Ch. 61 & 62: Stifle & TKR Flashcards
Kieves Vet Sx 2018
Effects of low-intensity pulsed US on radiographic healing of TPLO in dogs: a prospective, randomized, double-blinded study
- study groups
- conclusion?
Dogs were assigned to an active (LIPUS) treatment group or a placebo control (SHAM) treatment group
LIPUS tx 20min daily x 12 weeks
There was no significant difference in radiographic bone healing, or limb use as measured by objective gait analysis detected between the LIPUS treatment group and SHAM treatment group at any point in the study
Lopez JAVMA 2018
Retrospective study of factors associated with SSI in dogs following TPLO
- % SSI post-op?
- 3 factors that were associated w/ increased odds of SSI
SSI developed after 34 (8.4%) procedures
On multivariate analysis – GSD (vs other breeds), meniscectomy (vs no meniscectomy), & attending surgeon have performed < 20 (vs > 20) procedures during the study period were associated with increased odds of SSI
Mehrkens Vet Sx 2018
Factors associated with early TT fx after TPLO
- % fx?
- factors assoc w/ increased odds of fx?
Dogs (n = 2490) with cranial cruciate ligament rupture that underwent 3000 TPLO surgeries
23 (0.77%) cases of fx were ID
Factors that correlated with increased odds of fracture were:
- Placement of antirotational pins distal to insertion of patellar ligament (PL)
- Tuberosities w/ narrowest point below insertion of PL
- Placement of multiple pins distal to the PL
- Bilateral simultaneous TPLO
Selmic JAVMA 2018
Association of TPLO w/ proximal tibial OSA in dogs
- TPLO vs not and OSA
- Body weight and odds of OSA?
After adjusting for BW in multivariable model, dogs with history of TPLO were 40 x as likely to get proximal tibial OSA as were dogs with no hx of TPLO
Each 1 kg increase in BW was associated with 11% increase in odds of proximal tibial OSA
Barnes Vet Sx 2019
Randomized, prospective clinical trial
Extracorporeal shock wave therapy improves short-term limb use after canine TPLO
- weight bearing TPLO vs. TPLO + ESWT
peak vertical force (PVF) and vertical impulse (VI) of surgically treated limbs in the ESWT cohort were higher 8 wks after sx compared with preoperative
Weight bearing increased faster after TPLO in dogs treated with postoperative ESWT
Chiu Vet Sx 2019
Influence of fixation systems on complications after TPLO in dogs > 45.4 kg (100 lb)
- fixation systems
- which system had lowest odds of complications?
- which higher complications?
- conclusion
Fixation systems included a 3.5 mm broad TPLO plate alone (8 P 78.4%) , a 3.5 mm broad TPLO plate w/ SOP (8AP; 14.9%), a 3.5 mm standard TPLO plate (6 P 6.7%)
The 8P had the lowest odds ratio for complication among the 3 fixation systems.
Odds of developing complications were higher with the 8AP fixation system than with the 8P fixation system.
With nonlocking plates – for every 4.5 kg increased odds of complication by 50%
Locking fixation eliminated the association between weight and complication rate
Livet VCOT 2019
Comparison of outcomes associated with TPLO and a modified technique for TTA for the tx of CCLD in dogs: a randomized clinical study
- complications b/w groups?
- lameness high immediate post op which group?
- gait eval 1 month?
- gait 6 months?
26 dogs; 13 in TPLO and 13 in TTA rapid
no significant difference in the occurrence of complications between groups
Lameness scores were significantly higher during the first 3 days after surgery for the TPLO group
One month after surgery, the symmetry index between healthy and affected limbs for the relative stance time during the gait cycle (symmetry index/%) was significantly higher for the TTA Rapid group
No gait parameters were significantly different between the two groups 6 months after surgery
McGregor VCOT 2019
A retrospective study using the SOP TPLO locking plate for the tx of CCLD
- SOP plate healing at 6-8 weeks?
- what was assoc with increased union?
- what were two more common complications?
- SOP recommended?
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.
