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Guénégo L, Vezzoni A, Vezzoni L. Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) to Treat Cranial Cruciate Ligament Deficient Stifle in 204 Dogs Over 50 Kg: Magnitude of the Craniocaudal Angulation of the Proximal Tibia and Rate of Surgical Site Infection. Vet Comp Orthop Traumatol 2024. [PMID: 39255812 DOI: 10.1055/s-0044-1790511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVES The aim of this retrospective study was to report the magnitude of the craniocaudal angulation of the proximal tibia (CCAPT) quantified by the angle between the anatomical axis (AA) and the mechanical axis (MA), called the AMA angle, and the tibial plateau angle (TPA) in dogs >50 kg that were treated by cranial closing wedge osteotomy based on the AMA angle (AMA-based CCWO). Furthermore, the percentage of dogs in which the AA and MA could be aligned postoperatively and the rate of surgical site infection (SSI) were reported. STUDY DESIGN Medical records (between January 2016 and September 2023) were reviewed for 204 dogs that had AMA-based CCWO stabilized with a double locking plate (DLP) fixation with or without joint exploration plus a Robert Jones bandage (RJB) and were given postoperative antibiotics. RESULTS The median (range) preoperative AMA angle and TPA were 3.1° (0-5.1°) and 30° (22-49.6°), respectively, and the postoperative AMA angle and TPA were 0° (-2.4 to 1.6°) and 9.2° (4-15°), respectively. The AA and MA were aligned in 82% of dogs. Grade 4 healing occurred in all osteotomies by 8 weeks postoperatively. Except for one dog, no SSIs were recorded. CONCLUSION Concerning the magnitude of CCAPT in dogs >50 kg and the low SSI rate, AMA-based CCWO stabilized with a DLP fixation plus an RJB and postoperative antibiotics should be considered for treating cranial cruciate ligament-deficient stifles in this subset of dogs.
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Curuci EHP, Minto BW, Magalhães TV, de Barros LP, Dias LGGG. Double-Cut Tibial Plateau Leveling Osteotomy for the Management of Cranial Cruciate Ligament Insufficiency in Dogs with an Excessive Plateau Angle: Early Clinical Results in 16 Dogs. Vet Comp Orthop Traumatol 2024. [PMID: 39227027 DOI: 10.1055/s-0044-1790208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
OBJECTIVE To describe a modification of the tibial plateau leveling osteotomy technique wherein a double cut is made in the same plane to level the tibial plateau (double-cut tibial plateau leveling osteotomy [DCTPLO]) for treating dogs with cranial cruciate ligament (CrCL) and excessive tibial plateau angle (eTPA) diseases. STUDY DESIGN The DCTPLO technique was performed on 18 stifles in dogs with CrCL and an eTPA (>34°). This study evaluated the accuracy of preoperative planning, feasibility of the technique, postoperative clinical outcomes, radiographic examinations at the postoperative follow-up for the first 120 days, evolution of the tibial plateau angle (TPA), time of union of the osteotomy, apposition of the implants, and possible complications. RESULTS The described technique proved to be feasible for clinical application, with reproducibility from preoperative planning. An effective reduction in the eTPA levels was observed. The mean preoperative and postoperative TPA values were 39.4° (36°-43.5°) and 6.3° (3°-13°), respectively. Radiographic healing time was 60 days in 17/18 of stifles. Minor complications (not requiring surgical review or clinical treatment) were observed in 4/18 of stifles. CONCLUSION The DCTPLO technique was effective for treating CrCL disease with TPA of up to 43.5° in dogs.
