Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study

Objective The aim of this study was to compare complications between dogs with bilateral cranial cruciate ligament disease treated with single-session bilateral tibial plateau levelling osteotomies (BSSTPLO) versus staged bilateral TPLO (STPLO) procedures stabilized with locking plates. Study Design Medical records of client-owned dogs treated with BSSTPLO or STPLO stabilized with locking plates between March 2017 and July 2018 at two associated institutions were reviewed. Patient data and complications from 37 dogs with BSSTPLO and 18 with STPLO were compared between groups. Major complications were defined as any complication that required further surgical or medical treatment whereas minor complications did not. Results Incidence for major complications for BSSTPLO and STPLO was 7/37 and 6/18 respectively. Incidence for minor complications for BSSTPLO and STPLO was 3/37 and 2/18 respectively. No significant differences in minor or major complication rates existed between study groups (p = 0.2). Mean body weight was significantly higher in the STPLO group (p = 0.001); however, no correlation between weight or BCS and complication rate existed within either group. Increasing age was the only significant risk factor for major complications (p = 0.01) in either group. Conclusion Our findings support the claim that BSSTPLO and STPLO performed with locking implants have similar complication rates. The decision to perform BSSTPLO or STPLO in dogs with bilateral cranial cruciate ligament disease should be based on other considerations rather than just complication rates.

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Comparison of Complication Rates and Clinical Outcome Between Tibial Plateau Leveling Osteotomy and a Modified Cranial Closing Wedge Osteotomy for Treatment of Cranial Cruciate Ligament Disease in Dogs

Veterinary Surgery ◽

10.1111/j.1532-950x.2013.12033.x ◽

2013 ◽

Vol 42 (6) ◽

pp. 739-750 ◽

Cited By ~ 23

Author(s):

Bill Oxley ◽

Toby J. Gemmill ◽

Alasdair R. Renwick ◽

Dylan N. Clements ◽

W. Malcolm McKee

Keyword(s):

Clinical Outcome ◽

Tibial Plateau ◽

Cruciate Ligament ◽

Wedge Osteotomy ◽

Complication Rates ◽

Cranial Cruciate Ligament ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Cranial Cruciate Ligament Disease

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A Retrospective Study Using the String of Pearls Tibial Plateau Levelling Osteotomy Locking Plate for the Treatment of Cranial Cruciate Ligament Disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0039-1692189 ◽

2019 ◽

Vol 32 (06) ◽

pp. 483-491

Author(s):

Ross E. McGregor ◽

Eugene A. Buffa ◽

Christopher J. Tan ◽

Mark A. Schembri ◽

Caro-Anne Badcock ◽

...

Keyword(s):

Tibial Plateau ◽

Locking Plate ◽

Cruciate Ligament ◽

Radiographic Measurement ◽

Complication Rates ◽

Cranial Cruciate Ligament ◽

Fibular Fracture ◽

String Of Pearls ◽

Cranial Cruciate Ligament Disease

Objective The aim of this study was to describe the use of String of Pearls (SOP) tibial plateau levelling osteotomy (TPLO) locking plates for the treatment of cranial cruciate ligament disease and retrospectively assess osteotomy healing, tibial plateau angle (TPA) change (c) and overall complication rates. Methods Medical records and radiographic studies of 170 SOP TPLO surgical procedures were analysed. Radiographic measurement of TPAc and osteotomy union was determined 6 to 8 weeks postoperatively. Intra- and postoperative major and minor complications were identified. Factors influencing TPAc, osteotomy union and complications were assessed. Results Mean (standard deviation) TPAc was 1.3° (1.61) and median osteotomy union was graded as 2 (26–50%) union. Improved osteotomy union was associated with retention of the antirotational pin (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.3–4; p = 0.005) and reduced TPAc (OR: 0.8; 95%CI: 0.66–0.97; p = 0.02). Complications occurred in 42 (24.7%) procedures with 11 (6.5%) considered major and 31 (18.2%) minor. Clinical significance The use of the SOP TPLO plating system resulted in a median grade 2 (26–50%) radiographic osteotomy union score at 6 to 8 weeks' follow-up, less than previous TPLO locking plate studies. Osteotomy union was associated with retention of the antirotational pin and reduced TPAc. Major and minor complication rates were marginally greater than recent locking plate studies with fibular fracture and screw loosening common complications. The use of SOP TPLO plates is cautioned and further study is warranted.

