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Jeong E, Jeon Y, Kim T, Lee D, Roh Y. Assessing the Effectiveness of Modified Tibial Plateau Leveling Osteotomy Plates for Treating Cranial Cruciate Ligament Rupture and Medial Patellar Luxation in Small-Breed Dogs. Animals (Basel) 2024; 14:1937. [PMID: 38998050 PMCID: PMC11240633 DOI: 10.3390/ani14131937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
In small-breed dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), correcting both disorders is are essential for restoring normal gait. However, the previously described surgical treatment, using two osteotomy technique, poses a high risk of fracture and instability. Addressing CCLR and MPL with a single osteotomy and implant was considered superior to the conventional method. Therefore, a pre-contoured modified tibial plateau leveling osteotomy (PCM-TPLO) plate facilitating medial shifting of the proximal tibia was developed. We compared postoperative alignment and strength between this novel plate group and a conventional tibial plateau leveling osteotomy (TPLO) plate group using eight small-breed dog cadavers each. Additionally, we investigated the potential of the novel plate as an alternative to tibial tuberosity transposition. Postoperative alignment and strength were assessed through radiographs and mechanical testing. Measurements including tibial plateau angle, mechanical medial proximal tibial angle, and number of screws within the joint were also analyzed. There were no significant differences in all measured parameters. For the novel plate, the medial displacement ratio of the proximal tibia was confirmed to be approximately 30%, and the result was thought to be appropriate. These findings suggest that the PCM-TPLO plate could be a promising alternative for treating concurrent CCLR and MPL in small-breed dogs.
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Affiliation(s)
- Eunbin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea; (E.J.); (T.K.); (D.L.)
| | - Youngjin Jeon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea;
| | - Taewan Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea; (E.J.); (T.K.); (D.L.)
| | - Dongbin Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea; (E.J.); (T.K.); (D.L.)
| | - Yoonho Roh
- Department of Veterinary Surgery, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea; (E.J.); (T.K.); (D.L.)
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KWANANOCHA I, AKARAPHUTIPORN E, UPARIPUTTI R, LEKCHAREONSUK C, WANGDEE C. Short-term outcomes of cranial cruciate ligament rupture treated surgically with tibial plateau leveling osteotomy or non-surgically in small-breed dogs weighing less than10 kg. J Vet Med Sci 2024; 86:428-435. [PMID: 38417876 PMCID: PMC11061578 DOI: 10.1292/jvms.23-0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
Cranial cruciate ligament rupture (CCLR) is a common cause of stifle joint pain in dogs. This study assessed the short-term outcomes in the management of CCLR, with or without concurrent medial patellar luxation (MPL), in small-breed dogs, comparing surgical intervention using tibial plateau leveling osteotomy (TPLO) with non-surgical approaches. Dogs weighing less than 10 kg and suffering from CCLR were divided into two groups: surgical and non-surgical (nine stifles per group). Both groups followed the same rehabilitation protocol. Measurements were taken on days 0, 14, 28, 42, 56, 70, and 84. These measurements included the mean difference in orthopedic assessment score (diffOAS) and thigh muscle circumference (TMC) assessed by veterinarians, as well as the Canine Brief Pain Inventory score (CBPI) evaluated by the owners. Six stifles had concurrent MPL in the surgical group and five in the non-surgical group. No significant differences were observed in diffOAS (P=0.685), TMC (P=0.557), CBPI pain severity score (P=0.062), and CBPI pain interference score (P=0.29) between the two groups. However, both groups showed a significant decrease (P<0.05) in diffOAS and CBPI. The TMC remained relatively stable in the non-surgical group (P>0.05), but it significantly increased in the surgical group (P<0.05). Both groups demonstrated improved clinical outcomes in the short term, with no significant differences. However, cautious consideration should be given to a conservative treatment in small-breed dogs, particularly when considering the exclusive improvement observed in TMC within the TPLO group.