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Affiliation(s)
- Eloy H P Curuci
- Department of Veterinary Surgery, Vet Orthopedics Clinic, São Paulo, São Paulo, Brazil
| | - Bruno W Minto
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University, Jaboticabal, São Paulo, Brazil
| | - Thais V Magalhães
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University, Jaboticabal, São Paulo, Brazil
| | - Luciano P de Barros
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University, Jaboticabal, São Paulo, Brazil
| | - Luis Gustavo G G Dias
- Department of Veterinary Clinic and Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University, Jaboticabal, São Paulo, Brazil
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Shimada M, Huang C, Yamakawa S, Fujie H, Murakami S, Kanno N, Hara Y. Biomechanical effects of cranial closing wedge osteotomy on joint stability in normal canine stifles: an ex vivo study. BMC Vet Res 2024; 20:72. [PMID: 38402170 PMCID: PMC10893735 DOI: 10.1186/s12917-024-03923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Cranial closing wedge osteotomy (CCWO) is a functional stabilisation technique for cranial cruciate ligament (CrCL) ruptures. This biomechanical study aimed to evaluate the influence of CCWO on the stability of the stifle joint. Eighteen Beagle stifle joints were divided into two groups: control and CCWO. The stifle joints were analyzed using a six-degree-of-freedom robotic joint biomechanical testing system. The joints were subjected to 30 N in the craniocaudal (CrCd) drawer and proximal compression tests and 1 Nm in the internal-external (IE) rotation test. Each test was performed with an extension position, 135°, and 120° of joint angle. RESULTS The stifle joints were tested while the CrCLs were intact and then transected. In the drawer test, the CCWO procedure, CrCL transection, and stifle joint flexion increased CrCd displacement. The CCWO procedure and CrCL transection showed an interaction effect. In the compression test, the CCWO procedure decreased and CrCL transection and stifle joint flexion increased displacement. In the IE rotation test, CCWO, CrCL transection, and stifle joint flexion increased the range of motion. CONCLUSIONS CCWO was expected to provide stability against compressive force but does not contribute to stability in the drawer or rotational tests. In the CCWO-treated stifle joint, instability during the drawer test worsened with CrCL transection. In other words, performing the CCWO procedure when the CrCL function is present is desirable for stabilizing the stifle joint.
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Affiliation(s)
- Masakazu Shimada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan.
| | - Chenxu Huang
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Satoshi Yamakawa
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiromichi Fujie
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Sawako Murakami
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Nobuo Kanno
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
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Banks C, Jones GMC, Meeson RL. A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases. Vet Surg 2024; 53:113-121. [PMID: 37470173 DOI: 10.1111/vsu.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE (1) To determine whether Oxley's modified cranial closing wedge osteotomy (CCWO) results in a tibial plateau angle (TPA) of 5° in silico, (2) compare in silico to clinical postoperative TPA and (3) determine the impact of ostectomy distalization in silico. STUDY DESIGN Cross-sectional retrospective radiographic in silico study. SAMPLE POPULATION A total of 100 stifle radiographs; 90 dogs (small ≤25 kg = 84; large >25 kg = 16). METHODS Tibial plateau angles were measured preoperatively (TPAPre ), after in silico planning (TPAPlan ), and postoperatively (TPAPost ). Virtual ostectomies were evaluated for plate fit. Postoperative ostectomy position was measured. Virtual ostectomies were performed 5/7.5/10/15 mm from the patellar tendon insertion in 10 dogs from each preoperative TPA category (≤20°/21-25°/ 26-30°/31-35°/>35°). Comparisons for TPAPre , TPAPost , and TPAPlan were made between small and large dogs, and the outcome to the target 5° between TPA categories and ostectomy positions. RESULTS Mean ± SD TPAPre was 28.6 ± 6.2° and higher in small than large dogs. Mean TPAPlan was 7.6 ± 2.7°. Plate fit was appropriate in all. In silico, TPAs were greater than 5° except for cases with TPAPre > 35°. Median TPAPost was 5.5° (-4-21) and was higher in small (7°) than large (4.5°) dogs. Postoperative ostectomy position was more distal than Oxley's guidelines. When distalized >7.5 mm in silico, the magnitude of under-correction increased. CONCLUSIONS Oxley's modified CCWO did not result in TPA of 5° in most cases. Ostectomy distalization exacerbated under-correction. CLINICAL IMPACT Current guidelines should be modified to achieve 5° TPA postoperatively.
