Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs

Objective— To describe the surgical technique, early results and complications of tibial tuberosity advancement (TTA) for treatment for cranial cruciate ligament (CrCL)-deficient stifle joints in dogs.
Study Design— Retrospective clinical study.
Animals— Dogs (n=101) with CrCL-deficient stifles (114).
Methods— Medical records of 101 dogs that had TTA were reviewed. Complications were recorded and separated into either major or minor complications based on the need for additional surgery. In-hospital re-evaluation of limb function and time to radiographic healing were reviewed. Further follow-up was obtained by telephone interview of owners.
Results— Complications occurred in 31.5% of the dogs (12.3% major, 19.3% minor). Major complications included subsequent meniscal tear, tibial fracture, implant failure, infection, lick granuloma, incisional trauma, and medial patellar luxation; all major complications were treated with successful outcomes. All but 2 minor complications resolved. The mean time to documented radiographic healing was 11.3 weeks. Final in-hospital re-evaluation of limb function (mean, 13.5 weeks), was recorded for 93 dogs with lameness categorized as none (74.5%), mild (23.5%), moderate (2%), and severe (1%). All but 2 owners interviewed were satisfied with outcome and 83.1% reported a marked improvement or a return to pre-injury status.
Conclusions— TTA is a procedure comparable with alternate methods of CrCL repair with expected good to excellent functional outcome.
Clinical Relevance— TTA procedure can be successfully used to obtain the dynamic stability of a CrCL-deficient stifle joint in dogs.     

Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease

OBJECTIVE: To assess functional outcome in dogs with cranial cruciate ligament (CrCL) disease after tibial tuberosity advancement (TTA) using force plate gait analysis, and to evaluate parameters potentially influencing outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Consecutive clinical patients (n = 37) with CrCL-deficient stifles (n = 40). METHODS: The stifle joints were examined arthroscopically prior to TTA. Meniscal release was not performed if the medial meniscus was intact. Open medial arthrotomy and partial meniscectomy were performed in the presence of meniscal tears. Vertical ground reaction forces were measured preoperatively and at follow-up examinations four to 16 months postoperatively (mean: 5.9 months). The ground reaction forces of a group of 65 healthy dogs were used for the comparison. The potential effects of clinical parameters on functional outcome were evaluated statistically. RESULTS: Complete CrCL rupture was identified in 28 joints, and partial CrCL rupture in 12 joints. The medial meniscus was damaged in 21 stifles. Vertical ground reaction forces were significantly higher at follow-up (P < 0.01), but remained significantly lower than those of control dogs (P < 0.01). Complications were identified in 25% of joints, and the dogs with complications had significantly lower peak vertical forces at follow-up than the dogs without complications (P = 0.04). Other clinical parameters did not influence outcome. CONCLUSIONS: Tibial tuberosity advancement significantly improved limb function in dogs with CrCL disease, but did not result in complete return to function. Complications adversely affected functional outcome. CLINICAL SIGNIFICANCE: A return to a function of approximately 90% of normal can be expected in dogs with CrCL disease undergoing TTA.     

Relationship of tibial plateau slope to limb function in dogs treated with a lateral suture technique for stabilization of cranial cruciate ligament deficient stifles

OBJECTIVE: To evaluate the effect of a lateral suture technique (LST) on tibial plateau angle (TPA) measurement and to compare TPA with functional outcome in dogs treated for cranial cruciate ligament (CrCL) rupture with LST. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Dogs (n=34) with unilateral CrCL instability. METHODS: All dogs had lameness examination, survey stifle radiographs, and force plate analysis before and at 6, 12, 24, and 48 weeks after surgery. Radiographic osteoarthritis (OA) scores and lameness scores were assigned using previously reported methods. Preoperative radiographs were performed in all dogs, and postoperative serial radiographs were performed in 6 dogs for measurement of TPA. Differences in TPA measurements were evaluated with a random effects repeated measures model. The significance of LST on TPA measurement was established in 6 dogs and the effect of TPA on vertical impulse, peak vertical force, progression of radiographic scores, and lameness score were analyzed by general linear models in all dogs. Differences were considered significant if P<.05. RESULTS: Significant differences were not noted between pre- and serial postoperative measurements of TPA. A significant correlation was not established between TPA and postoperative vertical impulse, peak vertical force, lameness score, or radiographic OA scores. CONCLUSIONS: TPA values were unchanged after LST and TPA does not affect outcome measures in dogs treated with LST. CLINICAL RELEVANCE: TPA has no predictive value on clinical outcome in dogs treated with LST for stabilization of CrCL deficient stifles.     