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Affiliation(s)
- Irin KWANANOCHA
- Research and Academic Service, Faculty of Veterinary
Medicine, Kasetsart University, Bangkok, Thailand
| | - Ekkapol AKARAPHUTIPORN
- Department of Veterinary Surgery, Faculty of Veterinary
Science, Chulalongkorn University, Bangkok, Thailand
| | - Rutaitip UPARIPUTTI
- Rehabilitation Unit, Small Animal Teaching Hospital,
Chulalongkorn University, Bangkok, Thailand
| | - Chalermpol LEKCHAREONSUK
- Department of Companion Animals Clinical Sciences, Faculty
of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Chalika WANGDEE
- Department of Veterinary Surgery, Faculty of Veterinary
Science, Chulalongkorn University, Bangkok, Thailand
- Veterinary Clinical Stem Cells and Bioengineering Research
Unit, Chulalongkorn University, Bangkok, Thailand
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Redolfi G, Grand JG. Complications and Long-Term Outcomes after Combined Tibial Plateau Leveling Osteotomy and Tibial Tuberosity Transposition for Treatment of Concurrent Cranial Cruciate Ligament Rupture and Grade III or IV Medial Patellar Luxation. Vet Comp Orthop Traumatol 2024; 37:43-49. [PMID: 37487533 DOI: 10.1055/s-0043-1770740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVES This study aims to report complications and long-term outcomes of combined tibial plateau leveling osteotomy and tibial tuberosity transposition (TPLO-TTT) for treatment of concurrent cranial cruciate ligament rupture and medial patellar luxation (MPL). STUDY DESIGN This is a retrospective study. Dogs that underwent TPLO-TTT for treatment of combined cranial cruciate ligament rupture and grade III or IV MPL were included. Signalment, fixation method, and complications were recorded. Long-term outcome assessment (minimum 1 year postoperatively) was performed through clinical and radiographic reexamination at the authors' institution. RESULTS Twenty-four stifles (22 dogs) were included. Twenty-one stifles had a grade III MPL, and 3 stifles had grade IV MPL. Four major complications consisting of surgical site infection (n = 3) and recurrent grade II MPL (n = 1) were observed. Dogs with surgical site infections were successfully treated with implant removal and oral antibiotics. No additional surgery was performed for the patient with recurrent MPL as no signs of lameness were observed. Minor complications occurred in five cases. At long-term evaluation (median: 27 months; range: 12-67 months), 21/22 dogs were clinically sound and 23/24 stifles had a complete resolution of MPL. CONCLUSION TPLO-TTT can be considered as an effective surgical option to treat patients with concurrent cranial cruciate ligament rupture and MPL with a relatively low major complication rate. Owners should be warned of the potential need for implant removal.
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Affiliation(s)
- Giovanna Redolfi
- Surgical Department, Centre Hospitalier Vétérinaire Anicura - Aquivet, Eysines, France
| | - Jean-Guillaume Grand
- Surgical Department, Centre Hospitalier Vétérinaire Anicura - Aquivet, Eysines, France
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Dallago M, Baroncelli AB, Hudson C, Peirone B, De Bakker E, Piras LA. Effect of Plate Type on Tibial Plateau Levelling and Medialization Osteotomy for Treatment of Cranial Cruciate Ligament Rupture and Concomitant Medial Patellar Luxation in Small Breed Dogs: An In Vitro Study. Vet Comp Orthop Traumatol 2023. [PMID: 37130555 DOI: 10.1055/s-0043-1768163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The main aim of this study was to determine the effective magnitude of proximal tibial segment medialization achievable during tibial plateau levelling and medialization osteotomy (TPLO-M) with Fixin 1.9-2.5 mm pre-contoured T plates with three different offsets. METHODS In this in vitro study, 36 tibia bone models reconstructed using stereolithography from hindlimb CT scans of a 5 kg dog and a 10 kg dog without orthopaedic disease were used. TPLO-M was performed using plates with three different offsets (2, 4 and 6 mm). Post-osteotomy radiographic and bone models measurements were performed. RESULTS Regardless of patient weight, the +4 mm offset plates provided a translation of 2.93mm (± 0.51) while the +6 mm offset plates provided a translation of 5.03mm (± 0.47). In the 5kg dog bone model group limited bone contact at the osteotomy site was documented when using the +6mm offset plate. CONCLUSION The +4mm and +6mm offset Fixin plates may be considered for TPLO-M in dogs weighing between 5 and 10 kg. The +6mm offset plate should be used cautiously in dogs weighing less than 10 kg since this plate may result in insufficient postoperative bone apposition at the osteotomy site.