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Affiliation(s)
- Charlotte Banks
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, London, UK
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Worden NJ, Oxley B, Naiman J, Karlin WM, Chen TM, Hetzel SJ, Bleedorn J. Radiographic Comparison of Virtual Surgical Corrective Options for Excessive Tibial Plateau Angle in the Dog. Vet Comp Orthop Traumatol 2023; 36:225-235. [PMID: 37130557 DOI: 10.1055/s-0043-1768229] [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: 05/04/2023]
Abstract
OBJECTIVE The main aim of this study is to compare the impact of six proximal tibial osteotomies on the geometry and alignment of tibias with and without excessive tibial plateau angle (TPA). STUDY DESIGN Mediolateral radiographs of 30 canine tibias were divided into three groups (n = 10/group): moderate TPA (≤34 degrees), severe TPA (34.1-44 degrees) and extreme TPA (>44 degrees). Six proximal tibial osteotomies were simulated on each tibia using orthopaedic planning software: cranial closing wedge ostectomy (CCWO), modified CCWO (mCCWO), isosceles CCWO (iCCWO), neutral isosceles CCWO (niCCWO), tibial plateau levelling osteotomy with CCWO (TPLO/CCWO) and coplanar centre of rotation of angulation-based levelling osteotomy (coCBLO). All tibias were reduced to a standard target TPA. Pre- and postoperative measurements were obtained for each virtual correction. Compared outcome measures included tibial long axis shift (TLAS), cranial tibial tuberosity shift (cTTS), distal tibial tuberosity shift (dTTS), tibial shortening and osteotomy overlap. RESULTS Across all TPA groups, TPLO/CCWO had the lowest mean TLAS (1.4 mm) and dTTS (6.8 mm); coCBLO had the largest TLAS (6.5 mm) and cTTS (13.1 mm); CCWO had the largest dTTS (29.5 mm). CCWO had the largest degree of tibial shortening of 6.5 mm, while mCCWO, niCCWO and coCBLO resulted in minimal tibial lengthening (1.8-3.0 mm). These trends were generally conserved across different TPA groups. All findings had a p-value less than 0.05. CONCLUSION mCCWO balances moderate alterations to tibial geometry while preserving osteotomy overlap. The TPLO/CCWO has the least effect on tibial morphology alteration, whereas the coCBLO results in the largest alteration.
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Affiliation(s)
- Natalie J Worden
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
| | - Bill Oxley
- Vet3D, Coventry, West Midlands, United Kingdom
| | - Jaron Naiman
- Department of Small Animal Surgery, ACCESS Specialty Animal Hospital - Pasadena, Pasadena, California, United States
| | - William Michael Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University North Grafton, Massachusetts, United States
| | - Tiffany M Chen
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Jason Bleedorn
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Veterinary Clinical Sciences, Colorado State University, Fort Collins, Colorado, United States
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Miles JE, Nielsen MBM. Reported accuracy of cranial closing wedge ostectomy variants for management of canine cranial cruciate ligament insufficiency: A systematic review and meta-analysis. Vet J 2023; 295:105989. [PMID: 37148995 DOI: 10.1016/j.tvjl.2023.105989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
Concerns have been raised about the predictability of achieving appropriate tibial plateau angles (TPA), the occurrence of axis shift and tibial length reduction following cranial closing wedge ostectomy (CCWO). The primary objective of this review was to quantify typical errors in achieving target TPA with CCWO, with secondary objectives of assessing axis shift and length reduction. Retrospective or prospective studies of CCWO used as the primary treatment, from any date and in English, were eligible for inclusion. Searches were performed in EMBASE, Ovid MEDLINE, Agricola, Scopus, Web of Science, and CAB abstracts. Risk of bias was assessed, and data were screened for outliers and influential cases. Extracted data from 11 included studies were tabulated and underwent meta-analysis using R. Mean errors in TPA after CCWO ranged from - 0.6-2.9°, indicating the possibility of both under- and over-correction depending on the selected technique. Errors were relatively consistent for technique subgroups. Mean axis shifts ranged from 3.4° to 5.2°, and length reduction ranged from 0.4% to 3.2% of initial length, based on 6/11 and 3/11 studies, respectively. Data had high heterogeneity, many studies had small populations, and reporting standards were inconsistent. Concerns about the predictability of postoperative TPA may be overstated. With the limited data available, limb shortening does not appear to be a clinically important consideration. Axis shift will occur to varying degrees and must be considered during CCWO planning, as it influences the postoperative TPA. Careful choice of CCWO technique may allow clinicians to reliably achieve predictable TPA values.