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Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-07-0106 ◽

2017 ◽

Vol 30 (04) ◽

pp. 299-305 ◽

Cited By ~ 15

Author(s):

Matthew Barnhart ◽

Shawn Kennedy ◽

Steven Naber ◽

Eric Hans

Keyword(s):

Antibiotic Therapy ◽

Tibial Plateau ◽

Cruciate Ligament ◽

Major Complication ◽

Surgical Revision ◽

Tibial Tuberosity ◽

Cranial Cruciate Ligament ◽

Major Complications ◽

One Year ◽

Cranial Cruciate Ligament Disease

SummaryObjectives: To analyse and compare major complications in dogs ≥50 kg undergoing tibial tuberosity advancement (TTA) or tibial plateau levelling osteotomy (TPLO) for treatment of cranial cruciate ligament disease.Methods: Medical records and radiographs of client-owned dogs (≥50 kg) treated for cranial cruciate ligament disease with either TTA or TPLO between January 2011 and November 2015 were reviewed. Ninety-one TTA cases and 54 TPLO cases met the study inclusion criteria. All complications within one year of surgery were recorded. Major complications were those requiring surgical revision or intervening medical therapy to resolve. Logistic regression analysis evaluated for associations with major complication occurrence. Major complications were statistically compared between TTA and TPLO treatment groups.Results: Incidence of major complications following TTA and TPLO surgery were 19.8% and 27.8%, respectively. Surgical site infection (SSI) was the single most common major complication following both TTA (15.4%) and TPLO (25.9%) surgery. There were no significant differences between TTA and TPLO treatment regarding the rate of SSI, surgical revision, or overall occurrence of major complications. Postoperative antibiotic therapy significantly reduced the risk of a major complication in all dogs ≥50 kg (p = 0.015; OR: 0.201: 95%CI: 0.055–0.737).Clinical significance: Major complications occurred frequently following TTA and TPLO treatment of cranial cruciate ligament disease in dogs ≥50 kg. The increased chance for SSI should be considered and postoperative antibiotic therapy is recommended.

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Conformation of the proximal tibia and cranial cruciate ligament disease in small breed dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-07-0115 ◽

2017 ◽

Vol 30 (03) ◽

pp. 178-183 ◽

Cited By ~ 2

Author(s):

Michal Kyllar ◽

Duncan Midgley ◽

Martin Owen ◽

Jan Janovec

Keyword(s):

Body Weight ◽

Clinical Significance ◽

Tibial Plateau ◽

Proximal Tibia ◽

Cruciate Ligament ◽

Tibial Tuberosity ◽

Cranial Cruciate Ligament ◽

Relative Body Weight ◽

Cranial Cruciate Ligament Disease ◽

Small Breed

SummaryObjectives: To investigate the conformation of the proximal tibia in small breed dogs with and without cranial cruciate ligament disease (CCLD) and to identify morphologic abnormalities that may predispose to development of CCLD.Methods: Mediolateral radiographs of the entire tibia of dogs <15 kg with surgically confirmed CCLD were retrospectively evaluated. Proximal tibial width (PTW), tibial plateau length (TPL), tibial plateau angle as described by Slocum and Slocum (sTPA), proximal tibial tuberosity angle (PTTA), tibial plateau angle as described by Inauen and colleagues (nTPA), and diaphyseal tibial width (DTW) were measured. The same variables were obtained from mediolateral radiographs of the entire tibia of dogs <15 kg without CCLD. In addition, a quotient nTPA/ PTW, relative tibial tuberosity width (rTTW), and relative body weight (rBW) were calculated for each dog. Independent two-sample t-test (p = 0.05) was used to compare mean ± SD of all measured variables between the two groups.Results: Gender, age, and weight mean ± SD were not significantly different between the two groups of dogs (p <0.05). Dogs with CCLD had significantly greater sTPA (p = 0.015) and rBW (p = 0.016).Clinical significance: In dogs of small breeds, a combination of an excessively steep tibial plateau and an increased relative body weight may predispose to early CCLD development. The slope of the tibial plateau was found to be caused by an abnormal caudal angulation of the proximal tibia, a phenomenon previously associated with CCLD development in small breed dogs in individual cases.

