breed dogs. Because of the smaller bones, it is difficult to manipulate the bone fragments during surgery, and small movements of bones can cause major differences in limb alignment. In TPLO, a jig is conventionally recommended to increase the accuracy of alignment; however, installation of the jig can be difficult in small-breed dogs, and it may cause problems such as iatrogenic fracture. The present study thus aimed to evaluate the accuracy of TPLO without a jig in toy-breed dogs. Paired stifles (n=22) obtained from 11 toy-breed dogs cadavers (body weight range, 2.0-7.4 kg) were randomly assigned to a jig or non-jig group. Radiographic images were obtained preoperative and postoperative TPLO. Tibias were dissected from the hindlimb and measured for evaluation of accuracy. The following postoperative parameters were compared: tibial plateau angle, mechanical medial proximal tibial angle, osteotomy location, tibia crest thickness, gap between segments, and orientation line angles. There were no significant differences between the two groups, demonstrating that jig usage does not affect precision of TPLO in toy-breed dogs. Therefore, it is better not to use a jig in toy-breed dogs with relatively small bones, considering the risk of iatrogenic injury, cost and operation time

Comparing approaches to sciatic nerve blocks in dogs during tibial plateau-levelling osteotomy

The aim of this study was to compare the postoperative analgesic requirements in dogs receiving a sciatic nerve block by either the lateral or transgluteal approach. The secondary aim was to determine if there was a difference in ease of performing the nerve block. Forty-two client-owned dogs were used in this study. Sciatic nerve block was performed by the transgluteal approach (group A), or the lateral approach (group B) combined with a psoas compartment block. All blocks were performed using a nerve stimulator and 0.1 ml/kg bupivacaine 0.5%, per block. The time taken to perform the sciatic nerve block, number of attempts, the current (mA), and intraoperative and postoperative opioid requirements were recorded. Overall, 52% of dogs required methadone intraoperatively, with no difference between groups (P=0.516). Postoperatively, 24% in group A and 12% in group B required methadone (P=0.314). There was no difference in the time taken to perform the sciatic nerve block, current or the number of attempts between groups. Both approaches to the sciatic nerve block conferred similar levels of analgesia and may be used as part of a multimodal analgesic protocol for dogs undergoing pelvic limb surgery.

Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy.

To determine the influence of follow-up radiographic examination on recommendations made during routine clinical re-evaluation of dogs that had undergone uncomplicated tibial plateau leveling osteotomy (TPLO). Retrospective multi-institutional case series. Client-owned dogs (N = 1010) that underwent uncomplicated TPLO. Records from 11 institutions were searched for dogs that had been treated with unilateral TPLO and had no history of postoperative complications before their routine follow-up examination. The frequency of change in further clinical recommendations resulting from client- or clinician-voiced concerns or radiographic abnormalities was investigated. Follow-up evaluation was performed at a median of 6 (range, 4-15) weeks after TPLO. Radiographic examination findings contributed to a change in recommendations in 4.15% (38/915) of dogs presented without client concerns and without abnormalities at orthopedic examination. Abnormal radiographic findings alone influenced the management of 3.76% (38/1010) of dogs. An association was detected between clinical features and radiological findings leading to a change in recommendations (P < .0001). Administration of analgesia at the time of follow-up was associated with radiographic abnormalities (P = .017) and change in postoperative plans (P = .0007). Radiographic examination findings at follow-up did not influence the management of most dogs with uncomplicated TPLO. Radiographic examination findings are unlikely to influence the treatment of dogs that seem to be recovering uneventfully from an uncomplicated TPLO without concerns from clients, analgesia, or abnormal findings on thorough orthopedic examination by a surgical specialist, at the time of the planned clinical re-evaluation.

Prevalence and Risk Factors for Bilateral Meniscal Tears Identified during Treatment for Cranial Cruciate Ligament Disease Via Tibial Plateau Levelling Osteotomy in Dogs.

The aim of this study was to report the prevalence and risk factors of bilateral meniscal tears during a tibial plateau levelling osteotomy (TPLO). Data from 362 dogs that underwent staged or simultaneous TPLO between January 2006 and April 2019 were retrospectively collected. Variables such as breed, sex, weight change and intervals between surgeries were analysed with logistic regression. Preoperative tibial plateau angle, age, cranial cruciate ligament status and body weight were analysed with a generalized linear mixed model. All analyses were performed to assess the likelihood of bilateral meniscal tears versus unilateral tears and no tears. Correlation of meniscal tears between stifles was assessed with Cohen's kappa coefficient. Prevalence of bilateral meniscal tears was 48.0% (95% confidence interval [CI]: 43.0-53.0%). There was moderate agreement of the presence of meniscal tears between stifles (Cohen's kappa coefficient = 0.41, 95% CI: 0.31-0.51).The odds for bilateral meniscal tears were higher for Rottweilers (odds ratio [OR:] 4.5 [95% CI 1.1-30.3], p = 0.033), older dogs (OR: 1.2 [95% CI: 1.1-1.4 per year], p < 0.0001), smaller dogs (OR: 0.98 [95% CI: 0.97-0.99 per 0.45-kg], p = 0.001), stifles with complete cranial cruciate ligament tears (OR: 21.1 [95% CI: 7.1-62.4], p < 0.0001). Contralateral meniscal tears, breed, older age, lower patient weight and complete cranial cruciate ligament tear were significant risk factors for bilateral meniscal tears. Surgeons can use these results to determine prognoses and propensities for meniscal tears in at-risk dogs.