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Affiliation(s)
- J E Miles
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark.
| | - M B M Nielsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
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Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than 30° and clinically normal Labradors retrievers. BMC Vet Res 2021; 17:368. [PMID: 34861875 PMCID: PMC8641203 DOI: 10.1186/s12917-021-03094-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) > 30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed 2 months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after 2 months. Results Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P = 0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (− 1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)). At 8 weeks, PLT grade differed significantly in the two operated groups (P = 0.000) (TPLO 40% 0–2, 20% 2–4, 40% > 4; CCWO 98.8% 0). Conclusions TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results 2 months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA > 30°.
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Dumartinet C, Bernardé A, Bernard F. Double-cut center of rotation of angulation-based leveling osteotomy for treatment of cranial cruciate ligament deficiency and excessive tibial plateau angle secondary to growth anomaly in two dogs. J Am Vet Med Assoc 2021; 259:885-891. [PMID: 34609183 DOI: 10.2460/javma.259.8.885] [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: 11/20/2022]
Abstract
CASE DESCRIPTION A 4-year-old female Staffordshire Bull Terrier (dog 1) and a 6-year-old male Yorkshire Terrier (dog 2) were evaluated because of left pelvic limb lameness. CLINICAL FINDINGS Both dogs had a partial rupture of the left cranial cruciate ligament associated with a unilateral excessive tibial plateau angle (51° in dog 1 and 41° in dog 2) secondary to a growth anomaly. TREATMENT AND OUTCOME Both dogs underwent a double-cut center of rotation of angulation-based leveling osteotomy combining rotation of the proximal fragment with a cranial closing wedge ostectomy. The procedure allowed leveling of the tibial plateau to a final angle of 11° in one dog and 10° in the other without perioperative complications. Both dogs had excellent functional outcomes ≤ 4 months after the surgery. No postoperative complications were reported during follow-up (12 months and 9 months for dogs 1 and 2, respectively). CLINICAL RELEVANCE Results for these dogs suggested that double-cut center of rotation of angulation-based leveling osteotomy can be considered as a viable treatment option for cranial cruciate ligament deficiency associated with excessive tibial plateau angle.
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Brioschi V, Arthurs GI. Cranial cruciate ligament rupture in small dogs (<15 kg): a narrative literature review. J Small Anim Pract 2021; 62:1037-1050. [PMID: 34269419 DOI: 10.1111/jsap.13404] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/06/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
Small breed dogs (<15 kg) affected by cranial cruciate ligament rupture secondary to cranial cruciate ligament disease are usually middle-aged (mean age at presentation: 5.4 to 9.8 years); terrier breeds, miniature and toy poodles are over-represented. Small breed dogs have a different morphology of the proximal tibia compared to medium and large breed dogs with a steep tibial plateau angle (mean tibial plateau angle 28.8° to 36.3°), absent base of the flare of the tibial tuberosity and a caudally bowed fibula. There is a lack of evidence regarding the optimal management of cranial cruciate ligament rupture in small dogs. The treatment options consist of conservative management, extracapsular stabilisation, cranial closing wedge ostectomy, tibial plateau levelling osteotomy and tibial tuberosity advancement. The limited evidence available shows that conservative management is likely to result in prolonged recovery time (average time to recovery approximately 4 months). There is paucity of reports focussing on extracapsular stabilisation in small breed dogs, and questions have been raised regarding the early failure of the extracapsular suture subject to higher loads due to the steep tibial plateau angle of small breed dogs. Cranial closing wedge ostectomy and tibial plateau levelling osteotomy have been reported to have low major complication rates and good subjective outcomes. It is controversial whether tibial tuberosity advancement is a suitable technique in dogs with steep tibial plateau angle, which includes most small breed dogs.