Cappelle VCOT 2019
Short-term complications following single-session vs staged bilateral TPLO stabilized with locking plates for tx of bilateral CCLD: a retrospective study
- difference in minor/major complications b/w procedures?
- age?
- conclusion
No significant differences in minor or major complication rates existed between study groups
Increasing age was the only significant risk factor for major complications in either group
findings support claim that BSSTPLO & STPLO performed with locking implants have similar complication rates
Aldrich VSURG 2023
Blinded, randomized, placebo-controlled study of the efficacy of bupivacaine liposomal suspension using static bodyweight distribution and subjective pain scoring in dogs after tibial plateau leveling osteotomy surgery
- conclusion?
For the population of dogs that underwent TPLO and received postoperative carprofen, LB did not provide an analgesic effect discernable by success/failure analysis, Glasgow CMPS-SF pain scores, or %BWdist measurement using a weight distribution platform, compared with saline placebo
Villatoro VRU 2023
Stifle joint osteoarthritis in small-breed and medium-breed dogs is more severe after cranial cruciate ligament injury than medial patellar luxation
- OA and weight?
- which dz process had more OA?
- conclusion
OA was more severe in heavier than lighter dogs
Joints with MPL had lower OA scores than joints w/ CCL injury or CCL injury + MPL
The retrospective nature of the study limited findings to associations but did not allow conclusions regarding factors causing OA or enhancing its progression.
Reader JAVMA 2020
Comparison of liposomal bupivacaine and 0.5% bupivacaine HCl for control of postoperative pain in dogs undergoing TPLO
- nocita vs. bupivacaine rescue analgesia
- conclusion
Dogs with Nocita were less likely to require rescue analgesia and received lower amounts of opioids than dogs given 0.5BH
Conclusion: the LEB appeared to provide adequate analgesia after TPLO with lower requirements for opioid treatments, which may allow dogs to be discharged from the hospital earlier than with traditional pain mgmt
Tinga Vet Sx 2020
Femorotibial kinematics in dogs treated with TPLO for CCL insufficiency: an in vivo fluoroscopic analysis during walking
- translation w/ CCLr
- translation post-TPLO
- conclusion
CCL rupture resulted in 10 ± 2.2 mm (mean ± SD) cranial tibial translation at midstance phase, which was converted to 2.1 ± 4.3 mm caudal tibial translation after TPLO
TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking
Vezzoni VCOT 2020
Use of a modified TPLO with double cut and medial crescentic CWO to treat dogs with CCLR and tibial valgus deformity
- mean pre + post TPA
- mean pre + post proximal tibial angle
- post-op complications
- conclusion
Mean pre and postop TPA were 27.8° and 6.5° respectively
Mean pre- and postop mechanical medial proximal tibial angle were 101° and 92.8° respectively
No postop complications recorded & all healed uneventfully
Conclusion: TPLO/medial crescentic CWO effective for this conformation and low complication rate
Alexander Vet Sx 2020
Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy
- % change in recommendations
- conclusion
1010 cases identified
Radiographic examination findings contributed to a change in recommendations in 4.15% (38/915) of dogs presented without client concerns and without abnormalities at orthopedic examination.
Radiographic examination findings are unlikely to influence the treatment of dogs that seem to be recovering uneventfully from an uncomplicated TPLO without concerns from clients, analgesia, or abnormal findings on thorough orthopedic examination by a surgical specialist, at the time of the planned clinical re-evaluation
Olivencia-Morell Vet Sx 2021
Evaluation of the clinical value of routine radiographic examination during convalescence for tibial plateau-leveling osteotomy
conclusion
At routine rechecks of dogs w/ no owner-perceived issues after TPLO, 49% had minor complications but only 2% (or 2 in 100 cases) were deemed significant enough to alter patient mgmt.
Ober Vet Sx 2019
Influence of TPLO and TTA on passive laxity of the cranial cruciate deficient stifle in dogs
conclusion
Conclusion: TPLO and TTA caused an angle dependent decrease in craniocaudal translation of tibia ; TPLO seems more effective than TTA at restoring craniocaudal stability of stifle
Moore Vet Sx 2020
Extended long-term radiographic & functional comparison of TPLO vs TTA for CCLR in the dog
- OA more with which procedures?