The influence of the choice of preemptive analgesia on long-term postsurgical pain after tibial plateau leveling osteotomy in dogs.

To evaluate the prevalence of chronic postsurgical pain (CPSP) after tibial plateau leveling osteotomy (TPLO) in dogs and to determine the influence of preemptive locoregional analgesia on CPSP. Retrospective study. One hundred twenty client-owned dogs. Medical records of dogs that underwent TPLO between 2012 and 2016 were reviewed for demographic information and type of preemptive analgesia. Owners were contacted to retrospectively assess the quality of life of their dogs by using the Helsinki Chronic Pain Index (HCPI) before and 6 months after surgery and at the time of questioning. An HCPI score > 12 was considered indicative of CPSP. Medical records were reviewed for demographic information and type of preemptive analgesia. A cumulative logit model was used to assess correlation of type of perioperative analgesia, HCPI, and demographic data. The HCPI score was consistent with CPSP in 41 of 101 dogs with long-term follow-up (2.9 ± 1.5 years after surgery). Chronic postsurgical pain was documented in 11 of 32 and 13 of 28 dogs that received a spinal or epidural injection, respectively, or in 28 of 80 and 25 of 67 dogs with sciatic-femoral block at 6 months or with long-term follow-up after TPLO, respectively (P > .05). A negative correlation was found between HCPI and both weight and age 6 months after surgery. Only weight remained negatively correlated 2.9 years after surgery. Forty-one percent of dogs that were evaluated exhibited HCPI values compatible with CPSP long-term after TPLO, regardless of the type of preemptive analgesia. Increased body weight was a negative prognostic factor for CPSP development. Additional studies are required to evaluate CPSP development after TPLO.

Does traditional tibial tuberosity advancement yield similar postoperative outcomes as tibial plateau levelling osteotomy in dogs with cranial cruciate ligament disease?

#### Bottom Line An orthopaedic surgeon has recently joined the practice you work in, and they routinely perform traditional tibial tuberosity advancement (TTA) when surgically treating dogs with cranial cruciate...

Stance and weight distribution after tibial plateau leveling osteotomy in forelimb and hind limb amputee dogs

BackgroundLittle is known about the weight distribution to the remaining limbs for amputee dogs that undergo orthopedic surgery.The objective of the paper was to describe stance and weight distribution after tibial plateau leveling osteotomy (TPLO) in forelimb and in hind limb amputees (AmpTPLO) and to compare them to four-legged TPLO patients (4LTPLO) and amputees without TPLO (Amp). Weight bearing distribution at a stance was compared between groups. Joint angles of forelimb and hind limb joints in a sagittal plane, hind limb orientation in a frontal plane, and pelvic orientation in a transverse plane (pelvic tilt) were measured and compared between groups.ResultsJoint angles, hind limb abduction, and pelvic tilt of AmpTPLO and Amp did not differ statistically. Mean weight bearing in the operated hind limb was higher for AmpTPLO than 4LTPLO. Mean weight bearing for thoracic limbs of AmpTPLO and 4LTPLO did not differ statistically. Weight bearing of the hind limb of AmpTPLO and Amp did not differ statistically.ConclusionsThe position of the center of mass and posture of AmpTPLO and Amp does not differ. The weight distribution and posture of Amp is not impacted negatively by TPLO.

Contributing factors to surgical site infection after tibial plateau leveling osteotomy: A follow-up retrospective study.