Hamstring graft technique for stabilization of canine cranial cruciate ligament deficient stifles

OBJECTIVE: To investigate the harvest and application of hamstring grafts for canine cranial cruciate ligament (CrCL) reconstruction. STUDY DESIGN: Experimental study. ANIMALS: Four adult female hounds, weighing 26.3 +/- 1.6 kg (mean +/- SEM). METHODS-One stifle in each dog was randomly chosen for hamstring graft CrCL reconstruction after native CrCL transection. Arthroscopy was performed to evaluate graft integrity at 12 weeks. Gait analysis and stifle radiographs were performed preoperatively and up to 52 weeks after graft placement. Dogs were killed 12 (n = 2) or 52 weeks (n = 2) after CrCL reconstruction. Tissues were evaluated grossly and with light and confocal laser microscopy. RESULTS: Hamstring grafts were intact in all stifles at 12 weeks (n = 4) and 52 weeks (n = 2). Grossly, there was no osteoarthritis in stifles at 12 weeks and only chondrophytes along the trochlear ridges at 52 weeks. Minimal radiographic evidence of osteoarthritis developed in stifles with grafts during the study. Lameness in limbs with grafts resolved by 52 weeks. Graft tissue was highly vascular, ligamentized, and undergoing active remodeling at 12 weeks. Fifty-two weeks after graft placement, intraarticular graft tissue was well vascularized, mature, and encapsulated by synovium, and graft-bone interfaces were characterized by Sharpey's fiber insertions. There was no evidence of graft necrosis using confocal laser microscopy at either time point. CONCLUSIONS: The hamstring graft technique may be a viable method of canine CrCL reconstruction. CLINICAL RELEVANCE: Hamstring grafts may be an alternative technique for canine CrCL reconstruction. Further study is needed before clinical application.     

Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft

Objective: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA). Study Design: Prospective study and case series. Animals: Dogs treated with TTA (n=67). Methods: Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). Case series: nongrafted TTA (4–25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t‐tests and ANOVA. Significance was set at P≤.05. Results: Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. Case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2–4). No healing related complications were observed. Conclusion: The osteotomy gap created during TTA healed within expected time regardless of bone graft use.     

Comparison of Short‐ and Long‐term Function and Radiographic Osteoarthrosis in Dogs After Postoperative Physical Rehabilitation and Tibial Plateau Leveling Osteotomy or Lateral Fabellar Suture Stabilization

Objectives— To compare short‐ and long‐term functional and radiographic outcome of cranial cruciate ligament (CrCL) injury in dogs treated with postoperative physical rehabilitation and either tibial plateau leveling osteotomy (TPLO) or lateral fabellar suture stabilization (LFS). Study Design— Prospective observational clinical study. Animals— Medium to large breed dogs with naturally occurring CrCL injury (n=65). Methods— Dogs with CrCL injury were treated with either TPLO or LFS and with identical physical rehabilitation regimes postoperatively. Limb peak vertical force (PVF) was measured preoperatively and at 3, 5, and 7 weeks, and 6 months and 24 months postoperatively. Stifles were radiographically assessed for osteoarthrosis (OA) preoperatively and 24 months postoperatively. Results— Thirty‐five dogs had LFS and 30 dogs had TPLO. Radiographic OA scores were significantly increased at 24 months compared with preoperative scores in all dogs. Radiographic OA scores preoperatively and at 24 months were not significantly different between treatment groups. PVF was significantly increased from preoperative to 24 months among both treatment groups but not significantly different between treatment groups preoperatively or at 3, 5, 7 weeks, 6, or 24 months. Conclusion— No significant difference in outcome as determined by ground reaction forces or radiographic OA scores were found between dogs with CrCL injury treated with LFS or TPLO. Clinical Relevance— LFS and TPLO remain good options for stabilizing stifles with CrCL injury with all dogs showing significant functional improvement. This study does not support the superiority of either surgical technique.     

