Vet Surg. 2013 Jan;42(1):38-50. doi: 10.1111/j.1532-950X.2012.01052.x. Epub 2012 Nov 15.
Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs.
Nelson SA, Krotscheck U, Rawlinson J, Todhunter RJ, Zhang Z, Mohammed H.
Source
Departments of Clinical Sciences and Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY.
Abstract
OBJECTIVE:
To compare the long-term outcome of tibial plateau leveling osteotomy (TPLO) and extracapsular repair (ECR) for treatment of a ruptured cranial cruciate ligament (RCCL).
STUDY DESIGN:
Prospective clinical trial.
ANIMALS:
Normal adult dogs (control, n = 79); dogs with unilateral CCL disease (n = 38).
METHODS:
Dogs had TPLO (n = 15) or ECR (n = 23) for treatment of RCCL. Force plate gait analysis was performed for the control group at one time point and for treatment groups at serial points: preoperatively, 2 weeks, 8 weeks, 6 and 12 months postoperatively. Symmetry indices (SIs) were calculated between operated and unoperated pelvic limb for ground reaction forces (GRFs), including peak vertical force (PVF), contact time (CT), and vertical impulse (VI). GRFs of the treatment groups and control group were compared using a general linear model and Kaplan-Meier survival analysis.
RESULTS:
At 8 weeks, for PVF and VI, the TPLO group had more symmetric limb loading than the ECR group at the walk and trot. SIs of the TPLO group were not different from the control group by 6 months to 1 year postoperatively. SIs for the ECR group were less symmetrical than the control group at all time periods. Using survival analysis, median time to normal function was no different at the walk between groups, but was shorter for the TPLO group for VI and PVF.
CONCLUSIONS:
Dogs achieved normal limb loading faster after TPLO than ECR. TPLO resulted in operated limb function that was indistinguishable from the control population by 1 year postoperatively.
© Copyright 2012 by The American College of Veterinary Surgeons.
PMID:
23153073
[PubMed - indexed for MEDLINE]
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2011;39(5):323-35.
[Lameness and osteoarthritis development following Tibial Plateau Leveling Osteotomy (TPLO) and potential prognostic predictors. A long-term retrospective study].
[Article in German]
Imholt KM, Möller S, Fehr M, Meyer-Lindenberg A.
Source
Klinik fur Kleintiere der Stiftung Tierarztliche Hochschule, Hannover.
Abstract
OBJECTIVE:
Evaluation of lameness and osteoarthritis (OA) progression following Tibial Plateau Leveling Osteotomy (TPLO) in dogs with naturally-occurring rupture of the cranial cruciate ligament (CCL) and investigation of factors with potential influence on long-term outcome.
MATERIAL AND METHODS:
In a retrospective clinical study medical records of 119 client-owned dogs (135 operated stifle joints) and corresponding client-questionnaires were reviewed, collecting data on radiologic and surgery results, course of surgery and complications. In a check-up, orthopaedic examination and stifle radiographs were performed to assess status quo of OA, lameness, and progression of OA.
RESULTS:
58 dogs (66 stifle joints) could be examined clinically and radiologically, whereas 61 dogs (69 stifle joints) were re-checked by client-questionnaire only. Up to 6.8 years after TPLO surgery, in 90.4% of all cases lameness results were judged "excellent" (n=84) or "good" (n=38). In the long term, there was a moderate but significant progression of OA following TPLO surgery. Patients with totally ruptured CCL were significantly more likely to have meniscal injury than dogs with partially ruptured CCL. Dogs with partial meniscectomy had a significantly higher rate of "excellent" long-term clinical results and less frequently showed progression of OA compared to those having the meniscus released or left untouched. The overall complication rate was 22.2% (n=30), with the type of complication having no influence on the long-term clinical outcome.
CONCLUSIONS AND CLINICAL RELEVANCE:
Regarding lameness, the long-term outcome following TPLO is very satisfying. Early surgical treatment of CCL rupture using TPLO can help to decrease the likelihood of OA progression. Partial medial meniscectomy may help to avoid repeated surgery due to subsequent meniscal injury without having a negative impact on long-term functional outcome or the progression of OA in the affected joint. Neither long-term clinical results, especially regarding lameness, nor OA were impaired by previous surgery prior to TPLO or the occurrence of complications associated with TPLO surgery.
PMID:
22134659
[PubMed - indexed for MEDLINE]
Vet Surg. 2010 Apr;39(3):350-4. doi: 10.1111/j.1532-950X.2010.00676.x.
