Lahmheits- und Osteoarthroseentwicklung nach Tibial Plateau Leveling Osteotomy (TPLO) und potenzielle prognostische Einflussfaktoren^[*]

Zusammenfassung

Gegenstand: Untersuchung von Lahmheits- und Arthroseentwicklung nach Tibial Plateau Leveling Osteotomy (TPLO) bei Hunden und Evaluierung potenzieller prognostischer Einflussfaktoren. Material und Methoden: Es erfolgte eine retrospektive Auswertung der Patientenakten von 119 Hunden (135 Kniegelenken). Das Therapieergebnis, aktueller Lahmheitsstatus, Arthrosegrad und Arthroseentwicklung wurden anhand der klinischen und röntgenologischen Befunde einer Kontrolluntersuchung sowie durch einen Besitzerfragebogen ausgewertet. Ergebnisse: 58 Hunde (66 Gelenke) konnten klinisch und röntgenologisch, 61 Hunde (69 Gelenke) nur mittels Fragebogen kontrolliert werden. Bis zu 6,8 Jahre nach der TPLO war das Lahmheitsergebnis in 90,4% der Fälle “sehr gut” bis “gut”. Es kam zu einem moderaten Fortschreiten der Arthrose. Patienten mit Totalruptur des vorderen Kreuzbandes wiesen häufiger Meniskusschäden auf als Patienten mit Teilruptur. Patienten, bei denen eine mediale Teilmeniskektomie erfolgte, zeigten häufiger “sehr gute” Langzeitergebnisse und seltener ein Fortschreiten der Arthrose als Hunde, deren Meniskus belassen oder bei denen ein Release durchgeführt wurde. Die Komplikationsrate lag bei 22,2%. Schlussfolgerung und klinische Relevanz: Die klinischen Langzeitergebnisse nach TPLO sind sehr zufriedenstellend. Eine Teilmeniskektomie kann helfen, spätere Meniskusoperationen zu verhindern, ohne das langfristige Lahmheitsergebnis oder die Arthroseentwicklung negativ zu beeinflussen. Durch eine vorangegangene Operation oder postoperative Komplikationen verschlechtert sich weder das langfristige Lahmheitsergebnis noch beschleunigt sich das Fortschreiten der Arthrose.

Summary

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” longterm 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.

Schlüsselwörter

Kreuzbandriss - Hund - Arthrose - Prognose - TPLO

Key words

Cranial cruciate ligament rupture - dog - osteoarthritis - prognosis - TPLO

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