To identify factors associated with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPLO). Retrospective case series. Dogs (n = 541) that underwent TPLO (n = 659). Medical records of dogs that underwent TPLO from 2011-2018 were reviewed. Data collected included perioperative and postoperative antimicrobial administration, stifle inspection, duration of surgery and anesthesia, comorbidities, and development of SSI including timing, microbiological investigation, and implant removal. Referring veterinarians were contacted for all dogs without a recorded return visit. Risk factors for SSI were assessed by using a multivariable logistic regression model built by using a stepwise approach. Surgical site infection was documented in 71 of 659 (11%) TPLO, with methicillin-resistant Staphylococcus pseudintermedius accounting for 20 of 71 (28%) infections. Protective factors against SSI included administration of postoperative antimicrobials (odds ratio [OR] 0.263; 95% CI = 0.157, 0.442) and timing of preoperative antimicrobial administration. Preoperative antimicrobial timing was protective against SSI when it was administered more than 60 minutes before the first incision compared with administration within 30 minutes (OR 0.275; 95% CI = 0.112, 0.676) or within 60 minutes (OR 0.419; 95% CI = 0.189, 0.929) of the first incision. Early administration of perioperative antimicrobials and postoperative antimicrobial administration were protective against SSI after TPLO. Antimicrobials can influence the risk of SSI after TPLO. Perioperative and postoperative antimicrobial administration timing should be considered to reduce SSI.

Comparison of liposomal bupivacaine and 0.5% bupivacaine hydrochloride for control of postoperative pain in dogs undergoing tibial plateau leveling osteotomy

To compare liposome-encapsulated bupivacaine (LEB) and (nonliposomal) 0.5% bupivacaine hydrochloride (0.5BH) for control of postoperative pain in dogs undergoing tibial plateau leveling osteotomy (TPLO). 33 client-owned dogs. In a randomized clinical trial, dogs undergoing TPLO received LEB (5.3 mg/kg [2.4 mg/lb]) or 0.5BH (1.5 mg/kg [0.68 mg/lb]) by periarticular soft tissue injection. All dogs received carprofen (2.2 mg/kg [1 mg/lb], SC, q 12 h) beginning at extubation. Signs of pain were assessed at extubation and predetermined times up to 48 hours later with the Colorado State University-Canine Acute Pain Scale and Glasgow Composite Pain Scale-Short Form. A pressure nociceptive threshold device was used at the affected stifle joint before surgery and at 5 postoperative time points. Methadone (0.1 mg/kg [0.05 mg/lb], IV) was administered if the Colorado State University pain scale score was ≥ 2 (scale, 0 to 4). Surgical variables; pain scores; pressure nociceptive thresholds; times to first administration of rescue analgesic, first walk, and first meal consumption; and total opioid administration were compared between treatment groups. 28 dogs completed the study. Dogs administered LEB were less likely to require rescue analgesia and received lower amounts of opioids than dogs administered 0.5BH. There were no significant intergroup differences in other measured variables. The LEB appeared to provide adequate analgesia after TPLO with lower requirements for opioid treatments, which may allow dogs to be discharged from the hospital earlier than with traditional pain management strategies.

Biomechanical Effects of Tibial Plateau Levelling Osteotomy on Joint Instability in Normal Canine Stifles: An In Vitro Study.

The aim of the study was to determine the changes in biomechanical characteristics following tibial plateau levelling osteotomy (TPLO) using simulated manual tests. Twenty-one stifles from healthy Beagle dogs that had undergone TPLO or had not (control) were first tested in the intact form, and then the cranial cruciate ligament (CrCL) was transected in each to provide four test situations: control-intact, control-CrCL-transected, TPLO-intact and TPLO-CrCL-transected. The stifles were then analysed using a robotic joint biomechanical testing system. The craniocaudal drawer, axial rotation and proximal compression tests were applied. The craniocaudal displacement during the drawer test was not significantly different between the control-intact and TPLO-intact. However, the displacement was significantly greater in the TPLO-CrCL-transected than in the control-intact. In the axial rotation test, the internal-external (IE) rotation was significantly greater in the TPLO-intact than in the control-intact. Similarly, the IE rotation was significantly greater in the TPLO-CrCL-transected than in the control-CrCL-transected. In the proximal compression test, craniocaudal displacement was not significantly different among the control-intact, TPLO-intact and TPLO-CrCL-transected. These findings suggest that TPLO influences the tension of the collateral ligaments and might generate laxity of the tibiofemoral joint. Instability after the osteotomy might be associated with the progression of osteoarthritis.

Force Plate Gait Analysis and Clinical Results after Tibial Plateau Levelling Osteotomy for Cranial Cruciate Ligament Rupture in Small Breed Dogs

The aim of this study was to evaluate objective limb function using force plate gait analysis after tibial plateau levelling osteotomy (TPLO) in small breed dogs with cranial cruciate ligament rupture (CCLR). Small breed dogs (15 kg or less) with unilateral CCLR treated with TPLO were evaluated using symmetry index (SI) of peak vertical force (PVF), vertical impulse and vector magnitude at PVF performed preoperatively and at 1, 2, 4 and 6 months postoperatively after routine TPLO surgery. Twelve dogs met the inclusion criteria. Hindlimb function was markedly improved after TPLO, with all three postoperative SI significantly higher after a month than preoperative values (p < 0.01). At 2 months after surgery, the SI was nearly normalized to 1.0 (preoperative SI: 0.50 ± 0.20, 0.44 ± 0.19 and 0.51 ± 0.19, and 2 months postoperative SI: 0.92 ± 0.16, 0.90 ± 0.18 and 0.92 ± 0.16 respectively). Complications were noted in two dogs (fibular fracture and a partial implant failure), neither of which required a revision surgery for acceptable functional recovery. The objective limb function of the affected hindlimb improved continuously after surgery and reached a near normal value at 6 months after surgery. It was suggested that TPLO for small breed dogs had good outcomes based on force plate gait analysis.

