Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates

G. Cosenza; U. Reif; F. M. Martini

doi:10.3415/VCOT-14-09-0135

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2015; 28(05): 347-354
DOI: 10.3415/VCOT-14-09-0135

Clinical Communication

Schattauer GmbH

Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates

A clinical and radiographic retrospective assessment

Authors

G. Cosenza

¹Tierklinik Dr. Reif, Böbingen, Germany
U. Reif

¹Tierklinik Dr. Reif, Böbingen, Germany
F. M. Martini

²Unità operativa chirurgia e traumatologia veterinaria, Dipartimento di scienze medico-veterinarie, Università degli Studi di Parma, Italy

Abstract

Summary

Objective: To report clinical experiences with the tibial plateau levelling osteotomy (TPLO) procedure in small breed dogs with cranial cruciate ligament (CCL) disease using specific, conically coupled, 1.9/2.5 mm locking plates and evaluating short-term complications and outcome.

Methods: Medical records of small breed dogs (<15 kg) that underwent TPLO using 1.9/2.5 mm locking plates were reviewed retrospectively. The preoperative, postoperative and six to eight weeks postoperative tibial plateau angle (TPA) measurements were determined from the radiographic images. Lameness evaluation was assessed subjectively preoperatively and six to eight weeks postoperatively.

Results: Sixty-nine small breed dogs (n = 79 stifles) were included in the study. Mean (± SD) preoperative TPA was 29.0 ± 3.4°, postoperative TPA was 5.8 ± 2.5°, and six to eight weeks postoperative TPA was 7.3 ± 4.1°. Sixteen complications occurred in 12 out of 79 TPLO procedures: three were intra-operative (intra-articular screw placement) and 13 were postoperative complications, of which nine were identified as minor complications not requiring surgical reintervention, and four as major complications requiring additional surgical intervention, including tibial tuberosity fracture (n = 1), osteomyelitis (n = 1), screw failure (n = 1), and plate breakage (n = 1). Lameness scores by clinical assessment reduced from a median value of 3/4 preoperatively to 1/4 at six to eight weeks postoperatively.

Clinical significance: 1.9/2.5 mm locking plates appear to be a valid choice of implant for the stabilization of unilateral TPLO in small breed dogs.

Keywords

Complications - small breed dogs - stifle - retrospective study - TPLO - tibial plateau levelling osteotomy

