Modified Triple Tibial Osteotomy for Combined Cranial Cruciate Ligament Rupture, Tibial Deformities, or Patellar Luxation

2019 ◽  
Vol 55 (6) ◽  
pp. 291-300
Author(s):  
Véronique Livet ◽  
Mathieu Taroni ◽  
François-Xavier Ferrand ◽  
Claude Carozzo ◽  
Eric Viguier ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Radiographic Evaluation ◽  
Tibial Osteotomy ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
The Mean ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Rupture

ABSTRACT Proximal tibial deformities or patellar luxation may occur concurrently with cranial cruciate ligament rupture. The objective of this study was to describe the management of those conditions with a modified triple tibial osteotomy (TTO) in nine dogs. Medical records of dogs who underwent a modified TTO were reviewed. The mean pre- and postoperative patellar tendon angles were 104.2° and 92.9°, respectively. The mean pre- and postoperative mechanical medial proximal tibial angles were 99.5° and 91.5°, respectively. Medial patellar luxation was present in five dogs (55.6%) and treated in all five dogs with a tibial crest transposition. Tibial torsion was grossly resolved in two dogs (22.2%). Perioperative distal tibial crest fracture was treated by pins and a figure-of-eight tension-band wire in five dogs (55.6%). One major (surgical site infection) and three minor postoperative complications were observed. At the last follow-up, seven dogs (77.8%) had no lameness, one dog (11.1%) had mild lameness, and one dog (11.1%) had moderate lameness. Radiographic evaluation showed good (2/9; 22.2%) to excellent (7/9; 77.8%) bone healing. The visual analog scale evaluation revealed good-to-excellent owner satisfaction. Cranial cruciate ligament rupture, tibial deformities, and medial patellar luxation are difficult to treat together. A modified TTO may be used to treat these conditions.

scholarly journals Risk factors and long-term surgical outcome of patellar luxation and concomitant cranial cruciate ligament rupture in small breed dogs

2020 ◽  
Vol 65 (No. 4) ◽  
pp. 159-167
Author(s):  
M Candela Andrade ◽  
P Slunsky ◽  
LG Klass ◽  
L Brunnberg
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Cruciate Ligament ◽  
Surgical Equipment ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
The Mean ◽  
Cranial Cruciate Ligament Rupture ◽  
Small Breed

Concomitant cranial cruciate ligament rupture (CCLR) is a common complication in small breed dogs with patellar luxation (PL) with an elusive pathogenesis. Surgical treatment is available and commonly includes remodelling osteotomies. While these modern techniques have shown good functional results, access is limited due to the high costs for owners and the need for special surgical equipment. The objectives of the study were to evaluate the frequency and risk factors for concomitant CCLR in small breed dogs with PL. To study the outcome and complications of the combination of the Wedge recession osteotomy (WR) and Tibial tuberosity transposition (TT) with a Fascia over-the-top (OT) or a Capsular and fascial imbrication technique (CFI) for the simultaneous treatment of PL and concomitant CCLR. A retrospective study is presented here. The signalment, body weight, luxation grade and direction, affected side, bilateral or unilateral PL, CCLR and meniscal status were analysed. The surgical treatment for PL and concomitant CCLR, outcome and complications were investigated. Of 233 small breed dogs with PL, 52 (22.31%) had a concomitant CCLR. Maltese dogs were more likely to have concomitant CCLR. The mean age for the dogs with PL only was 5.32 years, which was significantly younger than the mean age of dogs with PL and concomitant CCLR (7.39 years). Overweight dogs with PL were prone to develop concomitant CCLR. Surgical stabilisation with a combination of WR, TT and OT or CFI had excellent or good results in 86.63% of the cases, while 16.67% of the cases developed complications. In conclusion, PL and concomitant CCL ruptures can be managed successfully by performing a combination of WR, TT and OT or CFI. The outcomes and complication rates are comparable to remodelling osteotomies. Moreover, these techniques are less expensive and can be performed with standard surgical equipment. These findings should be beneficial for clinical diagnosis, client education and treatment.

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

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.

