Tibial plateau leveling osteotomy and cranial closing wedge ostectomy in a cat with cranial cruciate ligament rupture

A 5-year-old domestic shorthair cat was presented for a nonweight-bearing left pelvic-limb lameness. Orthopedic and radiographic examinations revealed a cranial cruciate ligament rupture and deformity of the proximal tibial metaphysis. The deformity of the proximal tibia resulted in an exaggerated tibial plateau angle of approximately 75 degrees. Surgical correction was performed with a combination of tibial plateau leveling osteotomy and cranial closing wedge ostectomy. The procedures resulted in an excellent clinical outcome with immediate return to weight bearing in the operated limb and progressive improvement in function over the ensuing 4 months.     

Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle

OBJECTIVE: To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). STUDY DESIGN: Retrospective clinical study. ANIMALS: Fifteen client-owned dogs (18 stifle joints). METHODS: Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. RESULTS: Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. CONCLUSIONS: Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. CLINICAL RELEVANCE: TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.     

Risk factors for excessive tibial plateau angle in large-breed dogs with cranial cruciate ligament disease

OBJECTIVE: To identify risk factors for development of excessive tibial plateau angle (TPA) in large-breed dogs with cranial cruciate ligament disease (CCLD). DESIGN: Case-control study. ANIMALS: 58 dogs with excessive TPAs (ie, TPA >or= 35 degrees ; case dogs) and 58 dogs with normal TPAs (ie, TPA or= 35 degrees in both limbs were 13.6 times (95% confidence interval, 2.72 to 68.1) as likely to have been neutered before 6 months of age as were control dogs with TPA 相似文献   

Change in tibial plateau angle after tibial plateau leveling osteotomy in dogs

OBJECTIVE: To determine the change in tibial plateau angle (TPA) during healing after tibial plateau leveling osteotomy (TPLO) performed for cranial cruciate ligament insufficiency in dogs and to examine factors that may be associated with the change. STUDY DESIGN: Retrospective study. STUDY POPULATION: One hundred and forty-nine canine stifles after TPLO procedure. METHODS: Records of dogs that had TPLO were reviewed. Patient age, weight, sex, breed, pre- and postoperative TPA, recheck TPA, time to recheck, type of implant used, and radiographic evidence of healing were analyzed. RESULTS: Mean time to recheck evaluation was 46 days (range, 28-65 days). Mean difference between immediate postoperative and recheck TPA measurements was 1.5 degrees (range, -3 to 9 degrees). Recheck TPA was a significantly greater (numerically higher) than immediate postoperative TPA (P<.0001). There was no significant effect of patient weight, type of plate used, or healing status of the osteotomy at the time of recheck. No correlation between pre- or postoperative TPA angles and change in TPA angle was detected. CONCLUSIONS: TPA changes during osteotomy healing after TPLO, but factors influencing this change were not identified. CLINICAL RELEVANCE: TPA may increase during healing after TPLO despite apparently adequate osteotomy fixation. The clinical relevance of this increase is unknown but is likely minimal.     

Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle

Objective— To identify surgical techniques performed by veterinary surgeons for the treatment of cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle (eTPA), compare their outcomes, identify risk factors for postoperative complications, and compare outcome and complication rate with tibial plateau leveling osteotomy (TPLO) in dogs without eTPA.
Study Design— Multicenter, case–control study.
Animals— eTPA group (TPA≥35°)=58 dogs (78 stifles); control group (TPA≤30°)=58 dogs (72 stifles).
Methods— Control and eTPA group dogs were identified. Medical records, radiographic reviews, and pet-owner interviews were used to identify surgical treatments performed, their complications, and outcome. Odds ratios with 95% confidence intervals, χ² tests, and t-tests were calculated to discern differences between eTPA and control-group dogs.
Results— TPLO was the most common treatment for eTPA. Owner-perceived outcome was superior for eTPA group dogs when TPLO resulted in TPA≤14° compared with those with postoperative TPA>14°. Loss of tibial plateau leveling during convalescence was the most commonly observed major complication; addition of ancillary implants to TPLO significantly reduced its incidence. Postoperative complications were more common in dogs with eTPA than in dogs without eTPA; however, no difference in owner-perceived outcome was identified.
Conclusions— Surgical treatment of dogs with eTPA has a higher complication rate, but comparable outcome to that of dogs without eTPA.
Clinical Relevance— Postoperative TPA≤14° and addition of ancillary implants are recommended when using TPLO to treat dogs with eTPA.     

