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Niida A, Chou PY, Filliquist B, Marcellin-Little DJ, Kapatkin AS, Kass PH. The impact of surgery resident training on the duration of tibial plateau leveling osteotomy surgery. Vet Surg 2024; 53:808-815. [PMID: 38764197 DOI: 10.1111/vsu.14113] [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: 12/04/2023] [Revised: 04/22/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To investigate the impact of surgery resident training on surgery duration in tibial plateau leveling osteotomy (TPLO) and evaluate whether surgery duration differs with each year of residency training. STUDY DESIGN Retrospective medical record review. ANIMALS A total of 256 client-owned dogs underwent TPLO. METHODS Records of dogs that underwent TPLO between August 2019 and August 2022 were reviewed. The effects of the surgeon (faculty/resident) and the procedure (arthrotomy/arthroscopy) on TPLO surgery duration were examined with an analysis of variance, and geometric least squares means (GLSM) were compared. A linear mixed effects model (LMM) was fitted to quantify fixed and random effects. RESULTS Four faculty surgeons performed 74 (29%) TPLOs, while 10 residents performed 182 (71%) TPLOs under the direct supervision of a faculty surgeon. All TPLOs were conducted with arthrotomy (109; 43%) or arthroscopy (147; 57%). Overall, residents (GLSM, 153 min) required 54% more surgery duration than faculty surgeons (GLSM, 99 min). Surgery duration among first-year residents (GLSM, 170 min) was 15% longer than second- (GLSM, 148 min) and third-year (GLSM, 147 min) residents, whereas the duration did not differ statistically between second- and third-year residents. Arthroscopy, meniscal tear treatment, surgery on the right stifle, and increasing patient weight were also associated with longer surgery duration. CONCLUSION The duration of TPLO surgery significantly decreased after the first year of residency, but did not decrease afterward. CLINICAL SIGNIFICANCE The results will aid with resource allocation, curricula planning, and cost management associated with resident training.
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Affiliation(s)
- Atsushi Niida
- School of Veterinary Medicine, University of California, Davis, California, USA
| | - Po-Yen Chou
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Barbro Filliquist
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Denis J Marcellin-Little
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Amy S Kapatkin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA
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Volz F, Eberle D, Klever J, Zablotski Y, Kornmayer M. Effect of tibial plateau angle < 5° on ground reaction forces in dogs treated with tibial plateau leveling osteotomy for cranial cruciate ligament rupture up to 6 months postoperatively. Vet J 2024; 305:106126. [PMID: 38723995 DOI: 10.1016/j.tvjl.2024.106126] [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: 02/24/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
Tibial plateau leveling osteotomy (TPLO) has been commonly performed in dogs with cranial cruciate ligament disease (CCLD) since the introduction by Slocum and Slocum (1993). To reduce cranial tibial thrust the TPLO technique aims for a postoperative tibial plateau angle (TPA) of 5-6.5°. In recent years studies have shown that a postoperative TPA below 5° could be beneficial regarding stifle stability or meniscal load. Dogs with CCLD that were treated with TPLO, were examined preoperatively, six weeks, three and six months postoperatively with gait analysis and grouped according to their postoperative TPA. The aims of study was (1) to evaluate if dogs with a postoperative TPA below 5° would have a faster limb function recovery up to six months postoperatively as measured objectively with ground reaction forces (GRFs) and (2) to determine whether the postoperative TPA correlates with the outcome measurements. Dogs with TPA <5° showed no faster limb function recovery postoperatively up to six months as measured with peak vertical force (PVF) or vertical impulse (VI) (p > 0.05). No correlation for the postoperative TPA <5° on GRFs was demonstrated. But the postoperative TPA showed a significant correlation with the symmetry indices of PVF (SIPVF) and VI (SIVI) for all dogs (>5° and <5° TPA together), indicating that with lower postoperative TPA dogs had a more symmetrical gait in hindlimbs SIPVF (r = 0.144, p < 0.05) and SIVI (r = 0.189, p < 0.01). The study indicates that a lower postoperative TPA could be beneficial regarding hindlimb symmetry indices of GRFs.
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Affiliation(s)
- F Volz
- Small Animal Clinic, Ludwig-Maximilians University, Veterinaerstraße 13, Munich 80539, Germany.
| | - D Eberle
- Small Animal Clinic Stuttgart Plieningen, Hermann-Fein-Straße 15, Stuttgart 70599, Germany
| | - J Klever
- Royal Veterinary College, University of London, Hawkshead Ln, Brookmans Park, Hatfield AL97TA, UK
| | - Y Zablotski
- Small Animal Clinic, Ludwig-Maximilians University, Veterinaerstraße 13, Munich 80539, Germany
| | - M Kornmayer
- Small Animal Clinic, Ludwig-Maximilians University, Veterinaerstraße 13, Munich 80539, Germany
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Harrison JM, Muir P. Outcome in 12 Dogs with Chronic Radiographic Cranial Tibial Subluxation after Tibial Plateau Leveling Osteotomy (2019-2021). Case Rep Vet Med 2024; 2024:6681788. [PMID: 38803390 PMCID: PMC11129903 DOI: 10.1155/2024/6681788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/19/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Objective The objective of this study was to examine outcomes in dogs with cruciate ligament rupture (CR) that had chronic radiographic cranial tibial subluxation at the time of osteotomy healing after tibial plateau leveling osteotomy (TPLO). Study Design. Retrospective case analysis of 12 dogs with prospective follow-up. Four of the 12 dogs were prospectively studied 12-24 months after surgery to assess long-term radiographic and clinical outcomes. Results Three of the 4 dogs showed improvement in radiographic cranial tibial subluxation at long-term follow-up. In the other dog, minimally improved cranial tibial subluxation was associated with severe lameness. At long-term follow-up, gait analysis in 3 dogs with improved subluxation showed the symmetry of weight-bearing within 10% for peak vertical force, and no clinically lameness. Preoperative tibial plateau angle (TPA) and radiographic osteoarthritis in dogs with prospective follow-up and all dogs treated with TPLO surgery in the study period were not significantly different. Conclusion Dogs with chronic radiographic cranial tibial subluxation are acceptable candidates for TPLO. Radiographic improvement in stifle reduction may take more than 10 weeks. The dog with long-term persistent subluxation also had a higher TPA over time, suggestive of ineffective surgical correction with TPLO and treatment failure.
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Affiliation(s)
- Jacqueline M. Harrison
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Peter Muir
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
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Korytárová N, Kramer S, Harms O, Volk HA. Clinical relevance of positive intraoperative bacterial culture in tibial plateau leveling osteotomy in dogs: a retrospective study. BMC Vet Res 2024; 20:175. [PMID: 38704532 PMCID: PMC11069177 DOI: 10.1186/s12917-024-04007-w] [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: 02/11/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Tibial plateau leveling osteotomy (TPLO) belongs to the most frequently used surgical method for the treatment of cranial cruciate ligament rupture in dogs. Surgical site infection (SSI) is one of the possible postoperative complications. The aim of this study was to evaluate the diagnostic value of intraoperative bacterial culture as a tool for the detection of intraoperative bacterial contamination progressing to infection development in canine TPLO. Electronic patient records from dogs who underwent TPLO between January 2018 to December 2020 were retrospectively reviewed. Intraoperative bacterial culture results, used antimicrobial drugs and presence of SSI were recorded. RESULTS Ninety-eight dogs were included in the study. SSI rate was 10.2%. All dogs who developed SSI (n = 10) had negative intraoperative bacterial cultures. None of the dogs with positive intraoperative bacterial culture (n = 6) developed SSI. The most cultured bacteria causing SSI was Staphylococcus pseudintermedius (n = 4). CONCLUSIONS Intraoperative bacterial culture in dogs undergoing TPLO is not suitable as a predictor of surgical site infection.
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Affiliation(s)
- Natália Korytárová
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Sabine Kramer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Oliver Harms
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
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Dan MJ, Wills DJ, Crowley JD, Cance N, Romandini I, Walsh WR, Dejour DH. Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope. Knee Surg Sports Traumatol Arthrosc 2024; 32:1071-1076. [PMID: 38509848 DOI: 10.1002/ksa.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) is used to treat clinical instability post ACL rupture, however, there is a high rate of incomplete return to sport and rerupture. There is increasing interest in posterior tibial slope as an intrinsic risk factor for ACLR failure and persistent instability. Zoobiquity describes the collaboration between the human and veterinary professions in order to advance the scientific understanding of both fields. Given the cranial cruciate ligament (CCL) in dogs is synonymous with the anterior cruciate ligament in humans, functioning to control internal rotation and anterior translation, but osteotomies, rather than ligament reconstruction, are the mainstay of treatment for CCL rupture, this editorial sort to gain insights into this form of treatment from the veterinary world. Level of Evidence: Level V, evidence.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
- East Coast Athletic Orthopaedics, Merewether, New South Wales, Australia
| | - Daniel J Wills
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Coast OrthoVet-Veterinary Orthopaedic Referral Services, Sydney, New South Wales, Australia
| | - James D Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Nicolas Cance
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
| | | | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - David H Dejour
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
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Pegram C, Diaz-Ordaz K, Brodbelt DC, Chang YM, von Hekkel AF, Wu CH, Church DB, O'Neill DG. Target Trial Emulation: Does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? Prev Vet Med 2024; 226:106165. [PMID: 38503655 DOI: 10.1016/j.prevetmed.2024.106165] [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: 01/16/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Target trial emulation applies design principles from randomised controlled trials to the analysis of observational data for causal inference and is increasingly used within human epidemiology. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether surgical (compared to non-surgical) management for cranial cruciate ligament (CCL) rupture in dogs causes improved short- and long-term lameness and analgesia outcomes. The emulated target trial included dogs diagnosed with CCL rupture between January 1, 2019 and December 31, 2019 within the VetCompass database. Inclusion in the emulated trial required dogs aged ≥ 1.5 and < 12 years, first diagnosed with unilateral CCL rupture during 2019 and with no prior history of contralateral ligament rupture or stifle surgery. Dogs were retrospectively observed to have surgical or non-surgical management. Informed from a directed acyclic graph derived from expert opinion, data on the following variables were collected: age, breed, bodyweight, neuter status, insurance status, non-orthopaedic comorbidities, orthopaedic comorbidities and veterinary group. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, with weights calculated based on a binary logistic regression exposure model. Censored dogs were accounted for in the IPTW analysis using inverse probability of censoring weighting (IPCW). The IPCWs were combined with IPTWs and used to weight each dog's contribution to binary logistic regression outcome models. Standardized mean differences (SMD) examined the balance of covariate distribution between treatment groups. The emulated trial included 615 surgical CCL rupture cases and 200 non-surgical cases. The risk difference for short-term lameness in surgically managed cases (compared with non-surgically managed cases) was -25.7% (95% confidence interval (CI) -36.7% to -15.9%) and the risk difference for long-term lameness -31.7% (95% CI -37.9% to -18.1%). The study demonstrated the application of the target trial framework to veterinary observational data. The findings show that surgical management causes a reduction in short- and long-term lameness compared with non-surgical management in dogs.