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Affiliation(s)
- Melania Dallago
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
- Department of Medical Imaging and Orthopedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Caleb Hudson
- Department of Surgery, Gulf Coast Veterinary Specialists, Houston, Texas, United States
| | - Bruno Peirone
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Evelien De Bakker
- Department of Medical Imaging and Orthopedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lisa Adele Piras
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
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Polajnar P, Szanto Z, Willmitzer F, Medl N. Treatment of cranial cruciate ligament insufficiency and medial patellar luxation in a small‐breed dog with a true spherical osteotomy. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Petar Polajnar
- AniCura Small Animal Referral Clinic Babenhausen Germany
| | - Zsigmond Szanto
- Twin Falls Veterinary Clinic and Hospital Twin Falls Idaho USA
| | | | - Nikola Medl
- AniCura Small Animal Referral Clinic Babenhausen Germany
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Inter- and Intra-Observer Variations in Radiographic Evaluation of Pelvic Limbs in Yorkshire Terriers with Cranial Cruciate Ligament Rupture and Patellar Luxation. Vet Sci 2022; 9:vetsci9040179. [PMID: 35448677 PMCID: PMC9024879 DOI: 10.3390/vetsci9040179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
The main aims of the study were to describe bone alignment differences in Yorkshire Terriers (YT) with cranial cruciate ligament rupture (CCLR), patellar luxation (PL), or with a combination of both (CCLR + PL); to verify the theory of increased strain on cranial cruciate ligament (CrCL) due to PL as a predisposing factor; and to evaluate intra- and inter-observer variability of the protocols developed for measurement of femoral and tibial alignment in Yorkshire Terriers. Fifty-five hindlimbs of YT were divided into four groups: Control, CCLR, PL, and CCLR + PL. Thirty parameters were radiographically evaluated including hip joint, femoral, tibial, and intercondylar fossa (ICF) parameters. Three observers evaluated all parameters on two separate occasions with a twelve-week interval between measurements. Significant differences in conjunction with CCLR and PL theories between groups were noticed in: Norberg angle (NA), quadriceps angle (Qa), anatomic lateral distal femoral angle (aLDFA), femoral varus (FVA), mechanical cranial proximal tibial angle (mCrPTA), mechanical caudal proximal tibial angle (mCdPTA), tibial plateau angle (TPA), distal tibial axis/proximal tibial axis angle (DPA). Some interesting findings are the similarity of values between Control and CCLR vs. CCLR + PL and PL groups in Na, Qa, aLDFA; between CCLR + PL and PL in FVA and a significantly lower age of dogs in CCLR + PL compared to CCLR group. Based on our results, we can conclude that YT with different clinical findings have differing bone morphology. Moreover, these findings may support PL as a predisposing factor for CCLR in small breeds. Measurements in which excellent inter- observer agreement was achieved may be used for surgical planning or for further discussions.
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Clough WT, Dycus DL, Barnhart MD, Hulse DA, Litsky AS. Combined center of rotation of angulation-based leveling osteotomy and tibial tuberosity transposition: An ex vivo mechanical study. Vet Surg 2022; 51:489-496. [PMID: 35258115 DOI: 10.1111/vsu.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/18/2021] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the technique of combined center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) with tibial tuberosity transposition (TTT) and to compare the load to failure between CBLO combined with TTT and CBLO or TTT alone. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Twelve pairs of cadaveric pelvic limbs. METHODS Six pairs of cadaveric tibia were tested in each group (CBLO-TTT versus CBLO) and (CBLO-TTT versus TTT) with each limb randomly assigned to a treatment group. Construct stability was determined by applying a tensile force to each patellar tendon until failure occurred. Load at failure and mode of failure were recorded for each specimen. RESULTS No difference in mean load to failure was identified between CBLO-TTT (897 N) and CBLO alone (943 N) (P = .81). There was also no difference in the mean load to failure between the CBLO-TTT (928 N) and TTT alone (1046 N) (P = .12). CONCLUSION Performing a TTT in combination with a CBLO does not weaken the construct failure to load when compared with each procedure performed alone. CLINICAL SIGNIFICANCE A combined CBLO and TTT could be considered a viable option for concurrent management of a cranial cruciate ligament deficient stifle and medial patella luxation.