- long term outcome TPLO vs TTA?
All dogs had meniscal release (49.6%) or partial medial meniscectomy (51.3%)
OA score progressed more after TTA and in dogs with bilateral surgery
Long-term outcomes that were better after TPLO compared with TTA included avg pain in last 7 days, interference with walking, morning stiffness, jumping, and climbing, limping during mild activities, and overall QoL
Shimada VCOT 2020
Biomechanical effects of tibial plateau leveling osteotomy on joint instability in normal canine stifles: an in vitro study
findings suggest that TPLO influences tension of the collateral ligaments and might generate laxity of the tibiofemoral joint
Johnson VSURG 2022
Outcome of cranial cruciate ligament replacement with an enhanced polyethylene terephthalate (PET) implant in the dog: A pilot clinical trial
- outcome of PET implant
- conclusion
Prospective, clinical, 10 dogs
The PET implant appeared
- intact and functioning in 2/10
- partially intact and functioning in 4/10
- completely torn in 3/10
- infection and removed in 1/10
Although function improved over the course of this study, only 2/10 implants appeared intact 6 months after placement
Lechner JFMS 2020
Comparison of a novel extracapsular suture technique with a standard fabellotibial suture technique for cranial cruciate ligament repair using a custom-made limb-press model in cats
All fabellotibial sutures and Mini TightRope fixations neutralized excessive cranial tibial thrust.
Barnhart VCOT 2019
Biomechanical comparison of 4 methods of fixation of a polymeric cranial cruciate ligament in the canine femur & tibia
conclusion
The mean ultimate load was significantly greater for femur fixations than for tibias, when SW was added (spiked washer) and for 5 mm IS (interference screw) compared with 4.5 mm sizes
Conclusion: a 5 mm IS + SW provided superior fixation strength in femurs/tibias vs 4.5 IS without SW
Biskup Vet Sx 2020
Long-term arthroscopic assessment of intra-articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog
- % grafts survived at 12mo
- conclusion
According to scope – 45% of grafts seemed to survive at 12 mo after surgery
Conclusion: about ½ of intra-articular allografts survived 12 mo after implantation in CCL-deficient stifles ; dogs with intact graft had successful outcomes at 12 mo after sx
Agnello VCOT 2021
Arthroscopic articular cartilage scores of the canine stifle joint with naturally occurring cranial cruciate ligament disease
- which site had high cartilage score damage?
- did bucket handle tear change OA score?
- presence of synovitis?
- conclusion?
the proximal trochlear groove has significantly higher cartilage scores (2) than all other sites examined
bucket handle tear of medial meniscus present in 33.3% of cases but was not associated with increased MOCS or synovitis scores
all stifles had synovitis
conclusion: arthroscopic articular cartilage damage is common at the time of sx intervention for CrCL dz but changes are mild
Fox VCOT 2020 PQ
Average TPA of 3922 stifles undergoing surgical stabilization for CCLR
- avg pre-op TPA?
- breeds with higher TPA?
- breeds with smaller TPA?
- neuter status? PQ
Avg preop TPA was 29°, average breed specific preop TPA ranged 27° to 35.1° with 4 breeds having significantly lesser TPA and 4 greater TPA
Beagles, Bichon Frises, Westies, and Yorkies have highest at 32, 34, 35 & 34
Smaller were Cane Corso, German Shepherds, Labradors, Rottweilers
*Neutered dogs had a higher TPA of 28.9° than non-neutered dogs with avg 26.88°
Flesher VCOT 2019
Technique and outcome of a modified TPLO for tx of concurrent MPL and CCLR in 76 stifles
- technique
- complication rate?