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Affiliation(s)
- Camilla Pegram
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK.
| | - Karla Diaz-Ordaz
- University College London, Department of Statistical Science, Gower Street, London WC1E 6BT, UK
| | - Dave C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Yu-Mei Chang
- Research Support Office, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - Anna Frykfors von Hekkel
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Chieh-Hsi Wu
- Statistical Sciences Research Institute, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
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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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8
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Engdahl K, Bergström A, Höglund O, Moldal ER, Emanuelson U, Boge GS. Long-term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index. Vet Rec 2023; 193:e3172. [PMID: 37439319 DOI: 10.1002/vetr.3172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Cranial cruciate ligament disease (CCLD) is common in dogs, but studies on the long-term treatment outcome are scarce. METHODS The long-term outcome in a cohort of 71 dogs with CCLD treated with tibial plateau levelling osteotomy (TPLO, n = 18), tibial tuberosity advancement (TTA, n = 23) or lateral fabellotibial suture (LFS, n = 30) was evaluated using the canine orthopaedic index. RESULTS The risk of stiffness and lameness was increased in dogs treated with TPLO (stiffness: incidence rate ratio [IRR] 1.33, p = 0.015; lameness: IRR 1.34, p = 0.020) or TTA (stiffness: IRR 1.26, p = 0.035; lameness: IRR 1.31, p = 0.026) when compared to LFS at a median follow-up time of 4.6 years. LIMITATIONS No follow-up veterinary examination was performed. Data were collected from only two university animal hospitals, and thus, a referral bias towards more complicated cases is possible, which may limit the generalisability of the results. CONCLUSION Clinicians can use the results to inform dog owners about the expected long-term outcome in dogs with CCLD.
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Affiliation(s)
- Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Annika Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Odd Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Elena R Moldal
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Gudrun S Boge
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
- Norwegian Medicines Agency, Oslo, Norway
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Schmutterer JM, Augat P, Greinwald M, Meyer-Lindenberg A. Meniscal Load and Load Distribution in the Canine Stifle after Modified Tibial Tuberosity Advancement with 9 mm and 12 mm Cranialization of the Tibial Tuberosity in Different Standing Angles. Vet Comp Orthop Traumatol 2023; 36:241-249. [PMID: 37160259 DOI: 10.1055/s-0043-57046] [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: 05/11/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the kinetic and kinematic changes in the stifle after a modified tibial tuberosity advancement (TTA) with 9 and 12 mm cranialization of the tibial tuberosity in different standing angles. STUDY DESIGN Biomechanical ex vivo study using seven unpaired canine cadaver hindlimbs. Sham TTA surgery was performed. Motion sensors were fixed to the tibia and the femur for kinematic data acquisition. Pressure mapping sensors were placed between femur and both menisci. Thirty percent body weight was applied to the limbs with the stifle in 135 or 145 degrees of extension. Each knee was tested in 135 degrees with intact cranial cruciate ligament (CCL) and deficient CCL with 12 mm cranialization of the tibial tuberosity in 135 and 145 degrees of extension. The last two tests were repeated with 9 mm. RESULTS Transection of the CCL altered kinematics and kinetics. Tibial tuberosity advancement with 12 mm cranialization sufficiently restored stifle kinematics in 135 and 145 degrees but 9 mm TTA failed to do so in 135 degrees. The same effects were seen for internal rotation of the tibia. After TTA, a significant reduction in the force acting on both menisci was detected. CONCLUSION Tibial tuberosity advancement could restore stifle kinematics and meniscal kinetics after transection of the CCL ex vivo in the present study. Tibial tuberosity advancement reduced the contact force ratio on both menisci significantly. No changes of peak pressure and peak pressure location occurred following TTA under any of the tested experimental settings. Increased stifle extension (145 degrees) might lead to more stability, contradictory to biomechanical theory.
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Affiliation(s)
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Greinwald
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
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10
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Mazdarani P, Gundersen RS, Miles JE. Instantaneous center of rotation in the canine femorotibial joint: Ex vivo assessment of a tool to evaluate joint stabilization surgeries. Res Vet Sci 2023; 161:31-37. [PMID: 37307639 DOI: 10.1016/j.rvsc.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
Cranial cruciate ligament rupture is a common cause of femorotibial joint instability in the dog. Numerous techniques including several tibial osteotomies have been described for stabilization, but there is no current consensus on the best method. The instantaneous center of rotation (ICR) can aid investigations of pathological joint movement, but its use is problematic in the femorotibial joint due to combined rotation and translation during flexion and extension. Using fluoroscopic images from an earlier cadaveric study of canine joint stability, an interpolation method was used to create repeatable rotational steps across joint situations, followed by least squares approximation of the ICR. The ICR in intact joints was located mid-condyle but displaced significantly (P < 0.001) proximally following cranial cruciate ligament transection and medial meniscal release. Individual joints appear to respond differently to destabilization. Triple tibial osteotomy partially restored ICR location during early movement from flexion to extension. Joint instability significantly altered the proportions of rolling and gliding movement at the joint surface (P < 0.02), which triple tibial osteotomy partially improved. While triple tibial osteotomy restores joint stability ex vivo and clinically, normal biomechanics of the joint are not restored. The methods described here may prove useful for comparison of osteotomy techniques for stabilization of the cranial cruciate ligament deficient femorotibial joint in dogs.
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Affiliation(s)
- P Mazdarani
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
| | - R S Gundersen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark
| | - J E Miles
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870 Frederiksberg C, Denmark.
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11
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Hsu WR, Lin CC, Sun CY, Wu CH. Ex vivo biomechanical evaluation of extracapsular stabilization with quasi-isometric points in canine cranial cruciate ligament-deficient stifles. BMC Vet Res 2023; 19:93. [PMID: 37488563 PMCID: PMC10364379 DOI: 10.1186/s12917-023-03656-7] [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: 11/22/2022] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs. The extracapsular stabilization (ECS) utilizing bone anchors and monofilament nylon leader was an alternative treatment for CCL-deficient (CCLD) dogs. However, the biomechanical response of the canine stifle to such a surgical repair strategy in conjunction with the use of recently reported quasi-isometric anchoring points remains unclear. The objectives of the study were to evaluate the mobility and stability of CCL-intact, CCLD, and CCLD stifles repaired with ECS at two different pairs of quasi-isometric points (quasi-IPs). METHODS Twelve stifle specimens from 7 dogs underwent mobility and stability tests under 4 different conditions, namely, CCL-intact, CCLD, and ECS-repaired at 2 different pairs of quasi-IPs (referred to as ECS-IP1 and ECS-IP2). The mobility tests evaluated 6 degrees-of-freedom stifle kinematics during flexion and extension. The stability tests involved cranial drawer and tibial internal rotation (IR) tests at various stifle opening angles and quantifying the cranial tibial translation (CTT) and tibial IR angles under constantly applied loadings. RESULTS The ECS repaired at quasi-IPs was shown to restore cranial instability of the stifles with averaged CTT magnitudes < 1.4 mm. During the tibial IR test, the ECS treatments resulted in significantly less tibial IR compared to those in intact CCL stifles. The mobility tests showed similar results. CONCLUSION The 2 chosen pairs of quasi-IPs were shown to effectively correct the excessive CTT caused by CCLD stifles, whereas the excessive tibial external rotation in comparison to those of intact stifles should be considered for its subsequent influence on joint alignment and the contact pressure applied to the stifle joint.
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Affiliation(s)
- Wei-Ru Hsu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, No. 153, Sec. 3, Keelung Rd., Da'an Dist, Taipei City, 106328, Taiwan (R.O.C.)
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan (R.O.C.)
| | - Cheng-Yuan Sun
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, No. 153, Sec. 3, Keelung Rd., Da'an Dist, Taipei City, 106328, Taiwan (R.O.C.)
| | - Ching-Ho Wu
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, No. 153, Sec. 3, Keelung Rd., Da'an Dist, Taipei City, 106328, Taiwan (R.O.C.).
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Pennasilico L, Di Bella C, Sassaroli S, Salvaggio A, Roggiolani F, Piccionello AP. Effects of Autologous Microfragmented Adipose Tissue on Healing of Tibial Plateau Levelling Osteotomies in Dogs: A Prospective Clinical Trial. Animals (Basel) 2023; 13:2084. [PMID: 37443881 DOI: 10.3390/ani13132084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this study was to evaluate the effects of autologous microfragmented adipose tissue (MFAT) applied after mechanical fragmentation and assess these effects radiographically in bone healing in dogs subjected to tibial plateau levelling osteotomy (TPLO). Twenty dogs with unilateral cranial cruciate ligament disease were enrolled and randomly assigned to the treatment group (MFAT) or the control group (NT). The MFAT group underwent TPLO and autologous MFAT intra-articular administration, while the NT group underwent TPLO alone. Adipose tissue was collected from the thigh region, and MFAT was obtained by mechanical fragmentation at the end of the surgery. The patients were subjected to X-ray examination preoperatively, immediately postoperatively (T0), and at 4 (T1) and 8 (T2) weeks postoperatively. Two radiographic scores that had previously been described for the evaluation of bone healing after TPLO were used. A 12-point scoring system (from 0 = no healing to 12 = complete remodelling) was used at T0, T1, and T2, while a 5-point scoring system (from 0 = no healing to 4 = 76-100% of healing) was used at T1 and T2. The median healing scores were significantly higher at T1 and T2 for the MFAT group compared with the NT group for the 12-point (p < 0.05) and 5-point (p < 0.05) scoring systems. The intra-articular injection of autologous microfragmented adipose tissue can accelerate bone healing after TPLO without complications.