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Affiliation(s)
- V Brioschi
- Arthurs Orthopaedics, Northampton, NN12 6JW, UK
| | - G I Arthurs
- Arthurs Orthopaedics, Northampton, NN12 6JW, UK
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Minto B, Lopes C, Rossignoli P, Franco G, Kawamoto F, Sprada A, Dias L. Double plating technique for fixing tibial plateau leveling osteotomy and modified cranial closing wedge ostectomy of the tibia in a dog with cranial cruciate ligament disease and excessive plateau angle: case report. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Tibial plateau leveling osteotomy (TPLO) associated to cranial wedge closing ostectomy (CCWO) has been one of the best options to manage cranial cruciate ligament (CCL) disease and excessive tibial plateau angle (TPA) in large dogs, however, the complication rate is potentially high. It is believed that a more robust fixation is necessary to stabilize them and decrease the risk of implant failure. A 6-year-old male American Pit Bull, weighing 36kg, with 90-day history of right hind limb lameness, was diagnosed with CCL disease. Due to the excessive tibial plateau angle (42°), TPLO was associated with a modified CCWO using a double plating technique. A final TPA of 12⁰ was accomplished, and a restricted level of exercises and physiotherapy were recommended. The patient was followed monthly until the fifth month postoperatively, when radiographic bone consolidation and no lameness were observed. By the date of this submission, 3 years after the procedure, the owner has reported no complications. The double plating technique for fixing TPLO and modified CCWO proved to be effective for the treatment of CrCL deficiency in a large dog with an excessive TPA.
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Schlag AN, Peycke LE, Hulse DA. Center of rotation of angulation-based leveling osteotomy combined with a coplanar cranial closing wedge ostectomy to manage cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angle. Vet Surg 2020; 49:1125-1131. [PMID: 32615011 DOI: 10.1111/vsu.13480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe outcomes of dogs with excessive tibial plateau angle (eTPA) and cranial cruciate ligament (CrCL) disease treated with center of rotation of angulation-based leveling osteotomy (CBLO) and cranial closing wedge ostectomy (CCWO). STUDY DESIGN Retrospective study. ANIMALS Twenty-one dogs. METHODS Medical records of dogs with CrCL disease and eTPA (>34°) treated with CBLO/CCWO were reviewed. Signalment, body weight, intra-articular structure appearance, TPA (preoperatively, postoperatively, and at osteotomy healing), postoperative function, and complications were recorded. RESULTS Twenty-one dogs (28 stifles) with CrCL disease/eTPA underwent CBLO/CCWO. Twenty stifles had complete CrCL tears and eight tears were partial. Mean age and weight of dogs were 4 years (range, 1-9) and 27 kg (range, 4-65), respectively. Medial menisci were normal in 20 stifles, torn in 5, and degenerative in 3. All lateral menisci were normal. The caudal cruciate ligament was normal in 26 stifles and partially torn in 2. Mean TPA was 43° preoperatively, 10° postoperatively, and 10° at final recheck. Grade 4 healing occurred in all osteotomies by 8 weeks postoperatively. Complications included one pin migration, breakage of two proximal screws (1 case), one late-onset caudolateral band CrCL tear, two late-onset meniscal tears, and one surgical site infection. Eighteen dogs returned to full function, and three dogs achieved acceptable function, at a mean of 27 months. CONCLUSION Center of rotation of angulation-based leveling osteotomy/CCWO resulted in grade 4 osteotomy healing by 8 weeks, minimal complications, and acceptable to full return to function. CLINICAL SIGNIFICANCE Center of rotation of angulation-based leveling osteotomy/CCWO should be considered to treat canine CrCL disease/eTPA.