Second look arthroscopic findings after tibial plateau leveling osteotomy.
Hulse D, Beale B, Kerwin S.
Source
Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843-4474, USA.
dhulse@cvm.tamu.edu
Abstract
OBJECTIVE:
To describe the long-term (range, 2-69 months) arthroscopic appearance of intraarticular structures of the stifle after tibial plateau leveling osteotomy (TPLO).
STUDY DESIGN:
Case series.
ANIMALS:
Dogs (n=63) that had repeat arthroscopic examination of the stifle after TPLO for treatment of a cranial cruciate ligament (CCL) deficient stifle.
METHODS:
Medical records (2002-2008) of dogs that had repeat arthroscopic examination to evaluate intraarticular structures after previous TPLO for treatment of CCL injury. Regions of interest were the CCL, caudal cruciate ligament, articular cartilage, and menisci. Signalment, weight, and time to 2nd look arthroscopy were recorded. Radiographs were reviewed to measure pre- and postoperative tibial plateau angle, and craniocaudal limb alignment.
RESULTS:
There were 17 partial CCL tears with early fiber tearing and 46 stifles with a complete CCL tear or incompetent partial CCL tear. Stifles with an early partial tear had normal to near normal appearance of intraarticular structures. Most dogs with a complete or incompetent partial CCL tear had axial or abaxial grades 3 or 4 articular cartilage abrasion of the medial or lateral femoral condyle.
CONCLUSION:
Intraarticular structures appeared normal or near normal in dogs with early fiber tearing (caudolateral or craniomedial fibers). Most dogs that had a partial tear with an incompetent remaining CCL or a completely ruptured CCL had grades 3 or 4 articular cartilage abrasion.
CLINICAL RELEVANCE:
Early diagnosis of a CCL injury and treatment by TPLO may be protective against further CCL disruption lending stability to the joint and decreasing the incidence of meniscal injury and articular cartilage damage.
PMID:
20522215
[PubMed - indexed for MEDLINE]
Vet Surg. 2010 Apr;39(3):315-23. doi: 10.1111/j.1532-950X.2010.00658.x. Epub 2010 Mar 19.
Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs.
Cook JL, Luther JK, Beetem J, Karnes J, Cook CR.
Source
Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA.
cookjl@missouri.edu
Abstract
OBJECTIVE:
To develop and test a novel extracapsular technique, TightRope CCL technique (TR), and compare its 6-month clinical outcomes to tibial plateau leveling osteotomy (TPLO) in dogs with cranial cruciate ligament (CCL) deficiency.
STUDY DESIGN:
Prospective clinical cohort study.
ANIMALS:
Medium, large, and giant breed dogs (n=47) with CCL deficiency.
METHODS:
Before clinical use, TR was evaluated by mechanical testing and the surgical technique was developed and evaluated in canine cadavers. For the clinical study, dogs were assigned to either TR (n=24) or TPLO (n=23) groups and the assigned technique performed after arthroscopic assessment and treatment of joint pathology. Postoperative management was standardized for both groups. Outcome measures were performed immediately postoperatively and up to 6 months after surgery and included complication types and rate, subjective measurement of cranial drawer and tibial thrust, subjective assessment of radiographic progression of osteoarthritis (OA), and function using a validated client questionnaire (6 months only).
RESULTS:
TR with a fiber tape suture had superior mechanical properties for creep, stiffness, yield load, and load at failure. Duration of anesthesia, total surgical time, and stabilization procedure (TR versus TPLO) were all significantly (P<.001) shorter for TR compared with TPLO. Complications requiring further treatment occurred in 12.5% of TR cases and 17.4% of TPLO cases. No significant differences were noted between groups for cranial tibial thrust, but cranial drawer was significantly (P<.05) lower in TR stifles at all postoperative time points. No significant differences were noted between groups for radiographic OA scores. No statistically or clinically significant differences were noted between TR and TPLO for scores for each of the client questionnaire categories.
CONCLUSIONS:
TR resulted in 6-month outcomes that were not different than TPLO in terms of radiographic progression of OA and client-evaluated level of function. TR was associated with shorter anesthesia and surgery times as well as a lower complication rate.
CLINICAL RELEVANCE:
The TR technique is safe and effective and can be considered an appropriate surgical option as part of the overall treatment plan for CCL deficiency in dogs.
Ronnie