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Affiliation(s)
- Luca Pennasilico
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Caterina Di Bella
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Sara Sassaroli
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
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Wemmers AC, Pawlak S, Medl N, Bokemeyer J, Wagels R, Harms O, Volk HA. Economic Considerations on Costs and Pricing of Two Surgical Techniques for Treating Cranial Cruciate Disease in Dogs. Animals (Basel) 2023; 13:ani13091505. [PMID: 37174542 PMCID: PMC10177016 DOI: 10.3390/ani13091505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients' owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons' training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options.
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Affiliation(s)
- Annika Christina Wemmers
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559 Hannover, Germany
| | - Szymon Pawlak
- AniCura Small Animal Referral Clinic, Alpenstr. 27, 87727 Babenhausen, Germany
| | - Nikola Medl
- AniCura Small Animal Referral Clinic, Alpenstr. 27, 87727 Babenhausen, Germany
| | - Jan Bokemeyer
- IVC Evidensia Small Animal Clinic Kalbach, Max-Holder-Straße 37, 60437 Frankfurt am Main, Germany
| | - Rolf Wagels
- Department of Information and Data Processing Service (IDS), University of Veterinary Medicine Hannover, Bünteweg 2, 30559 Hannover, Germany
| | - Oliver Harms
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559 Hannover, Germany
| | - Holger Andreas Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559 Hannover, Germany
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Franklin CDH, House AK, Pfeiffer CN. Complications and postoperative non-steroidal anti-inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment. J Small Anim Pract 2023; 64:21-30. [PMID: 36324226 DOI: 10.1111/jsap.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To report complications and postoperative non-steroidal anti-inflammatory use associated with fabellotibial suture, Tightrope and Ligafiba Isotoggle procedures performed on dogs of varying weights within a general practice setting. MATERIALS AND METHODS Clinical records of eligible patients from 2009 to 2018 were retrospectively extracted from five general practice clinics. Data for signalment, patient weight, surgery performed, complications, postoperative use of non-steroidal anti-inflammatory drugs, and timing thereof were extracted and analysed using multinomial logistic regression. Predicted probability tables were generated for complications and non-steroidal anti-inflammatory drug use. RESULTS The study included 370 surgeries, with 97 fabellotibial suture, 158 Tightrope and 42 Ligafiba Isotoggle procedures in patients less than 15 kg, and 43 fabellotibial suture, 16 Tightrope and 30 Ligafiba Isotoggle procedures in patients at least 15 kg. The proportion of patients that can be expected to have no complications was greatest for older dogs (9 years) weighing less than 15 kg (fabellotibial suture, 91%; Tightrope/Ligafiba Isotoggle, 88%), and the highest major medical and surgical complication risks were expected in young dogs (1 year) weighing over 15 kg (fabellotibial suture, 28%; Tightrope/Ligafiba Isotoggle, 59%). The predicted risk of requiring repeated non-steroidal anti-inflammatory drug prescriptions in the 18-month postoperative period for an 15 kg patient was 37% to 39%. CONCLUSION Weight and age were significant factors influencing complications and postoperative non-steroidal anti-inflammatory drug use in fabellotibial suture, Tightrope and Ligafiba Isotoggle surgical patients in a general practice setting. CLINICAL SIGNIFICANCE Clinicians should consider the possibility of complications and requirement for ongoing non-steroidal anti-inflammatory drug use before performing extracapsular procedures in patients weighing more than 15 kg.
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Affiliation(s)
- C D H Franklin
- Peninsula Vet Emergency and Referral Hospital, Mornington, Australia
| | - A K House
- Peninsula Vet Emergency and Referral Hospital, Mornington, Australia
| | - C N Pfeiffer
- Melbourne Veterinary School, University of Melbourne, Parkville, Australia
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Leal RA, Lambrechts NE, Crowley JD, Griffin JF, Karnia JJ, Torres BT, Maritato KC, Kieves NR, Duerr FM. Comparison of radiographic scoring systems for assessment of bone healing after tibial plateau leveling osteotomy in dogs. Front Vet Sci 2023; 10:1147386. [PMID: 37089406 PMCID: PMC10117835 DOI: 10.3389/fvets.2023.1147386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Accurate radiographic assessment of bone healing is vital in determining both clinical treatment and for assessing interventions aimed at the promotion of bone healing. Several scoring systems have been used to evaluate osteotomy changes following tibial plateau leveling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing following TPLO over time (Aim I), and to evaluate the influence of limb positioning on TPLO osteotomy scoring (Aim II). Materials and methods Phase I-A randomized, blinded, prospective study was conducted using similarly positioned postoperative TPLO radiographs from seven dogs taken immediately postoperatively, 6-weeks, and 8-weeks postoperatively. Ten reviewers assessed the radiographs, and five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week postoperative were compared to 8-week postoperative. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score). Phase II-An international group of 39 reviewers was asked to score radiographs from three dogs, taken in different positions, using the VAS grading system. Scores were averaged and comparisons were made for each set. Results Phase I-The VAS system identified the greatest number of sets correctly (76%), with the least unchanged scores (15%), and 9% incorrect scores. Phase II-All three patients had an increase in the average difference between VAS-scores for differently positioned radiographs compared to similarly positioned radiographs. The magnitude of change between different positions far exceeded the magnitude of comparison of the similarly positioned radiographs from the 6- and 8-week time point. Discussion/Conclusion The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. In addition, the positioning of postoperative TPLO radiographs makes a substantial difference in the healing score that is assigned. Care must be undertaken when performing postoperative radiographs in both the clinical and research setting to ensure accurate assessment of bone healing.
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Affiliation(s)
- R. A. Leal
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - N. E. Lambrechts
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - J. D. Crowley
- Small Animal Specialist Hospital, North Ryde, NSW, Australia
| | - J. F. Griffin
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
| | - J. J. Karnia
- College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - B. T. Torres
- College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - K. C. Maritato
- MedVet Medical and Cancer Center for Pets, Cincinnati, OH, United States
| | - N. R. Kieves
- College of Veterinary Medicine, Ohio State University, Columbus, OH, United States
| | - F. M. Duerr
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
- *Correspondence: F. M. Duerr
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Creamer DG, Muir P. Arthroscopic Treatment of Chronic Cruciate Ligament Rupture in the Dog without Stifle Stabilization: 13 Cases (2001-2020). Case Rep Vet Med 2023; 2023:6811238. [PMID: 37082758 PMCID: PMC10113050 DOI: 10.1155/2023/6811238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
Objective The objective was to study clinical outcomes in dogs with chronic cruciate ligament rupture (CR) treated with palliative arthroscopy as the sole surgical treatment. Methods Thirteen client-owned dogs with CR underwent physical examination, stifle radiography, and arthroscopy with resection of damaged meniscal tissue. Records were evaluated, and orthopaedic examination, radiographs, and arthroscopy images were assessed. Long-term clinical outcome was also assessed by use of an owner questionnaire. Results Thirteen dogs that underwent arthroscopy at the UW Veterinary Care between 2001 and 2020 were included. Long-term follow-up was available for 7 of 13 dogs. Lameness was static to improved in all dogs in which arthroscopy was performed. Subsequent stifle stabilization was performed after arthroscopy in only 1 of 7 dogs with follow-up data. Conclusion Palliative arthroscopy and resection of damaged meniscal tissue in combination with medical management of osteoarthritis can be considered in dogs with chronic CR and cranial tibial subluxation with little passive laxity during examination. Revision surgery with TPLO is uncommon after arthroscopy based on this study.
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Affiliation(s)
- Danielle G. Creamer
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Peter Muir
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
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Wemmers AC, Charalambous M, Harms O, Volk HA. Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement-A systematic review with a meta-analytic approach. Front Vet Sci 2022; 9:1004637. [PMID: 36532339 PMCID: PMC9748159 DOI: 10.3389/fvets.2022.1004637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 12/17/2023] Open
Abstract
Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.
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Affiliation(s)
- Annika Christina Wemmers
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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Effect of Nail Grips on Weight Bearing and Limb Function in 30 Dogs 2 Weeks Post Tibial Plateau Leveling Osteotomy. Animals (Basel) 2022; 12:ani12182312. [PMID: 36139171 PMCID: PMC9494954 DOI: 10.3390/ani12182312] [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: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Devices made to improve mobility are becoming increasingly popular among owners of dogs with orthopedic conditions, but there are few studies investigating their efficacy. Nail grips are commonly used by veterinary rehabilitation practitioners to improve the security of foot placement by increasing nail traction. This study aimed to assess if nail grips would improve mobility outcomes in dogs recovering from knee surgery. The results did not show a significant effect on outcomes during the initial 2-week post-operative period; however, further research is needed to determine if they are useful for other applications. Abstract The objective of this study was to assess the functional outcomes of dogs wearing nail grips in the first 2 weeks following tibial plateau leveling osteotomy (TPLO). Thirty dogs were included (n = 13 nail grips and n = 17 sham grips). Visual lameness scores (VLS), total pressure index (TPI), and client-specific outcome measures (CSOMs) were obtained by blinded observers on day 1 and day 14 +/− 3 post TPLO. CSOMs were also obtained on day 7. There were no differences in VLS and TPI between the treatment and sham group on day 14 (p = 0.44 and p = 0.59, respectively) or at any time point. CSOMs assessing walking on slippery flooring, ability to rise, and consistent use of surgical limb on a 5 min walk were also not different between groups (p = 0.78, p = 0.80, and p = 0.63) at any time point. Nail grips were well tolerated in dogs after orthopedic surgery. This study did not demonstrate a benefit for dogs wearing nail grips during the first two weeks after TPLO; however, further studies are warranted.