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Affiliation(s)
- Ariel N Schlag
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Laura E Peycke
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Don A Hulse
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas.,Austin Veterinary and Emergency Specialty Center, Austin, Texas
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Terreros A, Daye RM. Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: Complications, owner satisfaction, and midterm to long-term outcomes. Vet Surg 2020; 49:1109-1117. [PMID: 32529724 DOI: 10.1111/vsu.13431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/08/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report midterm to long-term outcomes of dogs with cranial cruciate ligament (CCL) rupture and excessive tibial plateau angles (TPA) treated with a modified cranial closing wedge osteotomy (m-CCWO). STUDY DESIGN Retrospective case series. STUDY POPULATION Dogs (n = 21) with CCL rupture and excessive TPA treated with m-CCWO (n = 28). METHODS Medical records, midterm and long-term follow-up radiographic examination records, Canine Orthopedic Index data, and owner surveys were reviewed to determine functional outcomes, owner satisfaction, and complications associated with the technique. RESULTS Tibial plateau angle decreased from 42.3° ± 4.8° preoperatively to 4.8° ± 3.3° after m-CCWO. No catastrophic complications occurred, while major and minor complications occurred in three of 28 and six of 28 stifles, respectively. Canine Orthopedic Index scores and owner surveys were available in 16 of 21 dogs at a median of 608 days postoperatively (range 279-1225). Functional midterm or long-term outcomes for these dogs treated with m-CCWO were excellent in eight dogs, acceptable in seven dogs, and unacceptable in one dog. Progression of osteoarthritis was noted on all midterm and long-term follow-up radiographs. All owners but one were satisfied. CONCLUSION Modified cranial closing wedge osteotomy was associated with an acceptable morbidity and resulted in satisfactory functional outcomes in most dogs of this series. CLINICAL SIGNIFICANCE Modified cranial closing wedge osteotomy should be considered as an alternative to treat CCL rupture in dogs with excessive TPA.
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Affiliation(s)
- Alex Terreros
- Ohio Veterinary Surgery and Neurology, Metropolitan Veterinary Hospital, Copley, Ohio
| | - R Mark Daye
- Ohio Veterinary Surgery and Neurology, Metropolitan Veterinary Hospital, Copley, Ohio
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Correction of Excessive Tibial Plateau Angle and Limb Shortening in a Juvenile Dog Using a Hinged Circular Fixator Construct and Distraction Osteogenesis. Case Rep Vet Med 2019; 2019:1439237. [PMID: 31827971 PMCID: PMC6881767 DOI: 10.1155/2019/1439237] [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: 07/03/2019] [Accepted: 07/28/2019] [Indexed: 11/18/2022] Open
Abstract
An 18-week-old Rhodesian Ridgeback puppy that was hit by a car sustained a Salter-Harris type III fracture of the left proximal tibial physis and ipsilateral diaphyseal femoral and tibial fractures. The diaphyseal fractures were successfully stabilized with bone plate fixation. Premature closure of the caudal aspect of the proximal tibial physis, secondary to the proximal physeal fracture, resulted in an excessively high tibial plateau angle (TPA) of 50° with a limb length discrepancy of 13% by 24 weeks of age. The deformity was addressed by performing a proximal tibial osteotomy and subsequent distraction osteogenesis to reduce the TPA while concurrently lengthening the crus. A radial osteotomy was performed in the proximal metaphyseal region and the hinged fixator was applied. Distraction was initiated the day following surgery at a rate of 1 mm per day as measured along the caudal cortex of the tibia with a rhythm of three distractions daily. Distraction was terminated 19 days postoperatively. Sequential distraction of the osteotomy resulted in 17 mm of tibial lengthening and a final TPA of 3°. The fixator was removed 52 days after application. Complications included wire tract inflammation involving the wires securing the proximal segment and a calcaneal fracture which required bone plate stabilization. The left pelvic limb was only 8% shorter than the right pelvic limb and the dog had only a subtle lameness 12 months after surgery. The hinged circular fixator construct allowed for both the reduction of the TPA and limb segment lengthening in this dog.