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.

Long-term outcome and progression of osteoarthritis in uncomplicated cases of cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy in dogs.

The object of this study is to evaluate the long-term outcome of hind limb weight-bearing function and progression of stifle osteoarthritis (OA) after tibial plateau leveling osteotomy (TPLO). Groups were classified by the degree of cranial cruciate ligament (CrCL) damage and presence or absence of medial meniscus damage as macroscopically evaluated during surgery. Weight-bearing function was assessed via the peak vertical force (PVF), and OA progression was assessed via the radiographic OA score (OAS) preoperatively and 1, 3, 6, 12, 18, 24, and 36 months postoperatively. In all stifles, PVF was significantly higher within 6 months postoperatively than preoperatively, and this high ratio was maintained for 36 months. The OAS was significantly higher 24 months postoperatively than preoperatively in stifles with a partial CrCL tear, and significantly increased at each timepoint after 3 months postoperatively in stifles with complete CrCL rupture. The OAS remained consistently lower in stifles with a partial CrCL tear and no treatment of the medial meniscus than in stifles with complete rupture. Thus, after TPLO, the weight-bearing function improved in the early postoperative period and was maintained for as long as 36 months. Although OA progressed over time after TPLO, the progression was more gradual in stifles with partial tears than in those with complete rupture. Canine patients would benefit from earlier surgical intervention through development of technology that enables early detection of ligament degeneration.

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.

Femorotibial kinematics in dogs treated with tibial plateau leveling osteotomy for cranial cruciate ligament insufficiency: An in vivo fluoroscopic analysis during walking.

To determine the ability of tibial plateau leveling osteotomy (TPLO) to address abnormal femorotibial kinematics caused by cranial cruciate ligament (CCL) rupture during walking in dogs. Prospective, clinical. Sixteen dogs (20-40 kg) with unilateral complete CCL rupture. Lateral view fluoroscopy was performed during treadmill walking preoperatively and 6 months after TPLO. Digital three-dimensional (3D) models of the femora and tibiae were created from computed tomographic (CT) images. Gait cycles were analyzed by using a 3D-to-2D image registration process. Craniocaudal translation, internal/external rotation, and flexion/extension of the femorotibial joint were compared between preoperative and 6-month postoperative time points for the affected stifle and 6-month postoperative unaffected contralateral (control) stifles. In the overall population, CCL rupture resulted in 10 ± 2.2 mm (mean ± SD) cranial tibial translation at midstance phase, which was converted to 2.1 ± 4.3 mm caudal tibial translation after TPLO. However, five of 16 TPLO-treated stifles had 4.1 ± 0.3 mm of cranial tibial subluxation during mid-to-late stance phase, whereas 10 of 16 TPLO-treated stifles had 4.3 ± 0.4 mm of caudal tibial subluxation throughout the gait cycle. Overall, postoperative axial rotational and flexion/extension patterns were not different from control, but stifles with caudal tibial subluxation had more external tibial rotation during mid-to-late stance phase compared with stifles with cranial tibial subluxation. TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking. Tibial plateau leveling osteotomy reduces cranial tibial subluxation during walking, but persistent instability is common.

Association of meniscal injury to joint space width on standard tibial plateau leveling osteotomy lateral radiographic projections of the canine stifle.

Up to 70% of dogs with cranial cruciate ligament tears have concurrent meniscal injury, and these injuries can increase the risk of developing osteoarthritis and persistent lameness. Studies assessing joint space width on knee radiographs in people have indicated associations between joint space width and meniscal injuries. The aim of this prospective analytical study was to determine if there was an association between stifle joint space width on three different radiographic projections (the standard tibial plateau leveling osteotomy projections and a standing lateral projection) and meniscal injuries identified at surgery in dogs. There was a significant association between dogs with a meniscal tear and the corresponding joint space width on standard tibial plateau leveling osteotomy lateral radiographic projections (P-value=.0028). Based on receiver operator characteristic curve analysis, joint space widths measuring less than 3.43mm may indicate a meniscal tear, with a corresponding 89.5% specificity and 40.5% sensitivity in dogs weighing 31kg. Joint space narrowing is seen with meniscal tears in dogs, and radiography may be a noninvasive way to identify meniscal tears prior to surgery.