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Shimada M, Takagi T, Kanno N, Yamakawa S, Fujie H, Hara Y. Influence of tibial plateau levelling osteotomy on the tensile forces sustained by ligaments in cranial cruciate ligament‐intact canine stifles: An ex vivo pilot study. Vet Med Sci 2022; 8:1904-1914. [PMID: 35947706 PMCID: PMC9514505 DOI: 10.1002/vms3.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masakazu Shimada
- Faculty of Veterinary Medicine Division of Veterinary Surgery Department of Veterinary Science Nippon Veterinary and Life Science University Musashino‐shi Tokyo Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory Faculty of System Design Tokyo Metropolitan University Hachioji‐shi Tokyo Japan
| | - Nobuo Kanno
- Faculty of Veterinary Medicine Division of Veterinary Surgery Department of Veterinary Science Nippon Veterinary and Life Science University Musashino‐shi Tokyo Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory Faculty of System Design Tokyo Metropolitan University Hachioji‐shi Tokyo Japan
- Department of Sports Medical Biomechanics Graduate School of Medicine Osaka University Suita Osaka Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory Faculty of System Design Tokyo Metropolitan University Hachioji‐shi Tokyo Japan
| | - Yasushi Hara
- Faculty of Veterinary Medicine Division of Veterinary Surgery Department of Veterinary Science Nippon Veterinary and Life Science University Musashino‐shi Tokyo Japan
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Griffeuille E, Ronot P, Fragano B, Gibert S, Dunié‐Mérigot A. Extracapsular stabilization for the treatment of cranial cruciate ligament rupture in a ferret. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Pierre Ronot
- Exotics Department CHV Languedocia Montpellier France
| | | | - Sophie Gibert
- Surgical Department CHV Languedocia Montpellier France
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Tibial Tuberosity Advancement Techniques (TTAT): A Systematic Review. Animals (Basel) 2022; 12:ani12162114. [PMID: 36009702 PMCID: PMC9404911 DOI: 10.3390/ani12162114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 01/07/2023] Open
Abstract
(1) Background: Several surgical techniques were described for the treatment of cranial cruciate ligament rupture in dogs. This report aims to critically review the available literature focused on preoperative planning, surgical procedure, follow-up, and complications of cranial cruciate ligament rupture treated by tibial tuberosity advancement techniques; (2) Methods: three bibliographic databases: PubMed, Google Scholar, and Scopus were used for a board search of TTAT (canine OR dog). Five GRADE recommendations according to Grading of Recommendations Assessment, Development and Evaluation and Joanna Briggs Institute Critical Appraisal Checklists were applied to the studies included. Data regarding preoperative planning (a measure of advancement), meniscal disease (meniscectomy, meniscal release, and late meniscal tears), and postoperative patellar tendon angle were recorded. Time frame, outcome, and complications were classified according to Cook’s guidelines; (3) Results: from 471 reports yielded, only 30 met the inclusion criteria. The common tangent method was the most commonly reported measurement technique for preoperative planning. The 40.21% of stifles presented meniscal tears at surgery, while 4.28% suffered late meniscal tears. In short-, mid-and long-term follow-ups examined showed a full/acceptable function was shown in >90% of cases. Among all new generation techniques, minor complications were reported in 33.5% of cases and major complications in 10.67%; (4) Conclusions: Compared to traditional TTA, new generation TTAT resulted effective in the treatment of cranial cruciate ligament failure, showing a lower rate of late meniscal injury but a higher rate of minor complications.
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Kettleman WS, Torres BT. Abstract Presentation at Two Veterinary Surgery Conferences and the Impact on Publication Rate. Vet Comp Orthop Traumatol 2022; 35:390-397. [PMID: 35815628 DOI: 10.1055/s-0042-1750717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of this study was to compare the publication rate (PR) and report descriptive findings from abstracts presented at the American College of Veterinary Surgeons (ACVS), the Veterinary Orthopaedic Society (VOS), and those presented at both conferences. STUDY DESIGN All conference abstracts from 2001 to 2010 ACVS and VOS meetings were reviewed. PR in peer-reviewed journals was evaluated and compared between Group 1 (abstracts presented at ACVS only; n = 1,277), Group 2 (abstracts presented at VOS only; n = 645), and Group 3 (abstracts presented at both conferences; n = 121) abstracts. Abstracts were assigned a level of evidence (LoE) score. RESULTS Approximately 6% of all abstracts evaluated were presented at two scientific meetings (Group 3). The PR of Group 1 (66%) and Group 3 (62%) abstracts was significantly higher than that of Group 2 (45%). The majority of abstracts were assigned a low LoE (3 or 4). Once presented, most Group 3 abstracts took <12 months to be submitted and <24 months to be published. CONCLUSION This study found that a limited number of abstracts were presented at both ACVS and VOS, and PR was significantly different between those presented at ACVS only or both ACVS and VOS compared with VOS only. There was no significant difference in PR between Group 1 and Group 3 abstracts. This study has provided the initial comparison between abstracts presented at two veterinary surgical conferences.
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Affiliation(s)
- William S Kettleman
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State University, Mississippi, United States
| | - Bryan T Torres
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri, United States
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Roses L, Lopez de la Oliva P, Arnott D. Rotation of the Tibial Plateau Segment to Control Arterial Haemorrhage during Tibial Plateau Levelling Osteotomy: A Cadaveric Experimental Study and Nine Clinical Cases. Vet Comp Orthop Traumatol 2022; 35:331-338. [PMID: 35764306 DOI: 10.1055/s-0042-1749452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe a simple and effective method to control severe haemorrhage from intraoperative trauma to the cranial tibial artery (CTA) during tibial plateau levelling osteotomy (TPLO) and to report long-term outcomes. STUDY DESIGN Cadaveric descriptive study and retrospective case series. A TPLO was performed in eight cadaveric limbs, followed by intentional laceration of the CTA under fluoroscopic guidance. Dissection of the limb was performed and the relationship between the CTA and the surrounding structures was evaluated. A computed tomography angiogram was performed following TPLO in one cadaveric limb. Medical records from cases that had intraoperative arterial bleeding between 2015 and 2019 were reviewed. Cases were included if bleeding was controlled by following the usual steps for TPLO. Radiographic follow-up 6 to 10 weeks postoperatively and long-term follow-up owner's questionnaire were available. RESULTS During TPLO, the CTA is tightly compressed between the caudal aspect of the proximal tibia and the popliteal musculature. Rotation and compression of the proximal tibia followed by closure of the pes anserinus successfully controlled arterial bleeding during TPLO in nine clinical cases without the need for direct ligation. CONCLUSION Continuing the usual steps of a TPLO can successfully control intraoperative bleeding from the CTA with no long-term complications. This technique should be considered in cases of arterial bleeding during TPLO before direct ligation.
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Binversie EE, Walczak BE, Cone SG, Baker LA, Scerpella TA, Muir P. Canine ACL rupture: a spontaneous large animal model of human ACL rupture. BMC Musculoskelet Disord 2022; 23:116. [PMID: 35123473 PMCID: PMC8818196 DOI: 10.1186/s12891-021-04986-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) rupture in humans is a common condition associated with knee pain, joint instability, and secondary osteoarthritis (OA). Surgical treatment with an intraarticular graft provides reasonable outcomes at mid and long-term follow-up. Non-modifiable and modifiable factors influence risk of ACL rupture. The etiology, mechanobiology, causal biomechanics, and causal molecular pathways are not fully understood. The dog model has shared features of ACL rupture that make it a valuable spontaneous preclinical animal model. In this article, we review shared and contrasting features of ACL rupture in the two species and present information supporting spontaneous canine ACL rupture as a potentially useful preclinical model of human ACL rupture with a very large subject population. Results ACL rupture is more common in dogs than in humans and is diagnosed and treated using similar approaches to that of human patients. Development of OA occurs in both species, but progression is more rapid in the dog, and is often present at diagnosis. Use of client-owned dogs for ACL research could reveal impactful molecular pathways, underlying causal genetic variants, biomechanical effects of specific treatments, and opportunities to discover new treatment and prevention targets. Knowledge of the genetic contribution to ACL rupture is more advanced in dogs than in humans. In dogs, ACL rupture has a polygenetic architecture with moderate heritability. Heritability of human ACL rupture has not been estimated. Conclusion This article highlights areas of One Health research that are particularly relevant to future studies using the spontaneous canine ACL rupture model that could fill gaps in current knowledge.
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Alvarez LX, Repac JA, Kirkby Shaw K, Compton N. Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs. Vet Surg 2022; 51:233-243. [PMID: 35023182 PMCID: PMC9303706 DOI: 10.1111/vsu.13755] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 12/31/2022]
Abstract
Objective To critically evaluate the evidence for rehabilitation interventions following surgery for cranial cruciate ligament disease (CCLD) in dogs. Study design Systematic review. Methods Google Scholar and Pubmed databases were searched for studies evaluating postoperative CCLD rehabilitation interventions from 1990 until March 2020 per the international Prospective Register of Systematic Reviews (PROSPERO). Each study was assigned a level of evidence score from I to IV and a risk of bias (RoB) score by 2 reviewers, and by a third reviewer, when consensus was not reached. Results Nineteen studies met the inclusion criteria. Twelve comprised randomized, controlled trials (Level II), 6 were nonrandomized or nonblinded (Level III), and one was retrospective (Level IV). Nine studies had high RoB scores. Sixteen studies yielded positive results. Therapeutic exercise had the most studies with positive results but all had high RoB. Cold compression therapy had 3 supporting studies (2 Level II, low RoB). Extracorporeal shockwave yielded 2 positive Level II studies (low‐moderate and high‐moderate RoB) and photobiomodulation had 1 positive study (Level II, low RoB) with objective outcomes. A negative outcome was noted in 1 photobiomodulation study. There was 1 supporting study on electrical stimulation and there was none on low‐intensity pulsed ultrasound. Conclusion This systematic review supports the use of rehabilitation interventions in recovery of postoperative CCLD in dogs; however, many studies had a high risk of bias. Clinical significance There is a lack of class I level evidence in veterinary rehabilitation. This study supports therapeutic exercise and cold compression therapy for postoperative CCLD rehabilitation. Existing studies on other modalities are limited and demonstrate conflicting results.