Full Text

References

References
1 Carlin I. Ruptur des ligamentum cruciatum anterius [Rupture of the anterior cruciate ligament]. In: Kniegelenk im Hund [The stifle joint in the dog]. Arch Wissensch Prakt Tierhalk 1926; 54: 420-426.
2 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-569.
3 Innes JF, Barr AR. Clinical natural history of the postsurgical cruciate deficient canine stifle joint: year 1. J Small Anim Pract 1998; 39: 325-332.
4 Gallowaway RH, Lester SJ. Histopathologic evaluation of the canine stifle joint synovial membrane collected at the time of cranial cruciate ligament rupture. J Am Anim Hosp Assoc 1995; 218: 289-294.
5 Jackson J, Vasseur PB, Griffey S. et al. Pathologic changes in grossly normal menisci in dogs with rupture of the cranial cruciate ligament. J Am Vet Med Assoc 2001; 218: 1281-1284.
6 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine stifle. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
7 Petazzoni M. TPLO in the small dog: 18 cases. Proceedings of the 12^th European Society of Veterinary Orthopaedics and Traumatology Congress. 2004. September 10-12 Munich, Germany: 258.
8 Vezzoni A. TPLO in small dogs. Proceedings of World Veterinary Orthopaedics Congress. 2010. September 15-18 Bologna, Italy: 306.
9 Macias C, McKee WM, May C. Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs. J Small Anim Pract 2002; 43: 433-438.
10 Selmi AL, Padilha Filho JG. Rupture of the cranial cruciate ligament associated with deformity of the proximal tibia in five dogs. J Small Anim Pract 2001; 42: 390-393.
11 Vasseur PB. Clinical results following nonoperative management for rupture of the cranial cruciate ligament in dogs. Vet Surg 1984; 13: 243-246.
12 Pond MJ, Campbell JR. The canine stifle joint I. Rupture of the anterior cruciate ligament: an assessment of conservative and surgical management. J Small Anim Pract 1972; 13: 1-10.
13 Kunkel KA, Basinger RR, Suber JT. et al. Evaluation of a transcondylar toggle system for stabilization of the cranial cruciate deficient stifle in small dogs and cats. Vet Surg 2009; 38: 975-982.
14 Tamburro R, Pinna S, Tribuiani AM. et al. Biceps femoris muscle transposition for treatment of cranial cruciate ligament rupture in small breed dogs. J Vet Sci 2012; 13: 93-98.
15 Olmstead ML. The use of orthopaedic wire as a lateral suture for stifle stabilization. Vet Clin N Am Small Anim Pract 1993; 23: 735-756.
16 Stork CK, Gibson NR, Owen MR. et al. Radiographic features of a lateral extracapsular wire suture in the canine cranial cruciate deficient stifle. J Small Anim Pract 2001; 42: 487-490.
17 Piermattei DL, Flo GL, De Camp CE. The stifle joint. In: Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopaedics and Fracture Repair. 4th ed. St. Louis, MO: Saunders Elsevier; 2006: 562-632.
18 Korvick DL, Johnson AL, Schaeffer DJ. Surgeon’s preference in treating cranial cruciate ligament ruptures in dogs. J Am Vet Med Assoc 1994; 205: 1318-1324.
19 Cook JL. Extra capsular stabilization. In Muir P.. editor Advances in the canine cranial cruciate ligament. Ames, IA: ACVS Foundation/Wiley Blackwell; 2010: 163-168.
20 Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). J Am Vet Med Assoc 2009; 234: 229-235.
21 Slocum B, Slocum TD. Knee. In Bojrab MJ.. editor Current Techniques in Small Animal Surgery. 4th ed. Baltimore, MD: Williams & Wilkins; 1998: 1187-1244.
22 Talaat MB, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. Vet Surg 2006; 35: 729-739.
23 Duerr FM, Duncan CG, Savicky RS. et al. Comparison of surgical treatment options for cranial cruciate ligament disease in large breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37: 49-62.
24 Witte PG, Scott HW. Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate. Vet Surg 2014; 43: 549-557.
25 Leitner M, Pearce SG, Windolf M. et al. Comparison of locking and conventional screws for maintenance of tibial plateau positioning and biomechanical stability after locking tibial plateau leveling osteotomy plate fixation. Vet Surg 2008; 37: 357-365.
26 Garnett SD, Daye RM. Short-term complications associated with TPLO in dogs using 2.0 and 2.7 mm plates. J Am Anim Hosp Assoc 2014; 6: 396-404.
27 Krotscheck U, Thompson MS, Ryan KK. et al. Comparison of TPA, bone healing, and intra-articular screw placement using conventional nonlocked application of surgeon-contoured versus locked application of precontoured TPLO plates in dogs. Vet Surg 2012; 41: 931-937.
28 Petazzoni M, Urizzi A, Verdonck B. et al. Fixin internal fixator: concept and technique. Vet Comp Orthop Traumatol 2010; 23: 250-253.
29 Reif U, Dejardin LM, Probst CW. et al. Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. Vet Surg 2004; 33: 368-375.
30 Glasser D, Langlais F. The ISOLS radiological implants evaluation system. In Langlais F, Tomeno B.. editors Limb Salvage: Major Reconstructions in Oncologic and Nontumoral Conditions. Berlin, Germany: Springer; 1991: pg. xxiii-xxxi.
31 Conkling AL, Fagin B, Daye RM. Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology. Vet Surg 2010; 39: 475-481.
32 Guastella DB, Fox DB, Cook JL. Tibial plateau angle in four common breeds with cranial cruciate ligament rupture, and its relationship to meniscal tears. Vet Comp Orthop Traumatol 2007; 21: 125-128.
33 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
34 Thiemann KM, Tomlinson JL, Fox DB. et al. Effect of meniscal release on rate of subsequent meniscal tears and owner assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35: 705-710.
35 Ralphs SC, Whitney WO. Arthroscopic evaluation of menisci in dogs with cranial cruciate ligament injuries: 100 cases (1999-2000). J Am Vet Med Assoc 2002; 221: 1601-1604.
36 Case JB, Hulse D, Kerwin SC. et al. Meniscal injury following initial cranial cruciate ligament stabilisation surgery in 26 dogs (29 stifles). Vet Comp Orthop Traumatol 2008; 21: 365-367.
37 Flo GL. Meniscal injuries. Vet Clin North Am Small Anim Pract 1993; 23: 831-843.
38 Ritzo ME, Ritzo BA, Siddens AD. et al. Incidence and type of mCook JL injury and associated long-term clinical outcomes in dogs treated surgically for cranial cruciate ligament disease. Vet Surg 2014; 43: 952-958.
39 Mahn MM, Cook JL, Cook CR. et al. Arthroscopic verifi cation of ultrasonographic diagnosis of meniscal pathology in dogs. Vet Surg 2005; 34: 318-323.
40 Pozzi A, Hildreth BE, Rajala-Schultz PJ. Comparison of arthroscopy and arthrotomy for the diagnosis of medial meniscal pathology: an ex - vivo study. Vet Surg 2008; 37: 23-32.
41 Priddy NH, Tomlinson JL, Dodham JR. et al. Complications with an owners assessment of the outcome of tibial plateau leveling osteotomy for the treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). J Am Vet Med Assoc 2003; 222: 1726-1732.
42 Kim SE, Pozzi A, Kowaleski MP. et al. Tibial osteotomies for cranial cruciate ligament insufficiency. Vet Surg 2008; 37: 111-125.
43 Bergh MS, Rajala-Schultz P, Johnson KA. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy. Vet Surg 2008; 37: 374-382.
44 Kergosien DH, Barnhart MD, Kees CE. et al. Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy. Vet Surg 2004; 33: 468-474.
45 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-193.
46 Collins JE, Degner DA, Hauptman JG. et al. Benefits of pre- and intraoperative planning for tibial plateau leveling osteotomy. Vet Surg 2014; 43: 142-149.
47 Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury 2003; 34: B63-B76.
48 Savicky R, Beale B, Murtaugh R. et al. Outcome following removal of TPLO implants with surgical site infection. Vet Comp Orthop Traumatol 2013; 26: 260-265.
49 Kowaleski M, Boudrieau RJ, Beale BS. et al. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. Vet Surg 2013; 42: 847-852.
50 Frey TN, Hoelzler MG, Scavelli TD. et al. Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006). J Am Vet Med Assoc 2010; 236: 88-94.
51 Stauffer KD, Tuttle TA, Elkins AD. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
52 Gatineau M, Dupuis J, Planté J. et al. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Vet Comp Orthop Traumatol 2011; 24: 333-341.
53 Coletti TJ, Anderson M, Gorse MJ. et al. Complications associated with tibial plateau leveling osteotomy: a retrospective of 1519 procedures. CanVet J 2014; 55: 249-254.