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Affiliation(s)
- W Tyler Clough
- MedVet Medical and Cancer Center for Pets, Worthington, Ohio, USA
| | - David L Dycus
- Nexus Veterinary Bone & Joint Center, Baltimore, Maryland, USA
| | | | - Don A Hulse
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomechanical Sciences, Texas A&M University, College Station, Texas, USA
| | - Alan S Litsky
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio, USA
- Department of Orthopedics, College of Medicine, Ohio State University, Columbus, Ohio, USA
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Andrade MC, Slunsky P, Klass LG, Brunnberg L. Patellar luxation and concomitant cranial cruciate ligament rupture in dogs - A review. VET MED-CZECH 2022; 67:163-178. [PMID: 39170807 PMCID: PMC11334444 DOI: 10.17221/111/2021-vetmed] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/29/2021] [Indexed: 08/23/2024] Open
Abstract
A patellar luxation and concomitant cranial cruciate ligament rupture is a common pathology in dogs. Diagnosis is based on clinical evidence of a patellar luxation and stifle joint instability. However, diagnostic imaging is required to assess the number of skeletal deformities and signs of instability. Surgical options include both soft tissue and osseous techniques, although, in most cases, a combination of multiple procedures is necessary to correct the patellar luxation and restore the stifle joint stability. Complication rates are generally low, but can include reluxation and implant-associated complications. This article describes the patellar luxation and cranial cruciate ligament rupture signs in dogs, including the clinical presentation and diagnosis, and discusses current treatment options.
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Affiliation(s)
- Mario Candela Andrade
- Department of Human Anatomy, Health and Medical University Potsdam, Potsdam, Brandenburg, Germany
| | - Pavel Slunsky
- Surgical Department, Small Animal Hospital, Anicura Kleintierspezialisten Augsburg, Augsburg, Bavaria, Germany
| | - Luise Grace Klass
- Department of Veterinary Medicine, Institute for Parasitology and Tropical Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany
| | - Leo Brunnberg
- Department of Veterinary Medicine, Small Animal Clinic, Freie Universitaet Berlin, Berlin, Germany
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Bula E, Perry KL. Tibial tuberosity transposition advancement for treatment of concomitant cranial cruciate ligament rupture and medial patellar luxation in four feline stifles. JFMS Open Rep 2021; 7:20551169211044695. [PMID: 34552760 PMCID: PMC8451263 DOI: 10.1177/20551169211044695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case series summary Three cats (four stifles) were diagnosed with varying grades of medial patellar luxation and stifle instability in cranial tibial thrust. Radiographs showed periarticular osteophytosis, intra-articular mineralization and opacification encroachment of the infrapatellar fat pad. Stifle exploration revealed either partial (n = 2) or complete (n = 2) cranial cruciate ligament tear and medial meniscal injury in all cases. Medial meniscectomy, partial parasagittal patellectomy, femoral trochleoplasty and tibial tuberosity transposition advancement using a 6 mm cage, two-fork plate and 4 mm spacer were performed in four stifles. Screws (2.0 mm) and washers were used in the cranial cage ears rather than conventional 2.4 mm screws. By the 2-week recheck, lameness was minimal and stifles were stable. Radiographic follow-up at 8 weeks showed appropriate progression of osseous union in all cases. One cat experienced a major complication, suffering tibial fracture following a lapse in exercise restriction, and revision surgery was performed successfully with subsequent osseus union of the osteotomy site. At the mid-term follow-up, all cats had a return to previous level of function, as assessed by both owner questionnaire and clinical evaluation. Relevance and novel information Tibial tuberosity transposition and advancement has been shown to be successful in dogs for the treatment of concomitant medial patellar luxation and cranial cruciate ligament rupture. To date, there have been no reports of tibial tuberosity transposition and advancement in cats. A benefit of this approach is concomitant alignment of the extensor mechanism and neutralization of the femorotibial shear force. Our case series describes successful use of tibial tuberosity transposition advancement in cats.
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Affiliation(s)
- Edyta Bula
- Small Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, MI, USA
| | - Karen L Perry
- Small Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, MI, USA
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Curuci EHP, Bernardes FJL, Minto BW. Modified tibial plateau levelling osteotomy to treat lateral patellar luxation and cranial cruciate ligament deficiency in a dog. Clin Case Rep 2021; 9:e04365. [PMID: 34429977 PMCID: PMC8365398 DOI: 10.1002/ccr3.4365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 11/07/2022] Open
Abstract
The use of modified tibial plateau leveling osteotomy adapted for correction of the lateral patellar dislocation was effective, allowing simultaneous treatment of lateral patellar luxation and cranial cruciate ligament deficiency.