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Affiliation(s)
| | - Jennifer A Repac
- College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Nashua Compton
- Veterinary Specialty Center of Seattle, Lynnwood, Washington, USA
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Roydev R. Long-term clinical and goniometric follow-up of lateral suture surgery in dogs with cranial cruciate ligament rupture. BULGARIAN JOURNAL OF VETERINARY MEDICINE 2022. [DOI: 10.15547/bjvm.2021-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to evaluate the complications and the short-, medium-, and long-term outcomes following treatment of cranial cruciate ligament (CCL) rupture in dogs using the lateral fabello-tibial suture technique. The patients were ten dogs of various breeds, 62.5 ± 18.8 months of age, weighing 30.2 ± 3.3 kg, with unilateral CCL rupture. At 2, 6, 12, 24, and 52 weeks after surgery, the dogs were re-evaluated with clinical examination, gait and pain analysis, and radiography. A major complication was identified in one dog (10%), requiring second surgery due to implant failure and destabilisation of stifle joint. Minor complications occurred in two dogs postoperatively (one late meniscal injury and one case of seroma formation). The short-term outcome at two and six weeks postoperatively was considered good in six dogs and satisfactory in four dogs, while the mid-term outcome (between 12 and 24 weeks) was good to excellent in eight dogs and satisfactory in two dogs. All ten dogs had a good to excellent outcome 52 weeks after surgery. The lateral suture technique is generally safe and given the major benefits, such as lower costs, lower technical difficulty, and minimal requirement for specialised equipment, will probably remain a popular and alternative method for treatment of CCL insufficiency in dogs with good degree of owner satisfaction.
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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: 3] [Impact Index Per Article: 1.0] [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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Engdahl K, Emanuelson U, Höglund O, Bergström A, Hanson J. The epidemiology of cruciate ligament rupture in an insured Swedish dog population. Sci Rep 2021; 11:9546. [PMID: 33953264 PMCID: PMC8100293 DOI: 10.1038/s41598-021-88876-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/16/2021] [Indexed: 01/21/2023] Open
Abstract
Cruciate ligament rupture (CLR) is a common orthopedic disorder in dogs. The study objectives were to evaluate incidence rate (IR), cause-specific mortality rate (CSMR) and risk factors for CLR in insured dogs. A single cohort study of dogs insured in Agria Pet Insurance in Sweden (2011–2016) was performed. Age at diagnosis, IR, CSMR and relative risk (RR) for CLR was calculated overall and per breed. The cohort included just over 600,000 dogs. The IR of CLR was 23.8 (95% confidence interval, 23.1–24.6) cases per 10,000 DYAR. The breeds with highest RR of CLR were Boerboel and Dogo Canario, while the breeds with lowest RR were Standard Dachshund and Miniature Pinscher. Dogue de Bordeaux had highest RR of euthanasia due to CLR. The median age at veterinary care claim for CLR was 7.1 (range 0.3–16.0) years and 6.6 (0.3–12) years at life insurance settlement. Large and giant breeds were generally diagnosed and euthanized due to CLR at a younger age compared to smaller breeds. The majority of the breeds with increased RR of CLR diagnosis and CLR-related euthanasia were large or giant. A pattern of increasing size and decreasing age at diagnosis/CLR-related euthanasia was observed.
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Affiliation(s)
- Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, 75007, Uppsala, Sweden.
| | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, 75007, Uppsala, Sweden
| | - Odd Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, 75007, Uppsala, Sweden
| | - Annika Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, 75007, Uppsala, Sweden
| | - Jeanette Hanson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, 75007, Uppsala, Sweden
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Valiño-Cultelli V, Varela-López Ó, González-Cantalapiedra A. Preliminary Clinical and Radiographic Evaluation of a Novel Resorbable Implant of Polylactic Acid (PLA) for Tibial Tuberosity Advancement (TTA) by Modified Maquet Technique (MMT). Animals (Basel) 2021; 11:ani11051271. [PMID: 33925099 PMCID: PMC8145287 DOI: 10.3390/ani11051271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Our objectives were to determine whether PLA implants can be used in TTA with successful results; secondly, to observe whether they provide a faster bone healing; finally, to determine whether weight or age influences bone healing scores. PLA cages were created with a 3D printer. TTA by MMT with PLA implants was performed in 24 patients. Follow-ups were carried out pre-surgical, at 1, 2, and 5 months and consisted of a radiographic study and a lameness assessment. A comparison was performed in terms of weight and age. Patients data, time between follow-up examinations, healing score, and lameness score were compared between patients using commercial software for statistically significant differences p < 0.05. Eighteen dogs finished the study. The ossification degrees presented statistically significant differences between each other. PLA implants maintained the advancement in 100% of cases. Comparing weight and age did not present any statistically significant differences between groups. Lameness presented statistically significant differences between follow-up examinations. Complications were observed in 20.8%. PLA implants for TTA provide good functional results, presenting an acceptable rate of complications. They provide a faster bone healing of the osteotomy gap, which was not affected by age or body weight, and have a clinical recovery time similar to metallic implants.
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Engdahl KS, Boge GS, Bergström AF, Moldal ER, Höglund OV. Risk factors for severe postoperative complications in dogs with cranial cruciate ligament disease - A survival analysis. Prev Vet Med 2021; 191:105350. [PMID: 33892253 DOI: 10.1016/j.prevetmed.2021.105350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze the effect of surgical technique and other risk factors on severe postoperative complications in dogs with cranial cruciate ligament disease (CCLD). MATERIALS AND METHODS A cohort study of 255 dogs (287 stifles) surgically treated for CCLD at two veterinary university hospitals (2011-2016) was performed. The electronic medical records were reviewed and dog owners and referring veterinarians contacted for additional information. The complications were classified as minor, major and catastrophic, where major and catastrophic were considered severe. A multivariable Cox proportional hazards model was applied to assess risk factors for severe postoperative complications. RESULTS Three surgical techniques were used; lateral fabellotibial suture (LFS, 141 stifles), tibial plateau leveling osteotomy (TPLO, 77 stifles) and tibial tuberosity advancement (TTA, 69 stifles). The most common severe postoperative complications were surgical site infections or complications related to the surgical implant. Severe postoperative complications occurred in 31 % of the stifles treated with TPLO, 22 % of the stifles treated with LFS and 25 % of the stifles treated with TTA. The multivariable Cox proportional hazards model identified surgical technique (p = 0.0258) as a risk factor for severe postoperative complications; TPLO had a significantly lower hazard than LFS (hazard ratio (HR) = 0.37, p = 0.007) when controlling for body weight and age, which also were identified as risk factors (HR = 1.05, p < 0.001 and HR = 0.91, p = 0.047, respectively). CONCLUSION AND CLINICAL RELEVANCE Although TPLO procedures had the highest occurrence of severe postoperative complications, the hazard was lower than for LFS after adjusting for body weight and age. This implies that it is important to consider potential effect-modifiers when comparing postoperative complications after CCLD surgery.
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Affiliation(s)
- Karolina S Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Gudrun S Boge
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway
| | - Annika F Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden
| | - Elena R Moldal
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway
| | - Odd V Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden
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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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White C, Morrow L. Does traditional tibial tuberosity advancement yield similar postoperative outcomes as tibial plateau levelling osteotomy in dogs with cranial cruciate ligament disease? Vet Rec 2021; 187:69-71. [PMID: 32723894 DOI: 10.1136/vr.m2796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Constance White
- Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Lisa Morrow
- School of Veterinary Medicine and Science, University of Nottingham, UK
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Dominic C, Lanz OI, Muro N, Sawyere D, Aulakh K, Pancotto T, Seda D. Titanium-Alloy Anchoring System as a Suitable Method of Extracapsular Repair. Front Vet Sci 2020; 7:592742. [PMID: 33392286 PMCID: PMC7773701 DOI: 10.3389/fvets.2020.592742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To characterize the effect of a titanium-alloy anchoring system (TAS) on the motion of the cranial cruciate ligament (CrCL) deficient stifle. To compare the motion with the TAS to that of the CrCL-intact and CrCL-deficient stifle. Study Design: Each canine pelvic limb was mounted in a loading jig under 30% body weight. Motion data was collected using an electromagnetic tracking system at stifle angles of 125°, 135°, and 145° with the CrCL-intact, CrCL-deficient and the TAS applied. Results: Total translation of the CrCL-deficient stifle following the TAS was reduced, but remained greater than the CrCL-intact stifle at angles of 125°, 135°, and 145°. Internal rotation of the TAS groups was greater than the CrCL-intact group at 145°, but not 125° and 135°. Varus motion of the TAS group was decreased compared to the CrCL-deficient group, but increased compared to the CrCL-intact group at angles of 125°, 135°, and 145°. Conclusion: Total translation and internal rotation of the CrCL-deficient stifle following the TAS differed from that of the CrCL-intact stifle. However, the TAS reduced total translation and internal rotation of the tibia relative to the femur in the CrCL-deficient stifle to levels that may yield clinically acceptable results.