Effect of doxycycline on contra lateral canine cranial cruciate ligament rupture

2015 ◽  
Vol 28 (06) ◽  
pp. 371-378
Author(s):  
J. Sung ◽  
J. Barry ◽  
K. Hayashi ◽  
M. R. Edwards ◽  
D. J. F. von Pfeil
Keyword(s):  
Cruciate Ligament ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Group D ◽  
Labrador Retrievers ◽  
Cranial Cruciate Ligament Rupture

SummaryObjective: To evaluate whether doxycycline administered to dogs with unilateral cranial cruciate ligament rupture (Uni-CCLR) would decrease the risk of contralateral-CCLR (CoCCLR). To evaluate predictors for Co-CCLR survival. To evaluate if a predisposition of Labrador Retrievers to Co-CCLR exists when compared to other breeds.Methods: In this prospective randomized controlled clinical trial, 69 client-owned dogs with Uni-CCLR were randomly assigned to a doxycycline (group-D: 7.5 mg/kg PO BID x 6 weeks) or non-doxycycline (group-ND: negative control). Medical and imaging data, time from Uni- to Co-CCLR and to follow-up were recorded. Statistics included chi-squared test, logistic regression, Kaplan-Meier survival analysis, log rank test, survival curves, and frailty model (p <0.05).Results: This study included 32 dogs in group-D, and 37 dogs in group-ND. Median follow-up was 54.5 and 61 months, respectively. Contralateral CCLR occurred in 53.1% and 48.6% at medians of 20 and 11 months, respectively. Doxycycline did not significantly decrease the risk of Co-CCLR (p = 0.83). This risk was decreased by 14.2% with each year of age but increased with each increasing kilogram of body weight and each increasing degree of tibial plateau angle by 5.4% and 9.7%, respectively. Labrador Retrievers were not significantly predisposed (p = 0.37).Clinical significance: At the dose regimen investigated doxycycline does not decrease the risk for Co-CCLR.

scholarly journals Tibial tuberosity transposition advancement for treatment of concomitant cranial cruciate ligament rupture and medial patellar luxation in four feline stifles

2021 ◽  
Vol 7 (2) ◽  
pp. 205511692110446
Author(s):  
Edyta Bula ◽  
Karen L Perry
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Tibial Tuberosity ◽  
Osteotomy Site ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Medial Meniscectomy ◽  
Cranial Cruciate Ligament Rupture

Case series summary Three cats (four stifles) were diagnosed with varying grades of medial patellar luxation and stifle instability in cranial tibial thrust. Radiographs showed periarticular osteophytosis, intra-articular mineralization and opacification encroachment of the infrapatellar fat pad. Stifle exploration revealed either partial (n = 2) or complete (n = 2) cranial cruciate ligament tear and medial meniscal injury in all cases. Medial meniscectomy, partial parasagittal patellectomy, femoral trochleoplasty and tibial tuberosity transposition advancement using a 6 mm cage, two-fork plate and 4 mm spacer were performed in four stifles. Screws (2.0 mm) and washers were used in the cranial cage ears rather than conventional 2.4 mm screws. By the 2-week recheck, lameness was minimal and stifles were stable. Radiographic follow-up at 8 weeks showed appropriate progression of osseous union in all cases. One cat experienced a major complication, suffering tibial fracture following a lapse in exercise restriction, and revision surgery was performed successfully with subsequent osseus union of the osteotomy site. At the mid-term follow-up, all cats had a return to previous level of function, as assessed by both owner questionnaire and clinical evaluation. Relevance and novel information Tibial tuberosity transposition and advancement has been shown to be successful in dogs for the treatment of concomitant medial patellar luxation and cranial cruciate ligament rupture. To date, there have been no reports of tibial tuberosity transposition and advancement in cats. A benefit of this approach is concomitant alignment of the extensor mechanism and neutralization of the femorotibial shear force. Our case series describes successful use of tibial tuberosity transposition advancement in cats.

Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture

2020 ◽  
Vol 33 (06) ◽  
pp. 409-416
Author(s):  
Thomas Cox ◽  
Thomas W. Maddox ◽  
Robert Pettitt ◽  
Brandan Wustefeld-Janssens ◽  
John Innes ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Cruciate Ligament ◽  
Site Infection ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Ordinal Logistic Regression Analysis ◽  
Cranial Cruciate Ligament Rupture

Abstract Objective This study investigated variables associated with surgical site infection (SSI) in dogs with cranial cruciate ligament rupture managed with stifle joint examination and lateral fabellotibial suture stabilization. Study Design A retrospective study of dogs that had stifle arthroscopy, stifle arthrotomy, or a combination of both, followed by lateral fabellotibial suture stabilization for cranial cruciate ligament rupture. All cases had a minimum follow-up of 90 days. Lameness grades were recorded preoperatively, and at 6-week and final follow-up. Results One hundred fifty procedures in 130 dogs met the inclusion criteria. Overall, SSI rate was 17.3% and removal of the lateral fabellotibial suture was performed in 53% of SSI. Multivariable analysis showed significant association between SSI and bodyweight (p = 0.013), and induction using propofol (p = 0.029). Multilevel ordinal logistic regression analysis showed a greater proportion of dogs had a higher lameness grade at 6-week (p = 0.021) and final follow-up (p = 0.002) assessments in the infected compared with non-infected dogs. Conclusion Our study demonstrated a higher SSI incidence than previously reported in dogs undergoing a lateral fabellotibial suture for cranial cruciate ligament rupture. Bodyweight and induction with propofol were identified as significant risk factors for postoperative SSI. Owners could be advised of an increased SSI risk in larger dogs and consideration should be given to selection of induction agent. Dogs that develop an SSI have a worse lameness grade at 6-week and final follow-up.

Prospective Evaluation of a Citrate-Based Biomaterial Wedge for a Modified Maquet Procedure in the Treatment of Cranial Cruciate Ligament Rupture in Dogs

2020 ◽  
Author(s):  
Alex Terreros ◽  
R. Mark Daye
Keyword(s):  
Cruciate Ligament ◽  
Intraoperative Complications ◽  
Prospective Clinical Study ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Rupture

Abstract Objective The aim of this study was to describe short- and mid-term outcomes, complications, implant bioabsorption and owner satisfaction for a modified Maquet procedure (MMP) in which a novel bioabsorbable citrate-based implant is used as the wedge component to treat cranial cruciate ligament rupture in client-owned dogs. Study Design Prospective clinical study of dogs (n = 13) undergoing MMP (n = 15). Intraoperative complications, postoperative complications, clinical follow-up using a 5-point lameness score and radiographs at 8 weeks and 6 months postoperatively were obtained. Mid-term outcome was assessed via physical examination, radiographs, canine orthopaedic index and owner satisfaction questionnaires. Results No catastrophic complications occurred. Major complications occurred in 3/15 stifles. All were surgical site infections and one case required implant removal. Minor complications occurred in 9/15 stifles. Non-displaced cortical hinge fractures were the most common minor complication, and these occurred intraoperatively (4/15) or postoperatively (2/15). Three dogs achieved full function, eight dogs acceptable function and the outcome was unacceptable in two dogs. Most owners were satisfied with the procedure (11/13). Complete implant bioabsorption was not confirmed on mid-term radiographs. Conclusion The described MMP with a citrate-based implant can produce satisfactory mid-term results. However, the long-term outcome of this procedure must be evaluated and technical modifications need to be implemented prior to larger-scale use of this implant.

scholarly journals Therapeutic ultrasound as an aid in tibial fracture management in a dog

2017 ◽  
Vol 86 (1) ◽  
pp. 29-34
Author(s):  
J. Heremans ◽  
E. De Bakker ◽  
B. Van Ryssen ◽  
Y. Samoy
Keyword(s):  
Hind Limb ◽  
Tibial Fracture ◽  
Proximal Tibia ◽  
Cruciate Ligament ◽  
Radiographic Evaluation ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Fracture Management ◽  
Cranial Cruciate Ligament Rupture

A six-year-old, male, neutered Bernese mountain dog was presented with acute left hind limb lameness. Based on the symptoms, orthopedic examination and radiographic evaluation, a cranial cruciate ligament rupture was diagnosed. Surgical treatment with TTA Rapid was performed with good result. At two weeks postoperatively, the dog developed a fracture of the proximal tibia, due to excessive activity. Conservative treatment consisting of a splint and rest was advised. Physiotherapeutic ultrasonography and exercises were started to stimulate bone healing. After eight sessions, the dog was clinically much better, and radiographs showed a good evolution with a clear callus. Follow-up controls confirmed the progressive evolution.

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