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Affiliation(s)
- Eloy H. P. Curuci
- Faculty of Agrarian and Veterinary SciencesDepartment of Veterinary Clinic and SurgerySão Paulo State UniversityJaboticabalBrazil
| | - Filippo J. L. Bernardes
- Faculty of Agrarian and Veterinary SciencesDepartment of Veterinary Clinic and SurgerySão Paulo State UniversityJaboticabalBrazil
| | - Bruno W. Minto
- Faculty of Agrarian and Veterinary SciencesDepartment of Veterinary Clinic and SurgerySão Paulo State UniversityJaboticabalBrazil
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Marin K, Unis MD, Horgan JE, Roush JK. Risk factors for short-term postoperative complications in the 8 weeks after tibial plateau leveling osteotomy in dogs weighing less than 15 kilograms: A retrospective study. PLoS One 2021; 16:e0247555. [PMID: 33630887 PMCID: PMC7906318 DOI: 10.1371/journal.pone.0247555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose of this retrospective study was to evaluate the risk factors for short-term postoperative complications in the 8 weeks after unilateral tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament rupture in small dogs weighing less than 15 kg. Medical records were retrospectively reviewed for 90 dogs weighing <15 kg that underwent medial parapatellar arthrotomy with inspection of the meniscus and TPLO performed by the same surgeon between January 2012 and December 2017. The overall complication rate was 4.44% (4/90 dogs). There were four cases of partial incisional dehiscence, none of which required surgical revision. Complications were significantly more likely in dogs that had undergone placement of a 2.4-mm TPLO plate. Overall, the complication rate was less than that in previous studies of dogs weighing > 15kg. In this study, patients in which 2.4-mm TPLO plates were used were more likely to develop postoperative complications. Dogs weighing <15 kg that underwent TPLO had good short-term outcomes with minimal complications. In our study, the overall complication rate after TPLO in dogs weighing <15 kg is less than that historically reported in heavier dogs. Our data suggests that TPLO is a safe treatment option in small dogs with cranial cruciate ligament rupture.
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Affiliation(s)
- Karen Marin
- LeadER Animal Specialty Hospital, Cooper City, Florida, United States of America
- * E-mail:
| | - Marcos D. Unis
- LeadER Animal Specialty Hospital, Cooper City, Florida, United States of America
| | - Jason E. Horgan
- LeadER Animal Specialty Hospital, Cooper City, Florida, United States of America
| | - James K. Roush
- Department of Clinical Sciences, Kansas State University, Manhattan, Kansas, United States of America
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Perry KL, Déjardin LM. Canine medial patellar luxation. J Small Anim Pract 2021; 62:315-335. [PMID: 33600015 DOI: 10.1111/jsap.13311] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 12/09/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- K L Perry
- Section Head of Small Animal Surgery, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824-1314, USA
| | - L M Déjardin
- Head of Small Animal Orthopaedics, ACVS Founding Fellow MIS Orthopaedics SA, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824-1314, USA
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13
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Toth SA, Siegel MI. Canine cruciate ligament ruptures: Implications for financial costs and human health. Anat Rec (Hoboken) 2020; 304:222-230. [PMID: 32574421 DOI: 10.1002/ar.24460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/22/2020] [Accepted: 03/18/2020] [Indexed: 11/08/2022]
Abstract
The cranial cruciate ligament (CCL) in dogs is homologous to the anterior cruciate ligament (ACL) in humans. Factors that place an individual at-risk for noncontact ruptures are not clearly defined in humans or dogs. Cyclic variation in human females as well as early spay/neuter in canines has frequently implicated hormonal variation, however these factors do not fully explain the human dimorphic or canine breed rupture rates. The present study examined dogs as a proxy model for humans to better understand the covariance. A random clinical data sample from the Oklahoma State University Veterinary Hospital was obtained on (n = 29) CCL surgical cases and nonsurgical (n = 28) controls. A statistical test for association of spay/neuter with CCL rupture was significant (chi-square = 21.7, p < .01). Sex balance between the groups was not significantly (p > .01) different. Data on other variables related to morphometric variability such as the tibial plateau angle was not available on the nonsurgical sample and comparisons could only be made to values from the literature. Though there may have been sample bias, this preliminary study found that more large than small dogs were represented in the surgical sample. Our results also support the claim that spayed/neutered dogs are more likely to rupture their CCL than intact dogs. Given the high costs of surgical repair, both for canines and humans, we argue for multivariate studies that investigate the interaction of variables in a larger subject sample which can provide comparable data on all parameters.