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Affiliation(s)
- Christopher Dominic
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Otto I Lanz
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Noelle Muro
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Dominique Sawyere
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Karanvir Aulakh
- Veterinary Clinical Sciences, Louisiana State University School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Theresa Pancotto
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
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Alexander A, Compagnone K, Grierson J, Keeley B, Kilduff-Taylor A, Maskell K, Moriera L, Roch S, Barnes D, Campmany MDM, Bovis MDM, Alexander SD, Matiasovic M. Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy. Vet Surg 2020; 50:44-52. [PMID: 33085802 DOI: 10.1111/vsu.13533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the influence of follow-up radiographic examination on recommendations made during routine clinical re-evaluation of dogs that had undergone uncomplicated tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Retrospective multi-institutional case series. ANIMALS Client-owned dogs (N = 1010) that underwent uncomplicated TPLO. METHODS Records from 11 institutions were searched for dogs that had been treated with unilateral TPLO and had no history of postoperative complications before their routine follow-up examination. The frequency of change in further clinical recommendations resulting from client- or clinician-voiced concerns or radiographic abnormalities was investigated. RESULTS Follow-up evaluation was performed at a median of 6 (range, 4-15) weeks after TPLO. Radiographic examination findings contributed to a change in recommendations in 4.15% (38/915) of dogs presented without client concerns and without abnormalities at orthopedic examination. Abnormal radiographic findings alone influenced the management of 3.76% (38/1010) of dogs. An association was detected between clinical features and radiological findings leading to a change in recommendations (P < .0001). Administration of analgesia at the time of follow-up was associated with radiographic abnormalities (P = .017) and change in postoperative plans (P = .0007). CONCLUSION Radiographic examination findings at follow-up did not influence the management of most dogs with uncomplicated TPLO. CLINICAL SIGNIFICANCE Radiographic examination findings are unlikely to influence the treatment of dogs that seem to be recovering uneventfully from an uncomplicated TPLO without concerns from clients, analgesia, or abnormal findings on thorough orthopedic examination by a surgical specialist, at the time of the planned clinical re-evaluation.
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Affiliation(s)
| | | | - James Grierson
- Anderson Moores Veterinary Specialists, Winchester, England
| | | | | | | | - Luis Moriera
- Willows Veterinary Centre and Referral Service, Solihull, England
| | | | | | | | | | | | - Matt Matiasovic
- Highcroft Veterinary Referrals, Bristol, England.,IVC Evidensia Small Animal Hospital Hart van Brabant, Waalwijk, The Netherlands
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Pownall W, Rytz U, Schuepbach G, Spadavecchia C, Rohrbach H. The influence of the choice of preemptive analgesia on long-term postsurgical pain after tibial plateau leveling osteotomy in dogs. Vet Surg 2020; 50:71-80. [PMID: 32956535 DOI: 10.1111/vsu.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/02/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the prevalence of chronic postsurgical pain (CPSP) after tibial plateau leveling osteotomy (TPLO) in dogs and to determine the influence of preemptive locoregional analgesia on CPSP. STUDY DESIGN Retrospective study. ANIMALS One hundred twenty client-owned dogs. METHODS Medical records of dogs that underwent TPLO between 2012 and 2016 were reviewed for demographic information and type of preemptive analgesia. Owners were contacted to retrospectively assess the quality of life of their dogs by using the Helsinki Chronic Pain Index (HCPI) before and 6 months after surgery and at the time of questioning. An HCPI score > 12 was considered indicative of CPSP. Medical records were reviewed for demographic information and type of preemptive analgesia. A cumulative logit model was used to assess correlation of type of perioperative analgesia, HCPI, and demographic data. RESULTS The HCPI score was consistent with CPSP in 41 of 101 dogs with long-term follow-up (2.9 ± 1.5 years after surgery). Chronic postsurgical pain was documented in 11 of 32 and 13 of 28 dogs that received a spinal or epidural injection, respectively, or in 28 of 80 and 25 of 67 dogs with sciatic-femoral block at 6 months or with long-term follow-up after TPLO, respectively (P > .05). A negative correlation was found between HCPI and both weight and age 6 months after surgery. Only weight remained negatively correlated 2.9 years after surgery. CONCLUSION Forty-one percent of dogs that were evaluated exhibited HCPI values compatible with CPSP long-term after TPLO, regardless of the type of preemptive analgesia. Increased body weight was a negative prognostic factor for CPSP development. CLINICAL SIGNIFICANCE Additional studies are required to evaluate CPSP development after TPLO.
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Affiliation(s)
- William Pownall
- Department of Surgery, Small Animal Clinic, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Ulrich Rytz
- Department of Surgery, Small Animal Clinic, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Gertraud Schuepbach
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Claudia Spadavecchia
- Division of Veterinary Anaesthesia and Pain Management, Vetsuisse Faculty, University of Berne, Berne, Switzerland
| | - Helene Rohrbach
- Division of Veterinary Anaesthesia and Pain Management, Vetsuisse Faculty, University of Berne, Berne, Switzerland
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Clinical Outcomes and Stifle Osteoarthritis Assessment of Nine Cats Before and After Tibial Plateau Levelling Osteotomy. ACTA VET-BEOGRAD 2020. [DOI: 10.2478/acve-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
This study aimed to evaluate the clinical and radio graphical outcome of cats following TPLO surgery for cranial cruciate ligament deficiency. Each cat underwent orthopedic assessment, pre-operative radio graphical evaluation, surgical procedure, postoperative management and clinical re-examination 1, 2, and 12 months following surgery. Age, body weights, TPAs, meniscal tears, implants and osteoarthritis progression were recorded. Postoperative OA score was compared with that obtained 1 year after surgery using a paired t-test with commercially available software. Radio graphical evaluation performed 1 year after surgery showed no significant OA progression (P-value > 0.1). Minor complications occurred in one case (#7) in which a mild to moderate seroma was observed ten days after surgery. No major complications were recorded. Although TPLO surgery in cats remains controversial, this study suggests that it was a suitable option for surgical treatment of feline cranial cruciate ligament rupture, but considering the ex vivo outcomes recently published, further in vivo evaluation is strongly recommended.
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Kettleman WS, Iuliani MC, Webb BG, Ceballos JM, Torres BT. Publication Rate and Evidence-Based Evaluation of Abstracts Presented at the Annual Veterinary Orthopedic Society Conference. Vet Comp Orthop Traumatol 2020; 33:333-339. [PMID: 32799313 DOI: 10.1055/s-0040-1714417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Scientific abstracts are a common method for disseminating new research. There is no information on the publication rate of orthopaedic surgery abstracts presented at the annual Veterinary Orthopedic Society (VOS) Conference. The objectives of this study were to document the publication rate, the publication timeline and the level of evidence (LoE) of abstracts presented at an annual orthopaedic meeting. STUDY DESIGN All conference abstracts from the 2001 to 2014 annual VOS meeting were reviewed, and final publication was determined through a comprehensive bibliographic search. RESULTS Over 14 conferences, 1,112 scientific abstracts were presented with an overall publication rate of 47%. The majority of abstracts had low LoE scores, and those abstracts were published less timely than ones with higher LoE scores. Once presented, most abstracts took 1 year to be submitted and 2 years to be published. Dog (45%) and ex vivo (19%) studies were the most common. Publication occurred most frequently in Veterinary Surgery (40%), Veterinary and Comparative Orthopaedics and Traumatology (17%) and the American Journal of Veterinary Research (12%). CONCLUSION The publication rate for abstracts presented at the annual VOS meeting is lower than those from a more generalized veterinary surgery conference. Publication occurs most frequently in a select group of journals, and the subject matter is limited in scope with a focus on dog and ex vivo studies. Overall, most abstracts presented at VOS contain a lower LoE.
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Affiliation(s)
- William S Kettleman
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States
| | - Matthew C Iuliani
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States
| | - Brenna G Webb
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States
| | - Joselys M Ceballos
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States
| | - Bryan T Torres
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States
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Ribitsch I, Baptista PM, Lange-Consiglio A, Melotti L, Patruno M, Jenner F, Schnabl-Feichter E, Dutton LC, Connolly DJ, van Steenbeek FG, Dudhia J, Penning LC. Large Animal Models in Regenerative Medicine and Tissue Engineering: To Do or Not to Do. Front Bioeng Biotechnol 2020; 8:972. [PMID: 32903631 PMCID: PMC7438731 DOI: 10.3389/fbioe.2020.00972] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Rapid developments in Regenerative Medicine and Tissue Engineering has witnessed an increasing drive toward clinical translation of breakthrough technologies. However, the progression of promising preclinical data to achieve successful clinical market authorisation remains a bottleneck. One hurdle for progress to the clinic is the transition from small animal research to advanced preclinical studies in large animals to test safety and efficacy of products. Notwithstanding this, to draw meaningful and reliable conclusions from animal experiments it is critical that the species and disease model of choice is relevant to answer the research question as well as the clinical problem. Selecting the most appropriate animal model requires in-depth knowledge of specific species and breeds to ascertain the adequacy of the model and outcome measures that closely mirror the clinical situation. Traditional reductionist approaches in animal experiments, which often do not sufficiently reflect the studied disease, are still the norm and can result in a disconnect in outcomes observed between animal studies and clinical trials. To address these concerns a reconsideration in approach will be required. This should include a stepwise approach using in vitro and ex vivo experiments as well as in silico modeling to minimize the need for in vivo studies for screening and early development studies, followed by large animal models which more closely resemble human disease. Naturally occurring, or spontaneous diseases in large animals remain a largely untapped resource, and given the similarities in pathophysiology to humans they not only allow for studying new treatment strategies but also disease etiology and prevention. Naturally occurring disease models, particularly for longer lived large animal species, allow for studying disorders at an age when the disease is most prevalent. As these diseases are usually also a concern in the chosen veterinary species they would be beneficiaries of newly developed therapies. Improved awareness of the progress in animal models is mutually beneficial for animals, researchers, human and veterinary patients. In this overview we describe advantages and disadvantages of various animal models including domesticated and companion animals used in regenerative medicine and tissue engineering to provide an informed choice of disease-relevant animal models.