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Extracapsular articulating implant to treat cranial cruciate ligament disease in a dog with multiple myeloma

Veterinary Record Case Reports ◽

10.1136/vetreccr-2018-000767 ◽

2019 ◽

Vol 7 (2) ◽

pp. e000767

Author(s):

Eloise Elisabeth Lhuillery ◽

Philip Georg Witte

Keyword(s):

Multiple Myeloma ◽

Medical Treatment ◽

Range Of Motion ◽

Tibial Plateau ◽

Cruciate Ligament ◽

Cranial Cruciate Ligament ◽

Mild Reduction ◽

Cranial Cruciate Ligament Disease ◽

Hindlimb Lameness ◽

Malignant Neoplasia

An 11-year-old Border collie was presented for left hindlimb lameness associated with cranial cruciate ligament disease. The history included right tibial plateau levelling osteotomy performed approximately two years previously, with a subjectively good outcome. Multiple myeloma had been diagnosed approximately two months before presentation of the left hindlimb lameness. Medical treatment of multiple myeloma included glucocorticoids (prednisolone) and melphalan. Stabilisation of the left stifle was performed with the Simitri Stable in Stride extracapsular articulating implant. The dog demonstrated weightbearing on the operated limb within 24 hours following surgery. Re-examination six weeks following surgery revealed mild left hindlimb lameness, no resentment to manipulation of the left stifle, no cranial tibial thrust and a mild reduction in the range of motion. Hindlimb function was affected by various neurological events considered secondary to the malignant neoplasia; however, left stifle function was good until euthanasia 11 months following surgery.

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A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1160/vcot-07-02-0013 ◽

2007 ◽

Vol 20 (04) ◽

pp. 312-319 ◽

Cited By ~ 38

Author(s):

C. Brown ◽

S. A. Corr

Keyword(s):

Tibial Plateau ◽

Cruciate Ligament ◽

Small Sample ◽

Wedge Osteotomy ◽

Complication Rates ◽

Cranial Cruciate Ligament ◽

Ligament Rupture ◽

Cruciate Ligament Rupture ◽

Significant Difference ◽

Cranial Cruciate Ligament Rupture

SummaryThe objective of this study was to determine whether clinical outcomes were superior and complication rates were lower in dogs that had had a cranial cruciate ligament rupture treated by tibial plateau levelling osteotomy (TPLO), compared to those dogs that had been treated using the original cranial tibial wedge osteotomy (CTWO) procedure. Thirty-seven client-owned dogs with cranial cruciate ligament rupture were included in the study: 19 dogs underwent a TPLO procedure, and 18 dogs underwent a CTWO procedure. The study was retrospective, with the data being obtained from medical records and a review of radiographs. The long-term outcome was assessed by means of an owner questionnaire using a visual analogue scale. For the majority of factors that were reviewed, there was not a significant difference in outcome between the dogs that had a TPLO or those that had undergone a CTWO. All of the dogs showed a rapid return to weight bearing after surgery, and at the six week re-examination, the majority of the dogs did not have any pain on stifle palpation. They displayed a good stifle range of motion and significantly lower lameness scores than those prior to surgery. The complication rates did not differ between the procedures, however, within this small sample of dogs, complications following a CTWO were more likely to require revision surgery.

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Complications of tibial plateau levelling osteotomy in dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-09-0122 ◽

2012 ◽

Vol 25 (05) ◽

pp. 349-358 ◽

Cited By ~ 34

Author(s):

B. Peirone ◽

M. S. Bergh

Keyword(s):

Risk Factors ◽

Surgical Procedures ◽

Tibial Plateau ◽

Postoperative Morbidity ◽

Cruciate Ligament ◽

Cranial Cruciate Ligament ◽

Technical Errors ◽

Surgeon Experience ◽

Incidence Risk ◽

Cranial Cruciate Ligament Disease

SummaryThe tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intraoperative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.

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In canine cranial cruciate ligament rupture is outcome following TPLO improved compared with lateral suture?

Veterinary Evidence ◽

10.18849/ve.v4i3.213 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Catrina Pennington ◽

Mark Morton ◽

Ben Walton

Keyword(s):

Tibial Plateau ◽

Cruciate Ligament ◽

Complication Rates ◽

Bottom Line ◽

Cranial Cruciate Ligament ◽

Ligament Rupture ◽

Cruciate Ligament Rupture ◽

Owner Satisfaction ◽

Cranial Cruciate Ligament Rupture ◽

Improved Outcome

PICO question In dogs over 15 kg, with cranial cruciate ligament rupture is there evidence of improved outcome following tibial plateau levelling osteotomy or lateral fabellotibial suture? Clinical bottom line Although the evidence is not conclusive, the literature reviewed here suggests that tibial plateau levelling osteotomy (TPLO) results in superior limb function and owner satisfaction compared to placement of a lateral fabellotibial suture (LFS). There is currently insufficient evidence to determine if there is a difference in complication rates or osteoarthritis (OA) development following TPLO or LFS.

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