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Shamir SK, Wolynski JG, Duncan CG, Puttlitz C, Duerr FM. Ex vivo evaluation of a novel surgical guide on the accuracy of closing wedge osteotomies. Vet Surg 2019; 48:1429-1436. [PMID: 31120595 DOI: 10.1111/vsu.13237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/06/2019] [Accepted: 04/28/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of a novel surgical guide on the accuracy and technical difficulty of closing wedge osteotomies (CWO). STUDY DESIGN Ex vivo experimental study. SAMPLE POPULATION Canine tibia models (n = 40). METHODS A 20° cranial CWO (CCWO) was created without (standard procedure; STCCWO) or with the aid of a novel wedge osteotomy guide (WOCCWO). Procedures were performed by diplomate (n = 4) and resident (n = 6) surgeons, with each performing 2 STCCWO followed by 2 WOCCWO. To prevent bias, surgeons were unaware of the study purpose until after completing the STCCWO. The wedges were evaluated by comparing the deviation from the 20° target angle, divergence of the 2 osteotomies (osteotomy divergence angle [ODA]), and measurements of the wedge height at the caudomedial cortex (CMC) and caudolateral cortex (CLC). Technique difficulty was explored through a surgeon questionnaire. RESULTS The WOCCWO resulted in smaller mean ODA (WOCCWO = 0.86°, SD ± 0.38°, P < .001), and smaller mean difference between CMC and CLC (WOCCWO = 0.29 mm, SD ± 0.19, P < .001) than for the STCCWO (4.22°, SD ± 2.16° and 1.39 mm, SD ± 0.65 respectively). Deviation from the target 20° wedge angle was greater after STCCWO (1.46°, SD ± 1.27°) than after WOCCWO (0.53°, SD ± 0.33°, P = .004). No difference was reported regarding the difficulty of the procedures, but resident surgeons stated that they were more likely to use the guide in a clinical setting compared with diplomates. CONCLUSION The wedge osteotomy guide improved the accuracy of CCWO compared with standard technique. CLINICAL SIGNIFICANCE The clinical significance of the differences detected in this study is unclear and warrants in vivo investigation.
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Affiliation(s)
- Shelly K Shamir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jakob G Wolynski
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Colleen G Duncan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Christian Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Felix M Duerr
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Christ JP, Anderson JR, Youk AO. Modified cranial closing wedge ostectomy in 25 dogs. Vet Surg 2018; 47:683-691. [DOI: 10.1111/vsu.12912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jeffrey P. Christ
- Pittsburgh Veterinary Specialty and Emergency Center; Pittsburgh Pennsylvania
| | | | - Ada O. Youk
- Department of Biostatistics; University of Pittsburgh; Pittsburgh Pennsylvania
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Knight R, Danielski A. Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°. Vet Rec 2018; 182:461. [DOI: 10.1136/vr.104491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/26/2017] [Accepted: 12/31/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Rebekah Knight
- Hertfordshire UK
- Queen Mother Hospital for Animals, Royal Veterinary College; Hertfordshire UK
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Variation of tibial plateau geometry and cruciate ligament coordinates in six breeds of dogs. Vet Comp Orthop Traumatol 2017; 26:110-6. [DOI: 10.3415/vcot-11-09-0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 09/06/2012] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: The first aim of this study was to examine whether or not variations concerning the conformational characteristics of the proximal surface of the tibial plateau exist among six different dog breeds as well as within the same breed. The second aim of this study was to determine the coordinates of the cruciate ligaments.Methods: One hundred and four tibias of 52 mature dogs from six different breeds were used. Photographs of the proximal surface of tibial plateau were taken, and measurements for the length, width and area of the tibial plateau, and the lateral and medial condyles were taken. In addition, the intercondylar width, height of Gerdy's tubercle, popliteal notch depth, and extensor groove depth were measured and recorded. The quotients from these measurements were calculated and compared amongst the dog breeds. The coordinates of the cruciate ligaments, according to the centre of tibial plateau, were also determined.Results: Based on the calculated quotients, variations in the geometry of the tibial plateau geometry were common among the breeds. Within the same breed, on the other hand, length and width measurements of the tibial plateau were the least variable parameters among the other parameters examined. The cranial cruciate ligament was located in front of the surface centre of tibial plateau in all breeds. The position of cranial cruciate ligament was more variable in the craniocaudal direction than that observed in the mediolateral direction; this was the exact opposite of caudal cruciate ligament.Clinical significance: The inter-breed variations of the quotients determined in the present study may facilitate attempts aimed to assess the risk factors of stifle joint injury and to design total knee prostheses.