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Affiliation(s)
- Iris Ribitsch
- Veterm, Department for Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Pedro M. Baptista
- Laboratory of Organ Bioengineering and Regenerative Medicine, Health Research Institute of Aragon (IIS Aragon), Zaragoza, Spain
| | - Anna Lange-Consiglio
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Luca Melotti
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - Florien Jenner
- Veterm, Department for Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Eva Schnabl-Feichter
- Clinical Unit of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Luke C. Dutton
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - David J. Connolly
- Clinical Unit of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Frank G. van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jayesh Dudhia
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Louis C. Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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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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Boge GS, Engdahl K, Bergström A, Emanuelson U, Hanson J, Höglund O, Moldal ER, Skjerve E, Krontveit R. Disease-related and overall survival in dogs with cranial cruciate ligament disease, a historical cohort study. Prev Vet Med 2020; 181:105057. [PMID: 32569882 DOI: 10.1016/j.prevetmed.2020.105057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyse the effect of treatment method and other risk factors on survival in dogs with cranial cruciate ligament disease (CCLD). METHODS A historical cohort study of 333 dogs presenting with CCLD at two University Hospitals (2011-2016) was performed. Signalment, history, treatment and follow-up details were retrieved from medical records, dog owners and referring veterinarians. Treatment groups were defined; conservative or surgical with either lateral fabellotibial suture (LFS) or osteotomy procedures. Multivariable Cox proportional hazards models were applied to evaluate risk factors for disease-related and overall survival. RESULTS Sixty-five dogs were conservatively managed, 125 treated with LFS and 143 with osteotomy techniques. At follow-up (autumn 2018), 164 dogs (49.3 %) were alive and 169 (50.7 %) were dead. Both final Cox proportional hazards models included variables for treatment, age, weight and hospital. In addition, the final disease-related model included a variable for orthopaedic comorbidity, while non-orthopaedic comorbidities and a time-varying effect for age on a linear scale were included in the overall survival model. Treatment method was found to have an effect on both disease-related and overall survival and surgical treatment was associated with a lower hazard than conservative treatment. CONCLUSION Survival in dogs with CCLD is influenced by treatment strategy, comorbidities, age and weight.
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Affiliation(s)
- Gudrun S Boge
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway.
| | - Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Annika Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Jeanette Hanson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Odd Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Elena R Moldal
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway.
| | - Eystein Skjerve
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway.
| | - Randi Krontveit
- Norwegian Medicines Agency, P.O. Box 240 Skøyen, N-0213, Oslo, Norway.
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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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Shimada M, Mizokami N, Ichinohe T, Kanno N, Suzuki S, Yogo T, Harada Y, Hara Y. Long-term outcome and progression of osteoarthritis in uncomplicated cases of cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy in dogs. J Vet Med Sci 2020; 82:908-916. [PMID: 32448811 PMCID: PMC7399324 DOI: 10.1292/jvms.19-0613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The object of this study is to evaluate the long-term outcome of hind limb weight-bearing function and progression of stifle osteoarthritis (OA) after tibial plateau leveling osteotomy (TPLO). Groups were classified by the degree of cranial cruciate ligament (CrCL) damage and presence or absence of medial meniscus damage as macroscopically evaluated during surgery. Weight-bearing function was assessed via the peak vertical force (PVF), and OA progression was assessed via the radiographic OA score (OAS) preoperatively and 1, 3, 6, 12, 18, 24, and 36 months postoperatively. In all stifles, PVF was significantly higher within 6 months postoperatively than preoperatively, and this high ratio was maintained for 36 months. The OAS was significantly higher 24 months postoperatively than preoperatively in stifles with a partial CrCL tear, and significantly increased at each timepoint after 3 months postoperatively in stifles with complete CrCL rupture. The OAS remained consistently lower in stifles with a partial CrCL tear and no treatment of the medial meniscus than in stifles with complete rupture. Thus, after TPLO, the weight-bearing function improved in the early postoperative period and was maintained for as long as 36 months. Although OA progressed over time after TPLO, the progression was more gradual in stifles with partial tears than in those with complete rupture. Canine patients would benefit from earlier surgical intervention through development of technology that enables early detection of ligament degeneration.
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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
| | - Nichika Mizokami
- 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
| | - Tom Ichinohe
- 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.,Veterinary Teaching Hospital, Azabu University, 1-17-71 Fuchinobe, Chuou-ku, Sagamihara-shi, Kanagawa 252-5201, 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
| | - Shuji Suzuki
- 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
| | - Takuya Yogo
- 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
| | - Yasuji Harada
- 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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Maurin MP, Mullins RA, Singh A, Mayhew PD. A systematic review of complications related to laparoscopic and laparoscopic-assisted procedures in dogs. Vet Surg 2020; 49 Suppl 1:O5-O14. [PMID: 32333685 DOI: 10.1111/vsu.13419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate and report the quality of the scientific literature reporting complications associated with laparoscopic and laparoscopic-assisted procedures in client-owned or healthy research dogs and to report and illustrate laparoscopic complications related to individual organ systems. STUDY DESIGN Systematic review. ANIMALS Client-owned or healthy research dogs. METHODS A literature review was performed by using PubMed and CAB abstracts for English-language studies providing descriptions of complications related to laparoscopic and laparoscopic-assisted procedures in dogs. Study selection used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment was performed by using a MINORS (Methodological Items for Non-Randomized Studies) scoring system and a grading scale of level of evidence. Descriptive statistics were used. RESULTS In total, 741 manuscripts were identified, with 64 manuscripts eligible for data extraction and quality assessment. The most represented organ system was the female genital tract, represented by 22 (34.4%) studies. The most commonly reported intraoperative and postoperative complications were related to abdominal entry and portal incisions, respectively. In 53 of 54 non-randomized studies, high risk of bias was found. Forty-eight (75%) studies provided level III or IV evidence. CONCLUSION This report provides an updated review of complications related to laparoscopic and laparoscopic-assisted procedures in dogs, classified by organ system. The overall quality of evidence was low, limiting direct comparison of complication rates between studies. CLINICAL SIGNIFICANCE There is a need for implementation of standardized criteria for defining complications, study time frames and greater numbers of high quality prospective randomized trials in veterinary laparoscopy to permit comparison of complication and conversion rates between published studies and across organ systems.
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Affiliation(s)
| | - Ronan A Mullins
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
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Sargeant JM, O'Connor AM. Scoping Reviews, Systematic Reviews, and Meta-Analysis: Applications in Veterinary Medicine. Front Vet Sci 2020; 7:11. [PMID: 32047759 PMCID: PMC6997489 DOI: 10.3389/fvets.2020.00011] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Evidence-based decision making is a hallmark of effective veterinary clinical practice. Scoping reviews, systematic reviews, and meta-analyses all are methods intended to provide transparent and replicable ways of summarizing a body of research to address an important clinical or public health issue. As these methods increasingly are being used by researchers and read by practitioners, it is important to understand the distinction between these techniques and to understand what research questions they can, and cannot, address. This review provides an overview of scoping reviews, systematic reviews, and meta-analysis, including a discussion of the method and uses. A sample dataset and coding to conduct a simple meta-analysis in the statistical program R also are provided. Scoping reviews are a descriptive approach, designed to chart the literature around a particular topic. The approach involves an extensive literature search, following by a structured mapping, or charting, of the literature. The results of scoping reviews can help to inform future research by identifying gaps in the existing literature and also can be used to identify areas where there may be a sufficient depth of literature to warrant a systematic review. Systematic reviews are intended to address a specific question by identifying and summarizing all of the available research that has addressed the review question. Questions types that can be addressed by a systematic review include prevalence/incidence questions, and questions related to etiology, intervention efficacy, and diagnostic test accuracy. The systematic review process follows structured steps with multiple reviewers working in parallel to reduce the potential for bias. An extensive literature search is undertaken and, for each relevant study identified by the search, a formal extraction of data, including the effect size, and assessment of the risk of bias is performed. The results from multiple studies can be combined using meta-analysis. Meta-analysis provides a summary effect size, and allows heterogeneity of effect among studies to be quantified and explored. These evidence synthesis approaches can provide scientific input to evidence-based clinical decision-making for veterinarians and regulatory bodies, and also can be useful for identifying gaps in the literature to enhance the efficiency of future research in a topic area.
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Affiliation(s)
- Jan M Sargeant
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University College of Veterinary Medicine, Ames, IA, United States
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Nanda A, Hans EC. Tibial Plateau Leveling Osteotomy for Cranial Cruciate Ligament Rupture in Canines: Patient Selection and Reported Outcomes. VETERINARY MEDICINE-RESEARCH AND REPORTS 2020; 10:249-255. [PMID: 31921614 PMCID: PMC6938195 DOI: 10.2147/vmrr.s204321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/18/2019] [Indexed: 12/28/2022]
Abstract
Cranial cruciate ligament (CCL) rupture is one of the most common causes of pelvic limb lameness in dogs. In a CCL deficient stifle, joint lameness develops from cranial tibial translation in relation to the distal femoral condyles. The tibial plateau leveling osteotomy (TPLO) is a well-described surgical procedure that neutralizes tibiofemoral shear force by altering the tibial plateau via a proximal tibial osteotomy, and subsequently restores normal limb function. Current literature for the TPLO was reviewed and used to describe the optimal patient selection and to report clinical outcome with the TPLO in comparison to other surgical options for CCL rupture. The clinical outcomes reported to date, particularly those utilizing objective outcome data, support the TPLO as being able to consistently return dogs to normal limb function with a low risk for long-term morbidity. The TPLO procedure was found to be widely applicable to dogs ranging from small breed to large and giant breed, and does not appear to have some of the limitations that exist with alternative surgical options. This review concludes that the TPLO is an excellent treatment option for any dog with CCL rupture due to the excellent long-term outcome and high rate of owner satisfaction previously reported. Despite these conclusions, it is important to remember that treatment selection for CCL rupture remains dependent on multiple considerations including patient factors, surgeon experience, and costs.