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Affiliation(s)
- Sharon A Toth
- Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael I Siegel
- Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Orencole MJ, Nylund AM, Moorer JD, Wills RW, Witsberger TH. Effect of patellar luxation on radiographic measurements of tibial plateau angle in small-breed dogs. J Am Vet Med Assoc 2018; 253:746-751. [PMID: 30179096 DOI: 10.2460/javma.253.6.746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether medial patellar luxation would affect radiographic tibial plateau angle (TPA) measurements in small-breed dogs. DESIGN Prospective cross-sectional study. ANIMALS 15 small-breed dogs (25 stifle joints) with grade 2 or 3 medial patellar luxation (5 dogs with unilateral luxation and 10 dogs with bilateral luxation). PROCEDURES Digital mediolateral radiographic images of each affected stifle joint were acquired with the patella in manually reduced (n = 25) and luxated (25) positions. In 2 measurement sessions separated by > 48 hours, 3 observers unaware of patella status (luxated or reduced) measured the TPA in each image twice in random order. Mixed linear modeling was performed to determine the effect of patella status on TPA measurements, and intraobserver and interobserver variation in measurements were calculated. RESULTS TPA measurements by all observers differed significantly between the first and second measurement sessions, but by a mean value of only 0.7°. A few significant differences were identified between 1 pair of observers by patella status and between patella statuses for 1 observer, but all mean differences were ≤ 1.7°. No significant difference in intraobserver variation was identified between patella statuses for any observer. Interobserver variation was not affected by patella status and measurement session. CONCLUSIONS AND CLINICAL RELEVANCE Although some significant differences were identified in radiographic TPA measurements in dogs with medial patellar luxation, depending on whether the patella was luxated or manually reduced, these differences were so small they could be considered clinically unimportant. Consequently, we believe that in small-breed dogs with patellar luxation, patella status would be unlikely to have a clinically meaningful effect on the measured TPA.
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Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2017; 30:209-218. [DOI: 10.3415/vcot-16-10-0148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/31/2017] [Indexed: 12/23/2022]
Abstract
SummaryObjectives: To compare complication rates and outcomes between cases of concomitant cranial cruciate ligament (CrCL) disease and medial patellar luxation (MPL) treated using extracapsular stabilization and tibial tuberosity transposition (ECS+TTT) and tibial tuberosity transposition and advancement (TTTA).Methods: In a multicentre retrospective study, records from four referral hospitals were reviewed for dogs with concomitant CrCL pathology and MPL treated using ECS+TTT or TTTA. Data retrieved included signalment, partial/complete CrCL tear, MPL grade, treatment performed, occurrence of postoperative complications, and postoperative outcome grade. Associations between surgical procedure and risk of complication and surgical procedure and outcome were investigated using univariable logistic regression and proportional odds logistic regression respectively. Multiple logistic regression was used to explore confounding factors.Results: A total of 72 stifles were evaluated in 66 dogs; 32 stifles were stabilized using ECS+TTT and 40 using TTTA. Overall complications were 2.7 times more frequent in the ECS+TTT group and major complications occurred only in this group. The TTTA group was less likely to suffer complications (17.5%) compared to the ECS+TTT group (46.9%) (p = 0.009) and TTTA cases had lower odds of a poorer clinical outcome (p = 0.047).Clinical significance: Stifles stabilized using ECS+TTT are more likely to suffer from postoperative complications and a poorer clinical outcome when compared to TTTA.Supplementary Material to this article is available online at https://doi.org/10.3415/VCOT-16-10-0148
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Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs. Vet Comp Orthop Traumatol 2016; 30:20-27. [PMID: 27935008 DOI: 10.3415/vcot-16-07-0103] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique. METHODS Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner. RESULTS A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51). CLINICAL SIGNIFICANCE In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by femoral varus, and supports an association between stifle instability and medial patellar luxation.