Tibial plateau leveling osteotomy in a llama with a ruptured cranial cruciate ligament

A 3-year-old 155-kg (342-lb) castrated male llama was examined because of left hind limb lameness of acute onset. A diagnosis of cranial cruciate ligament and medial collateral ligament rupture was made, and tibial plateau leveling osteotomy was recommended. The tibial plateau leveling osteotomy procedure was performed as described for dogs, except that 2 orthopedic plates were used to stabilize the osteotomy because of the size of the llama. The medial collateral ligament was sutured and reinforced with 2 strands of size-2 polypropylene placed in a figure-8 fashion between cancellous bone screws in the femur and tibia. Four days after surgery, failure of the medial collateral ligament repair was evident. Approximately 3.5 years after surgery, the llama was reexamined. The owners reported that the llama had full use of its left hind limb, and only mild lameness (grade 1 of 5) was evident. Results suggest that tibial plateau leveling osteotomy may be applicable in camelids with rupture of the cranial cruciate ligament. However, additional study is needed before tibial plateau leveling osteotomy can be routinely recommended. In particular, additional information is needed on the tibial plateau slope in healthy camelids, the role of the fibula in tibial plateau leveling osteotomy procedures, and the prevalence of cranial cruciate ligament rupture in camelids.     

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

OBJECTIVE: To determine effects of early intensive postoperative physiotherapy on limb function in dogs after tibial plateau leveling osteotomy (TPLO) for deficiency of the cranial cruciate ligament (CCL). ANIMALS: 8 adult dogs with CCL deficiency. PROCEDURE: After TPLO, dogs underwent a physiotherapy program 3 times/wk (physiotherapy group; n = 4) or a walking program (home-exercise group; 4). All dogs were evaluated before surgery, 1 and 10 days after surgery, and 3 and 6 weeks after surgery. Thigh circumference (TC), stifle joint flexion and extension range of motion (ROM), lameness, and weight-bearing scores were recorded. RESULTS: Before surgery, CCL-deficient limbs had significantly reduced TC and reduced flexion and extension ROMs, compared with values for the contralateral control limb. Six weeks after TPLO, the physiotherapy group had significantly larger TC than the home-exercise group, with the difference no longer evident between the affected and nonaffected limbs. Extension and flexion ROMs were significantly greater in the physiotherapy group, compared with values for the home-exercise group, 3 and 6 weeks after surgery. Six weeks after surgery, the difference in flexion and extension ROMs was no longer evident between the affected and nonaffected limbs in the physiotherapy group. Both groups had improvements for lameness and weight-bearing scores over time, but no difference was found between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE: After TPLO in CCL-deficient dogs, early physiotherapy intervention should be considered as part of the postoperative management to prevent muscle atrophy, build muscle mass and strength, and increase stifle joint flexion and extension ROMs.     

Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog

OBJECTIVE: Comparison of 2 methods of surgical management of cranial cruciate ligament (CCL) injury in large-breed dogs using a radiographic osteoarthrosis (OA) scoring system. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n=66). METHODS: Radiographs were evaluated from dogs weighing >/=22.7 kg, with surgical management of CCL rupture using extracapsular repair (ECR) or tibial plateau leveling osteotomy (TPLO). Radiographs were taken immediately before surgery and >/=12 months later. An OA score was assigned to each set of radiographs taken at the preoperative and final examinations by evaluating 32 specific features of stifle OA. The difference between preoperative and final OA scores were subtracted and 2 final score categories of a change 5 were created. A logistic regression model was used to evaluate the effect of right versus left pelvic limb, age, preoperative weight, postoperative weight, days from surgery until final radiographic recheck, cranial cruciate status at surgery, medial meniscus status at surgery, and ECR versus TPLO. RESULTS: The ECR group had 27 stifles (22 dogs) and the TPLO group had 52 stifles (44 dogs). ECR dogs had a preoperative weight of 33.4+/-9.3 kg (range 22.7-54.1 kg) and a preoperative OA score of 13.0+/-8.4 (range 1-34) compared with TPLO dogs that had a preoperative weight of 38.9+/-9.1 kg (range 25-63.9 kg) and preoperative OA score of 15.9+/-8.4 (range 4-44). Postoperative weights for ECR and TPLO dogs were 33.6+/-9 kg (range 21.8-54.6 kg) and 39.4+/-10.1 kg (range 24-72 kg), respectively. Final OA scores were: ECR dogs, 26.3+/-10.8 (range, 10-54); TPLO dogs, 23.3+/-9.5 (range, 12-50). Dogs with a final change in OA score of >/=6 were 5.78 times more likely to have had ECR compared with those that had TPLO as stabilization procedure (odds ratio=5.78; Log-likelihood test P-value=.025). Other dependent variables were not significant. CONCLUSIONS: Based on logistic regression analysis, dogs with larger OA score differences were 5.78 times more likely to have had ECR than TPLO. CLINICAL RELEVANCE: Prospective, randomized surgical trials with pre-defined objective measures would be required to further evaluate the clinical importance of these preliminary findings which suggest that TPLO may help stabilize the cranial tibial thrust as originally proposed.     

Relationship between age and tibial plateau angle in dogs with cranial cruciate rupture

The pathogenesis of cranial cruciate ligament (CCL) rupture remains controversial, and its relationship to tibial plateau angle is unknown. In this study, the tibial plateau angle was measured in 200 large-breed dogs diagnosed with CCL rupture. Correlation analyses were performed to determine whether the age at the time of CCL rupture and the tibial plateau angle were related. While these two values were inversely correlated, the relationship was not strong enough to explain the frequency of CCL rupture in young, large-breed dogs. There was no statistically significant correlation between age at the time of CCL rupture and tibial plateau angle.     