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Affiliation(s)
- Andy Nanda
- Department of Surgery, IronHorse VetCare, Dublin, CA, USA
| | - Eric C Hans
- Department of Surgery, MedVet Indianapolis, Indianapolis, IN, USA
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Tuan J, Solano MA, Danielski A. Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms. Vet Surg 2019; 48:1211-1217. [PMID: 31407819 DOI: 10.1111/vsu.13308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/11/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare surgical site infection (SSI) rates after double locking plate and screw fixation (DLP), standard locking plate and screw fixation (LP), and conventional nonlocking plate and screw fixation (NLP) in dogs weighing >50 kg undergoing tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Retrospective study (January 2003-October 2017). ANIMALS Two hundred seventy-five dogs weighing >50 kg with cranial cruciate ligament disease treated with TPLO. METHODS Medical records of dogs weighing >50 kg that underwent TPLO by DLP, LP, and NLP with a minimum follow-up period of 12 months were included. Data collected included signalment, details of any concurrent surgical procedure, type of implant used, use of postoperative antibiotic therapy, occurrence of perioperative complications, and presence of postoperative infection. The probability, risk difference, and relative risk of SSI were estimated for each fixation with a marginal model. RESULTS Nonlocking plate and screw fixation was used in 114 (41.5%) dogs, LP was used in 128 (46.5%) dogs, and DLP was used in 33 (12%) dogs. Surgical site infection was diagnosed in 48 of 275 (17.5%) dogs. Postoperative antibiotic therapy was used in 74 (64.9%) dogs, 62 (48.4%) dogs, and 32 (97.0%) dogs in the NLP, LP, and DLP groups, respectively. Dogs with NLP, LP, and DLP had postoperative infection rates of 24.5%, 13.3%, and 9.1%, respectively. There were no risk differences for the three groups (Holm-adjusted P > .05). CONCLUSION No difference in infection rates was detected between DLP, LP, or NLP for TPLO in these dogs weighing >50 kg. CLINICAL SIGNIFICANCE Fixation of TPLO with DLP in dogs weighing >50 kg does not seem to increase the risk of SSI compared with LP and NLP.
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Affiliation(s)
- Jayson Tuan
- Department of Orthopaedics and Neurology, Fitzpatrick Referrals, Eashing, Godalming, Surrey, United Kingdom
| | - Miguel A Solano
- Department of Orthopaedics and Neurology, Fitzpatrick Referrals, Eashing, Godalming, Surrey, United Kingdom
| | - Alan Danielski
- Department of Orthopaedic, Davies Veterinary Specialists, Higham Gobion, Hertfordshire, United Kingdom
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Eiermann J, Kirkby-Shaw K, Evans RB, Knell SC, Kowaleski MP, Schmierer PA, Bergh MS, Bleedorn J, Cuddy LC, Kieves NR, Lotsikas P, Pozzi A. Recommendations for rehabilitation after surgical treatment of cranial cruciate ligament disease in dogs: A 2017 survey of veterinary practitioners. Vet Surg 2019; 49:80-87. [PMID: 31390083 DOI: 10.1111/vsu.13294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/29/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report current recommendations made by veterinarians for rehabilitation after surgical treatment of cranial cruciate ligament (CrCL) disease. STUDY DESIGN Anonymized electronic survey. SAMPLE POPULATION Veterinarians performing CrCL stabilization. METHODS An electronic survey was created to collect information on general attitudes toward postoperative rehabilitation and recommendations regarding therapeutic modalities and bandaging. Quantitative data are reported by descriptive statistical analysis, percentage of responses, or mean (±SD). The recommendations for postoperative bandaging beyond 24 hours and for postoperative rehabilitation after extracapsular stabilization compared with after tibial osteotomy were tested by using Cochran-Mantel-Haenszel tests, with P < .05 considered statistically significant. RESULTS The data analysis included 376 responses (13% response rate). Most (71%) respondents consistently recommended postoperative rehabilitation. Rehabilitation was more than twofold more likely to be recommended after extracapsular stabilization than after osteotomies (P = .0142). Most respondents did not recommend bandaging beyond 24 hours postoperatively (P = .00012). CONCLUSION Most respondents recommended either formal or informal postoperative rehabilitation therapy. CLINICAL SIGNIFICANCE If the survey respondents are representative of veterinarians performing CrCL surgery, the current attitude is supportive of postsurgical rehabilitation. Most respondents would welcome evidence-based guidelines for rehabilitation protocols.
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Affiliation(s)
- Jennifer Eiermann
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Kristin Kirkby-Shaw
- Animal Surgical Clinic of Seattle, Seattle, Washington.,Sound Veterinary Rehabilitation Center, Seattle, Washington
| | | | - Sebastian C Knell
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Philipp A Schmierer
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Mary S Bergh
- Iowa State University College of Veterinary Medicine, Ames, Iowa
| | | | - Laura C Cuddy
- Veterinary Specialists, Summerhill, County Meath, Ireland
| | | | | | - Antonio Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Amimoto H, Koreeda T, Wada N. Evaluation of recovery of limb function by use of force plate gait analysis after tibial plateau leveling osteotomy for management of dogs with unilateral cranial cruciate ligament rupture. Am J Vet Res 2019; 80:461-468. [PMID: 31034268 DOI: 10.2460/ajvr.80.5.461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate recovery of limb function by use of gait force analysis after tibial plateau leveling osteotomy (TPLO) in dogs with unilateral cranial cruciate ligament (CrCL) rupture. ANIMALS 19 dogs with unilateral CrCL rupture treated with TPLO. PROCEDURES Force plate gait analysis was performed before and 1, 2, 4, and 7 months after TPLO. Ground reaction forces (GRFs; which comprised peak vertical force [PVF], vertical impulse [VI], peak braking force, braking impulse, peak propulsion force [PPF], and propulsion impulse), time to switching from braking to propulsion, and vector magnitude at PVF in the forelimbs and hind limbs were evaluated. RESULTS GRFs in the affected hind limb were significantly lower than in the contralateral hind limb before TPLO. These variables, except for PPF, were not significantly different 7 months after TPLO. Time to the switching point in the affected hind limb was significantly less from before to 2 months after TPLO. Vector magnitude at PVF had a similar pattern as PVF and VI during the recovery process. The PVF in the ipsilateral forelimb was significantly higher than in the contralateral forelimb before TPLO. CONCLUSIONS AND CLINICAL RELEVANCE A similar pattern was detected between PVF or VI and craniocaudal force during recovery of dogs that underwent TPLO. Rupture of he CrCl resulted in a decrease in GRFs in the affected hind limb as well as in the switching point and PVF of limbs. However, weight distribution for the craniocaudal force was normalized before PVF or VI. Vector magnitude at PVF might be effectively evaluated by combining vertical force and craniocaudal force.
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Zhalniarovich Y, Sobolewski A, Waluś G, Adamiak Z. Tibial Diaphyseal Fracture as a Major Complication of Tibial Tuberosity Advancement With Cranial Fixation (TTA CF)-A Case Report. Top Companion Anim Med 2019; 34:14-17. [PMID: 30808491 DOI: 10.1053/j.tcam.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/07/2018] [Accepted: 12/04/2018] [Indexed: 11/11/2022]
Abstract
This article reports a major complication of tibial tuberosity advancement with cranial fixation for the treatment of cranial cruciate ligament rupture in a Boxer. Twelve days postoperatively the dog underwent revision surgery for fracture of the tibia and tibial tuberosity. The tibial tuberosity fracture was secured to the tibial diaphysis using the 2 K-wires and a medial 3.5 dynamic compression plate was used to stabilize the tibial diaphysis fracture. The fracture was reduced and the plate applied using minimally invasive plate osteosynthesis to preserve the blood supply to the bone. Two weeks after revision surgery, the dog was using the operated limb without apparent lameness at a walk and trot. No complications were observed after revision surgery. Tibial tuberosity fracture and tibial diaphysis fracture as complications after tibial tuberosity advancement with cranial fixation healed with satisfactory clinical outcomes but revision surgery was required.
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Affiliation(s)
- Yauheni Zhalniarovich
- University of Warmia and Mazury in Olsztyn, Faculty of Veterinary Medicine, Department of Surgery and Radiology with Clinics, Olsztyn, Poland.
| | | | | | - Zbigniew Adamiak
- University of Warmia and Mazury in Olsztyn, Faculty of Veterinary Medicine, Department of Surgery and Radiology with Clinics, Olsztyn, Poland
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Baltzer WI, Smith-Ostrin S, Warnock JJ, Ruaux CG. Evaluation of the clinical effects of diet and physical rehabilitation in dogs following tibial plateau leveling osteotomy. J Am Vet Med Assoc 2019; 252:686-700. [PMID: 29504849 DOI: 10.2460/javma.252.6.686] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess clinical effects of an omega-3 fatty acid and protein-enriched diet, physical rehabilitation, or both in dogs following tibial plateau leveling osteotomy (TPLO) and arthroscopic surgery for cranial cruciate ligament (CCL) disease. DESIGN Randomized, prospective clinical trial. ANIMALS 48 dogs with unilateral CCL disease. PROCEDURES Dogs were randomly assigned to receive a dry omega-3 fatty acid and protein-enriched dog food formulated to support joint health (test food [TF]), a dry food formulated for maintenance of adult dogs (control food [CF]), TF plus rehabilitation (TF-R), or CF plus rehabilitation (CF-R). Data collected over 6 months included body weight, body condition score, ground reaction force data, tibial plateau angle, limb circumference measurements, subjective pain and lameness scores assigned by surgeons and dog owners, and daily activity measured by accelerometry. RESULTS Peak vertical force and vertical impulse were greater after surgery for dogs in the TF groups than in the CF groups; peak vertical force was greater after surgery in dogs that underwent rehabilitation than in those that did not. Owner scores indicated lower frequencies of lameness and signs of pain during some activities for the TF group, compared with other groups, and for the TF-R and CF-R groups, compared with the CF group. Sedentary time decreased and time spent in light-to-moderate or vigorous activity increased in all groups over time. Rehabilitation was significantly associated with greater time spent in light-to-moderate activity, regardless of diet. CONCLUSIONS AND CLINICAL RELEVANCE Feeding the TF and providing physical rehabilitation during the first 6 months after TPLO were associated with improvements in some indices of clinical outcome and function in dogs. Significant interactions between time and some outcome variables were observed, indicating further research is warranted.
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