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Frederick SW, Cross AR. Modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angles: Technique and complications in 19 cases. Vet Surg 2017; 46:403-411. [DOI: 10.1111/vsu.12614] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 10/13/2016] [Indexed: 11/30/2022]
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Campbell KA, Payne JT, Doornink MT, Haggerty J. Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (<15 kg). Vet Surg 2016; 45:1056-1062. [DOI: 10.1111/vsu.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn A. Campbell
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
| | - John T. Payne
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
| | - Michael T. Doornink
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
| | - Jamie Haggerty
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC); Pittsburgh Pennsylvania
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Barnes DC, Trinterud T, Owen MR, Bush MA. Short-term outcome and complications of TPLO using anatomically contoured locking compression plates in small/medium-breed dogs with "excessive" tibial plateau angle. J Small Anim Pract 2016; 57:305-10. [PMID: 27148864 DOI: 10.1111/jsap.12486] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/18/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report short-term radiographic and clinical outcome and complications following tibial plateau levelling osteotomy for the treatment of cranial cruciate ligament insufficiency in dogs less than 18·1 kg with tibial plateau angle greater than 35° using anatomically contoured six-hole locking compression plates. METHODS Retrospective data were collected on: preoperative, postoperative and follow-up tibial plateau angles, plateau segment rotation, tibial tuberosity width and length of the cranial aspect of tibial tuberosity segment from the patellar tendon insertion and rotation of the tibial plateau below the level of the insertion of the patellar ligament. RESULTS In 26 small dogs (29 stifles in total), mean preoperative, postoperative and follow-up tibial plateau angles were 38·2°, 4·8°, and 4·4°, respectively. Documented postoperative complications were limited to patellar tendinopathy in a single case (3·4%) and tibial tuberosity or fibula fracture were not observed. CLINICAL SIGNIFICANCE Short-term radiographic and clinical outcome of tibial plateau levelling osteotomy stabilised with anatomically contoured six-hole locking compression plates for the treatment of small dogs with large tibial plateau angle suggests a very low risk of complications. Rotation beyond the "safe point" is necessary to perform full rotation in some cases, but does not appear to incur an increased risk of tibial tuberosity fracture.
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Affiliation(s)
- D C Barnes
- Dick White Referrals, Station Farm, London Road, Six-Mile-Bottom, Cambridgeshire, CB8 0UH
| | - T Trinterud
- Dick White Referrals, Station Farm, London Road, Six-Mile-Bottom, Cambridgeshire, CB8 0UH
| | - M R Owen
- Dick White Referrals, Station Farm, London Road, Six-Mile-Bottom, Cambridgeshire, CB8 0UH
| | - M A Bush
- Dick White Referrals, Station Farm, London Road, Six-Mile-Bottom, Cambridgeshire, CB8 0UH
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Addison ES, Emmerson TD, de la Puerta B, Groth A, Black T, Smith BA, Burton NJ, Toscano MJ, Wallace AM. Evaluation of Osteotomy Accuracy and Rotational and Angular Alignment for Cranial Closing Wedge Ostectomy Performed With and Without Alignment Aids. Vet Surg 2014; 44:78-84. [DOI: 10.1111/j.1532-950x.2014.12228.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Elena S. Addison
- Royal (Dick) School of Veterinary Studies; Division of Veterinary Clinical Sciences; The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre; Roslin United Kingdom
| | | | | | - Anna Groth
- North Downs Specialist Referrals; Bletchingley United Kingdom
| | - Tony Black
- Small Animal Specialist Centre; North Ryde Australia
| | - Bruce A. Smith
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - Neil J. Burton
- Langford Veterinary Services; University of Bristol; Langford United Kingdom
| | - Michael J. Toscano
- Langford Veterinary Services; University of Bristol; Langford United Kingdom
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Oxley B, Gemmill TJ, Renwick AR, Clements DN, McKee WM. Comparison of Complication Rates and Clinical Outcome Between Tibial Plateau Leveling Osteotomy and a Modified Cranial Closing Wedge Osteotomy for Treatment of Cranial Cruciate Ligament Disease in Dogs. Vet Surg 2013; 42:739-50. [DOI: 10.1111/j.1532-950x.2013.12033.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Bill Oxley
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
| | - Toby J. Gemmill
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
| | | | - Dylan N. Clements
- Division of Veterinary Clinical Sciences; Royal (Dick) School of Veterinary Studies and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Easter Bush Veterinary Centre; Roslin; Midlothian, Scotland
| | - W. Malcolm McKee
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
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