Proximal tibial epiphysiodesis to reduce tibial plateau slope in young dogs with cranial cruciate ligament deficient stifle

The purpose of this study was to evaluate the ability of proximal tibial epiphysiodesis to reduce the tibial plateau slope in young dogs with cranial cruciate ligament (CCL) deficient stifles. Of the 14 treated dogs, eight had a bilateral injury, for a total of 22 joints. After physical and radiographical examination and measurement of tibial plateau slope, all of the dogs underwent surgery. Insertion of the screw was placed in the most proximal part of the tibial plateau, in its medio-lateral centre, aiming to the tibial shaft and using a K wire predriven as a guide; correct position of the screw was confirmed with intraoperative fluoroscopy or radiography. In all of the dogs the tibial slope was decreased at the time of physis fusion and the degree of change depended on the age and the breed of the dog at the time of surgery. The minimum change was 4 degrees and the maximum was 24 degrees. There was a statistically significant difference between tibial slope measured before surgery compared to tibial slope measured at the last follow-up visit after surgery. This study shows that the partial proximal tibial fusion in dogs with ACL injuries was effective in reducing the tibial slope during the residual growing time to such an extent to stabilize the joint, provided that the surgery had been carried out when there was still residual growing potential. The technique appeared to be mini-invasive and malalignment complications could be avoided by correct and precise insertion of the screw.     

Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs.

The tibial wedge osteotomy (TWO), a procedure that reduces the tibial plateau slope, has become an established surgical technique for the treatment of cranial cruciate ligament injuries in dogs, yet variation from the desired postoperative tibial plateau slope of 6 degrees has been noted. The objectives of this study were to investigate the geometric implications of this procedure and to identify factors that affect the postoperative angles. The records of 35 consecutive cases that had a TWO performed were reviewed and comparisons were made between the alignment of the cortices and level of the osteotomy using duplicated tracings of a preoperative radiograph. The existing method for calculating the size of wedge to be removed was found to result in a postoperative slope greater than the expected 6 degrees. Our results indicate that the desired postoperative angle is more likely to be achieved if the cranial cortices are aligned and the osteotomy is performed proximally.     

Pre- and postoperative force plate analysis of dogs with experimentally transected cranial cruciate ligaments treated using tibial plateau leveling osteotomy

Objective— Quantitative and objective assessment of hindlimb kinetics after cranial cruciate ligament (CrCL) transection and subsequent stifle stabilization using the tibial plateau leveling osteotomy (TPLO) in normal dogs.
Study Design— In vivo experimental biomechanical evaluation.
Animals— Six healthy adult foxhounds.
Methods— Dogs were screened by orthopedic and radiographic examination before study entry. Force plate analysis of gait was measured before extirpation of the right CrCL and TPLO and again at 8 and 18 weeks after surgery.
Results— There was a significant decrease in peak vertical forces (PVFs) and vertical impulse (VI) of the treated hindlimb at 8 weeks when compared with preoperative and 18-week measurements. When compared with preoperative values, there was no significant difference in 18 week PVF and VI in dogs that had TPLO.
Conclusion— TPLO can restore kinetic measures of limb function at 18-weeks after surgery when compared with preoperative values after experimental transection of the CrCL in dogs.
Clinical Relevance— TPLO induces lameness that returns to near normal at 18 weeks. The severity and duration of lameness was similar to that reported for other experimental models of stifle instability repaired by different techniques.     

Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries

OBJECTIVE: To measure and compare tibial plateau angles (TPA) of dogs with cranial cruciate ligament (CrCL) injuries and dogs without CrCL injuries. DESIGN: Prospective study. ANIMALS: 87 dogs. PROCEDURE: Stifle joints were measured from lateral radiographic views to determine TPA in 3 groups: group-1 dogs had CrCL injuries, group-1a dogs, a subgroup of group 1, had 1 unaffected stifle joint, and group-2 dogs had no CrCL injuries. Age, sex, breed, body weight, limb injured, and TPA were recorded for each dog. RESULTS: 56 stifle joints were measured in group-1 dogs; mean TPA was 23.76 degrees , and mean age and weight were 5.7 years and 37.91 kg (83.4 lb), respectively. Fourteen stifle joints were measured in group-1a dogs; mean TPA was 24.71 degrees , and mean age and weight were 5.6 years and 38.06 kg (83.8 lb), respectively. Sixty stifle joints were measured in group-2 dogs; mean TPA was 18.10 degrees , and mean age and weight of these dogs were 4.83 years and 35.85 kg (79 lb), respectively. The most common breeds included Labrador Retriever, Golden Retriever, and Rottweiler. The TPA of dogs in group 1 and group 1a were significantly greater than the TPA of dogs in group 2. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs with CrCL injuries have a significantly greater TPA than dogs without CrCL injury. With further investigation, a normal TPA can be determined. In the future, TPA measurements may be used to screen dogs suspected of being susceptible to CrCL injury.