Synovitis in dogs with stable stifle joints and incipient cranial cruciate ligament rupture: a cross-sectional study

Objective: To evaluate stifle joints of dogs for synovitis, before development of joint instability and cranial cruciate ligament rupture (CrCLR). Study Design: Cross‐sectional study. Animals: Dogs (n=16) with CrCLR and stable contralateral stifles; 10 control dogs with intact CrCL. Methods: Arthritis and tibial translation were graded radiographically. Synovitis severity and cruciate pathology were assessed arthroscopically. Presence of inflammatory cells in synovial membrane biopsies was scored histologically. CrCLR stifle pairs and control stifles were compared. Results: Radiographic evidence of arthritis, cranial tibial translation, and arthroscopic synovitis were increased in unstable stifles, when compared with stable contralateral stifles in CrCLR dogs (P<.05). Arthroscopic synovitis in both joints of CrCLR dogs was increased compared with controls, was correlated with radiographic arthritis (S_R=0.71, P<.05), and was present in all stable contralateral stifles. Arthroscopically, 75% of stable stifle joints had CrCL fiber disruption, which correlated with severity of synovitis (S_R=0.56, P<.05). Histologic evidence of synovitis was identified in all CrCLR dogs, but was only significantly correlated with arthroscopic observations in stable stifles (r²=0.57, P<.005). Conclusion: Synovitis is an early feature of the CrCLR arthropathy in dogs before development of joint instability clinically. Severity of synovitis is correlated with radiographic arthritis in joints with minimal to no clinically detectable CrCL damage.     

Effect of Tibial Tuberosity Advancement on Femorotibial Contact Mechanics and Stifle Kinematics

Objective— To evaluate the effects of tibial tuberosity advancement (TTA) on femorotibial contact mechanics and 3-dimensional kinematics in cranial cruciate ligament (CrCL)-deficient stifles of dogs.
Study Design— In vitro biomechanical study.
Animals— Unpaired pelvic limbs from 8 dogs, weighing 28–35 kg.
Methods— Digital pressure sensors placed subjacent to the menisci were used to measure femorotibial contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. Three-dimensional static poses of the stifle were obtained using a Microscribe digitizing arm. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Repeated measures analysis of variance with a Tukey post hoc test ( P <.05) was used for statistical comparison.
Results— Significant disturbances to all measured contact mechanic parameters were evident after CrCL transection, which corresponded to marked cranial tibial subluxation and internal tibial rotation in the CrCL-deficient stifle. No significant differences in any contact mechanic and kinematic parameters were detected between normal and TTA-treated stifles.
Conclusion— TTA eliminates craniocaudal stifle instability during simulated weight-bearing and concurrently restores femorotibial contact mechanics to normal.
Clinical Relevance— TTA may mitigate the progression of stifle osteoarthritis in dogs afflicted with CrCL insufficiency by eliminating cranial tibial thrust while preserving the normal orientation of the proximal tibial articulating surface.     

The Effect of Intercondylar Notchplasty on the Normal Canine Stifle

This study evaluated the effect of notchplasty (enlargement of the intercondylar fossa) in stable and unstable canine stifles. Bilateral notchplasty and unilateral cranial cruciate ligament (CrCL) transection were performed in 6 dogs. Exercise, consisting of walking 1.5 miles three times a week, began 1 month after surgery and continued until euthanasia 6 months after surgery. Evaluation methods included orthopedic examination, serial radiographs, thin section radiography, histopathology, and gross pathology. Notchplasty in the stable stifle did not cause lameness beyond 3 weeks, joint instability, or degenerative joint disease. In the stable stifle, smooth resurfacing of the notchplasty site with fibrous and osseous tissue occurred. Stifles with notchplasty and CrCL transection exhibited persistent lameness, instability, and degenerative joint disease. In CrCL deficient stifles osteophytes formed within the notchplasty site, resulting in a rough surface. Our observations indicated significant refilling in notchplasties of both stable and unstable stifles ( P <.05). However, the intercondylar fossa (ICF) width 6 months after notchplasty was significantly smaller in unstable stifles compared with stable stifles ( P <.05) indicating that greater refilling of the notchplasties occurred in the unstable stifles. In clinical cases, notchplasty should be larger than the desired final result to accomodate the partial refilling that occurs even in stable stifles.     

Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs

Objective: To compare the resulting complications, short-term results, and client satisfaction for treatment of cranial cruciate ligament rupture using either unilateral or bilateral single-session tibial tuberosity advancement (TTA) in dogs. Methods: Medical records of 68 dogs (101 stifles) undergoing unilateral or bilateral single-session TTA were evaluated. Data gathered included signalment, history, physical examination findings, anaesthesia and surgical time, type of cranial cruciate ligament rupture and meniscal injury, implants, and intra-operative and postoperative complications. A mixed effect logistic regression analysis was performed to determine if complications were grouped by surgical procedure. Linear regression was performed to determine the influence of the variables on the occurrence of complications. Values of p <0.05 were considered significant. Results: No major intra-operative complications occurred. Twenty stifles (20%) developed a complication after surgery (11 minor, 9 major). There was no significant difference in occurrence of complications between dogs undergoing unilateral (n = 8) or bilateral single-session (n = 12) TTA (p = 0.69). The only risk factor found to be associated with complication occurrence was age. Clinical significance: This is the first report evaluating the use of bilateral simultaneous TTA. There was no significant difference in complication rates between unilateral and bilateral single-session TTA. Additional evaluation is needed to fully determine the extent of complications and long-term outcome of bilateral single-session TTA.     

Healing of Cortical Bone Grafts in the Dog The Role of Azathioprine

Sixteen unrelated beagles, randomly divided into groups of four, were used in evaluating the role of therapeutic immunosuppression in the healing of fresh cortical bone allografts over a 16-week period. The four groups included: nontreated allograft, treated allograft, nontreated autograft, and treated autograft. A 2.7-cm tibial cortical graft was fixed orthotopically using a dynamic compression plate. Healing was evaluated by radiography and by gross and histologic studies at 2, 4, 8, and 16 weeks after surgery. The treated dogs were immunosuppressed with azathioprine for eight weeks postsurgery. The conclusions were that: temporary immunosuppression did not significantly alter healing of fresh cortical bone autografts; healing of fresh cortical bone allografts in immunosuppressed dogs was similar to healing of fresh cortical bone autografts; slight differences were observed in the healing of bone grafts in all groups after eight weeks; and cellular reaction typical of graft rejection was found in nontreated allografts, but healing still occurred.     

In vivo evaluation of intra-articular protection in a novel model of canine cranial cruciate ligament mid-substance elongation injury

OBJECTIVES: To evaluate the effects of intra-articular protection (IAP) on the canine cranial cruciate ligament (CrCL) and stifle in a CrCL midsubstance elongation injury model. STUDY DESIGN: Experimental longitudinal cohort study. ANIMALS: Skeletally mature female mixed breed hounds (n=12; mean+/-SEM weight, 25.6+/-0.7 kg). METHODS: After CrCL elongation in 1 stifle of each dog, IAP was applied in 6 joints. In vivo assessment included radiographs, cranial-caudal joint translation, gait analysis, and synovial fluid levels of 3B3(-) (proteoglycan epitope) and C2C (collagen II neoepitope) up to 12 weeks after surgery. Joint translation and rotation were quantified at necropsy. CrCL midsubstance length was determined before and after elongation and at necropsy. CrCLs were subjectively assessed with light microscopy. Comparisons were made between stifles containing elongated CrCLs with and without IAP and unoperated controls. RESULTS: Four weeks after surgery, ground reaction forces were significantly decreased in operated limbs. Absolute C2C levels were significantly elevated in operated stifles 4 weeks post-surgery. C2C and 3B3(-) levels normalized to total protein were significantly elevated in IAP+ stifles 8 weeks after surgery. Protected CrCLs appeared to have decreased granulation tissue and better collagen fiber alignment. CONCLUSIONS: IAP has negligible effects on the canine stifle based on the response variables evaluated in this 12-week study. Protection of elongated CrCLs may promote reduced, organized scar formation. CLINICAL RELEVANCE: These results support the healing capacity of the canine CrCL midsubstance following elongation injury and IAP application to potentially reduce cicatrix formation in elongated CrCLs.     

Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints

OBJECTIVE: To describe a modification of the tibial tuberosity advancement (TTA) procedure that required tuberosity advancement in excess of 12 mm for the stabilization of cranial cruciate ligament (CrCL) deficient stifle joints. METHODS: Four large breed dogs with CrCL deficient stifle joints (one bilateral) underwent a modified TTA of 15 or 16 mm in order to obtain a patellar tendon angle of 90 degrees to the tibial plateau slope or common tangent between femur and tibia in the extended limb position. The desired TTA was achieved by displacing a 12-mm cage distally; this displacement distance was calculated from two similar triangles formed within the planned osteotomy site. An allogenous cancellous bone block placed proximal to the cage provided buttress support; a corticocancellous allograft filled the remainder of the gap. Tibial tuberosity fixation was performed as previously described. RESULTS: Healing of the osteotomy defects with incorporation of the cancellous block was observed at a mean of 8.6 weeks postoperatively. Normal return of limb function was reported in all of the dogs except for one dog that underwent revision surgery four months postoperatively for a continued lameness. Technical errors at the time of the original surgical procedure in this dog resulted in insufficient tuberosity advancement; additional advancement was performed, which resolved the lameness. CLINICAL SIGNIFICANCE: Results in this series suggest that our modification of the TTA, in order to advance the tuberosity in excess of 12 mm, could be successfully obtained using the currently available implants.     

Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study

OBJECTIVE: To evaluate the effect of tibial tuberosity advancement (TTA) on tibiofemoral shear force as reflected by measurement of cranial tibial subluxation (CTS) and patella tendon angle (PTA) in the canine cranial cruciate ligament (CrCL) deficient stifle joint. STUDY DESIGN: In vitro cadaver study. ANIMALS: Canine cadaveric hind limbs (n=10). METHODS: CTS and PTA were evaluated from lateral radiographic projections in axially loaded intact CrCL stifle joints, after transection of the CrCL, at a maximally advanced tibial tuberosity position, and at a critical point position. A custom-designed hinge plate allowed alteration of the tibia to tibial tuberosity distance (Ti-TT) under axial load. Digitized radiographic images were used to quantify CTS, PTA, and Ti-TT. Comparisons within groups were made using 1-way repeated measures ANOVA. A post hoc Tukey's HSD test was used to determine post-ANOVA pair-wise comparison within these groups. Significance was set at a value of P<.05. RESULTS: CTS occurred after CrCL transection, which was significantly different from the intact position (P<.01). Subsequent stability of the stifle joint was obtained by advancing the tibial tuberosity. In the maximally advanced tibial tuberosity position, caudal tibial thrust was generated resulting in caudal tibial subluxation that was significantly different from the transected CrCL position (P<.01) and from the intact CrCL position (P<.01). Despite a stable joint, there was slight CTS at the critical point position, which was significantly different from the intact CrCL position (P<.05). The PTA at the maximally advanced position was significantly different from the intact, critical point and reference 90 degrees PTAs (P<.01). The PTA at the critical point position was significantly different from the intact and maximally advanced tibial tuberosity PTAs (P<.01), but not different (P>.05) from the reference 90 degrees PTA. CONCLUSION: We demonstrated that advancement of the tibial tuberosity neutralized cranial tibial thrust, and converted cranial tibial thrust into caudal tibial thrust. Neutralization of tibiofemoral shear forces occurred at a PTA of 90.3+/-9.0 degrees. CLINICAL RELEVANCE: TTA can effectively change the magnitude and direction of the tibiofemoral shear force, and thus may be used to prevent craniotibial translation in a CrCL deficient stifle joint.     