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Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation. Vet Comp Orthop Traumatol 2016; 29:536-540. [PMID: 27739556 DOI: 10.3415/vcot-15-12-0195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the surgical technique and report short-term outcome for combined tibial plateau levelling osteotomy and tibial tuberosity transposition (TPLO-TTT) as an option in the treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation. METHODS Medical records were reviewed (2011-2013) of dogs that underwent a standard tibial plateau levelling osteotomy followed by a tibial tuberosity transposition in the frontal plane and stabilized with pin and tension-band wire fixation as a component of surgical treatment for combined cranial cruciate ligament insufficiency and medial patellar luxation. Signalment, fixation method together with any ancillary procedures, function at the in-hospital follow-up examinations, and any complications were recorded. Healing was assessed retrospectively based on the grading criteria of the International Society Of Limb Salvage. RESULTS Fifteen stifle joints in 11 dogs were identified; 13 stifles were available for in-hospital follow-up. All 13 achieved union (3 with grade III/IV and 10 with grade IV/IV radiographic healing scores); mean time to healing was 10.6 (± 2.9) weeks. Patellar ligament thickening was also identified radiographically in seven of the 13 of stifle joints. All dogs were reported to have mild or no lameness at their last follow-up examination. No catastrophic or major postoperative complications occurred that required additional surgery. Patellar re-luxation did not occur in any of the 13 stifles available for in-hospital follow-up. CLINICAL SIGNIFICANCE The TPLO-TTT was found to be a reliable and effective technique when used as a part of the treatment of combined cranial cruciate ligament insufficiency with concomitant medial patellar luxation in this series of dogs.
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Dunlap AE, Kim SE, Lewis DD, Christopher SA, Pozzi A. Outcomes and complications following surgical correction of grade IV medial patellar luxation in dogs: 24 cases (2008–2014). J Am Vet Med Assoc 2016; 249:208-13. [DOI: 10.2460/javma.249.2.208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kishi EN, Hulse D. Owner Evaluation of a CORA-Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs. Vet Surg 2016; 45:507-14. [PMID: 27041682 DOI: 10.1111/vsu.12472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n=70). METHODS Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dog's function after surgery. Based on owner responses, clinical outcomes were established. RESULTS CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related. CONCLUSION The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function.
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Affiliation(s)
- Erin N Kishi
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri
| | - Don Hulse
- Department of Small Animal Medicine and Surgery, Texas A&M University, College Station, Texas
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Pratesi A, Moores AP, Downes C, Grierson J, Maddox TW. Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases. Vet Surg 2015; 44:653-60. [PMID: 25756814 DOI: 10.1111/vsu.12326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate whether administration of postoperative oral antimicrobial drugs has a beneficial effect on preventing surgical site infections (SSI) in clean orthopedic surgery involving stainless steel plating systems. STUDY DESIGN Randomized prospective clinical study. ANIMALS Dogs (n = 97). METHODS One hundred consecutive cases (97 dogs) that had clean orthopedic surgery requiring stainless steel plate fixation were randomly assigned using a random number generator to either YES group (administration of postoperative oral antimicrobials) or NO group (no administration of postoperative oral antimicrobials). Dogs in YES group were administered oral cefalexin or potentiated amoxicillin for 7 days, whereas dogs in NO group were discharged without oral antibiotics. Minimum follow-up was 12 months. Multivariable logistic regression was used to determine risk factors for SSI. RESULTS Overall postoperative infection rate was 12.9%. Infection occurred in 2 cases (4.3%) administered postoperative oral antimicrobials and in 10 cases (21.3%) not administered postoperative antimicrobials. Total anesthetic time and use of oral antimicrobials were the only significant factors associated with SSI. Use of postoperative antimicrobials was associated with a significant reduction in the risk of infection by ~84% and risk of infection was increased by ~2% for each minute increase in anesthesia time. CONCLUSIONS Administration of oral postoperative antimicrobials had a protective effect against development of SSI in clean orthopedic implant surgery.
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Affiliation(s)
- Andrea Pratesi
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Andrew P Moores
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Ciara Downes
- Torrington Orthopaedics, Brighouse, United Kingdom
| | - James Grierson
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Thomas W Maddox
- School of Veterinary Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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Weh JL, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs. Vet Surg 2011; 40:670-86. [PMID: 21699550 DOI: 10.1111/j.1532-950x.2011.00826.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. STUDY DESIGN Cases series. ANIMALS Dogs (n=12; 19 stifle joints). METHODS Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. RESULTS Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88-96°) and 96.1° (range, 94-101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained. CONCLUSIONS Long-term clinical outcome of combination TPLO and transverse corrective osteotomy was excellent, and had a high owner satisfaction. Healing times were comparable to standard TPLO with a similar complication rate.
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Affiliation(s)
- Jennifer L Weh
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, USA
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