Evaluation of a Transcondylar Toggle System for Stabilization of the Cranial Cruciate Deficient Stifle in Small Dogs and Cats

Objective— To evaluate use of a transcondylar toggle system (TCTS) for stabilization of the cranial cruciate ligament (CrCL) deficient stifle in small dogs and cats. Study Design— Prospective clinical study. Animals— Small dogs (<7 kg; n=14) and cats (2) with CrCL‐associated lameness of <3 months duration and a tibial plateau angle <32°. Methods— Affected animals had an extracapsular CrCL repair using the TCTS. Lameness score, muscle atrophy, osteoarthritis (OA) score, and range of motion (ROM) were evaluated preoperatively, and at 6 weeks and 7–10 months postoperatively. Results— Operative time was 75 ± 16 minutes. Fifty‐six percent required >1 bone tunnel attempts. One dog required revision at 2 weeks because of suture loosening. All stifles were stable at 6 weeks postoperatively. Fifteen animals were available for follow‐up (7–10 months). Lameness improved significantly at 6 weeks (P<.0001), whereas muscle atrophy was worse at 6 weeks (P=.008) but improved at 7–10 months (P<.0001). OA scores were unchanged at 6 weeks (P=.08) but were significantly worse at 7–10 months (P<.0001). ROM remained unchanged at 6 weeks (P=1) and 7–10 months (P=.6). Conclusions— The medially placed toggle provides a reliable short‐term proximal anchor for the extracapsular suture with outcomes similar to other extracapsular techniques. The aiming device and drill bit are not recommended in their current form. Clinical Relevance— The TCTS appears to be a well‐tolerated technique for proximal suture anchoring in extracapsular CrCL repair in small dogs and cats where instrumentation and anatomic constraints preclude other techniques.     

Tibial tuberosity advancement in 92 canine stifles: initial results,clinical outcome and owner evaluation

Objective To investigate the clinical outcomes, complications and owners' evaluation of the tibial tuberosity advancement (TTA) procedure in canine stifles. Methods A retrospective study of hospital records was performed to identify dogs diagnosed with partial or complete cranial cruciate ligament (CCL) rupture that had undergone TTA repair. Information obtained included signalment, period of lameness, surgical report, evidence of meniscal injury, postoperative recovery and peri-operative complications. Owners were asked to assess the long-term outcome. Results In a total of 72 dogs (median age, 6 years; median body weight, 34.8 kg), TTA was performed in 92 stifles. Twenty breeds were represented, with Labrador Retrievers and Rottweilers the most common. The period of lameness ranged from 3 days to 24 months. The median pre-operative lameness score was 3/4 and meniscal injury was present in 51 stifles. Minor complications occurred in 29% of cases. Major complications occurred in 6.5% of cases and consisted of meniscal injury and two tibial tuberosity fractures. All were successfully managed, with good limb function when subsequently assessed. In the owner evaluation, 96% reported moderate to great improvement postoperatively, with no lameness at rest and mild to no lameness after vigorous exercise. Conclusion Clinical outcome and owner evaluations in this case series indicate favourable results can be expected when CCL-deficient stifles are treated with TTA.     

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.     

Feasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs

The patellar ligament angle (PLA) was assessed in 105 normal stifle joints of 79 dogs and 33 stifle joints of 26 dogs with a ruptured cranial cruciate ligament (CrCL). The PLA of stifles with complete CrCL rupture was significantly lower than that of normal stifles, particularly at a flexion angle of 60~80° in both plain and stress views. If the PLA was <90.55° on the stress view with a 60~80° flexion angle, the dog was diagnosed with a complete rupture of the CrCL with a sensitivity of 83.9% and specificity of 100%. In conclusion, measuring the PLA is a quantitative method for diagnosing complete CrCL rupture in canines.     

Retrospective comparison between minimally invasive plate osteosynthesis and open plating for tibial fractures in dogs

Objectives: To compare fracture healing in diaphyseal tibial fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF). Methods: Dogs in each group were matched for type of fracture, age and body weight. Stage of healing was measured blindly every four weeks postoperatively until complete healing. Outcome variables including fracture length, plate length, plate bridging ratio, plate working length, healing grading, and fracture reduction were compared between groups using the Mann-Whitney test. Significant difference was set at p <0.05. Results: Based on the definition of clinical union, at 30 days five out of eight dogs managed with MIPO had healed, while two of the eight of dogs managed with ORIF had healed. We did not find any significant differences in the other outcome measures. No complications were reported in the MIPO group whereas one major complication was reported in the ORIF group. Clinical significance: All dogs treated by MIPO healed rapidly without any complications, nevertheless the difference in radiographic healing between the two groups was not significant.