- conclusion
After osteotomy made, proximal segment rotated for TPA and simultaneous medially translated 1-5 mm to adjust alignment of quadriceps mechanism & center patella; then Fixin plate was contoured
Overall complication rate 18.4% in treatment group and 28.9% in non-tibial translation group
Conclusion: modified TPLO can be used to tx patients with concurrent MPL & CCLR with good clinical outcome; complication rates comparable to traditional repairs for MPL
Amimoto VCOT 2020
Force plate gait analysis & clinical results after TPLO for CCLR in small breed dogs
- TPLO impact on HL function?
- conclusion
Hindlimb fxn markedly improved after TPLO with all 3 postop symmetry index significantly higher after month than preop values
Conclusion: limb fxn improved continuously and reached near normal values 6 mo post-op
Husi VSURG 2023
Comparative kinetic and kinematic evaluation of TPLO and TPLO combined with extra-articular lateral augmentation: A biomechanical study
conclusion
TPLO combined with an extra-articular lateral augmentation neutralizes craniocaudal and rotational instability when performing tibial compression test and the tibial pivot compression test, applied with an external and an internal moment
Looi VCOT 2023
Effects of Angled Dynamic Compression Holes in a Tibial Plateau Levelling Osteotomy Plate on Cranially Directed Fragment Displacement
- objective
- displacement compared b/w aPlate and S plate?
- conclusions
Compare angled (aPlate) vs. standard (sPlate) dynamic compression holes in TPLO plates in 40 ovine tibias after a TPLO has been performed
craniocaudal Displacement was significantly greater in the aPlate (median 0.85mm) than sPlate
aPlate increases cranially directed displacement of the osteotomy w/o changing the TPA. This reduces interfragmentary distance and can potentially improve healing
Lee VSURG 2022
Evaluation of a customized 3D-printed saw guide for tibial plateau leveling osteotomy: an ex vivo study
conclusion
The 3D-printed guide during TPLO resulted in slightly more accurate osteotomies and proximal jig pin placement, and reduced medial cortex damage
Cieciora VCOT 2022
Ex vivo evaluation of the cranial tibial artery and its compression through fragment rotation during tibial plateau leveling osteotomy: an angiographic three-dimensional reconstruction
- % decrease of CTa with TPLO rotation
- conclusion
In all adequately rotated TPLO segments (11/12), the CTa measured 1.57mm^2 (0.89-2.93); a decrease of 81%
Proper fragment rotation leads to compression of the CTa
Schlag Vet Sx 2020
Center of rotation of angulation-based leveling osteotomy combined with a copolanar cranial closing wedge ostectomy to manage cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angle
- mean pre and post-op TPA?
- conclusion
Mean TPA was 43° preoperatively, 10° postoperatively, and 10° at final recheck
Center of rotation of angulation-based leveling osteotomy/CCWO resulted in grade 4 osteotomy healing by 8 weeks, minimal complications, and acceptable to full return to function
Christ Vet Sx 2018
Modified cranial closing wedge ostectomy in 25 dogs
- difference in osteotomy length mCCWO vs CCWO?
- mean TPA pre + post-op?
- complications? outcome?
Preop planning of mCCWO decreased the cranial wedge length by mean 23% compared with traditional CCWO planning
Mean TPA decreased from 40.7° (range 28-63) to 6.94° (range 2-20) after surgery
Minor complications 6.25% (2). No bone healing complications for implant failures were diagnosed, and all dogs returned to subjectively satisfactory fxn by 8 wks after surgery
Lee JFMS 2023
Biomechanical evaluation of three fixation methods in a feline transverse patella fracture model
- groups
- differences?
- conclusions?
Group 1 (n=9): modified tension band wiring technique with a single Kirschner wire (0.9mm) and figure-of-eight wiring (20G)
Group 2 (9): combination of circumferential and figure-of-eight wiring techniques with orthopaedic wire (20G).
Group 3 (9): same technique as group 2, but with #2 FiberWire.
No significant difference was observed between groups 1 and 2 or between groups 2 and 3.
Conclusions: The combination of circumferential and figure-of-eight techniques with FiberWire is more resistant to displacement than metal wire in this ex vivo feline patella fracture model.
Cortina VSURG 2023
Outcomes and complications of a modified tibial tuberosity transposition technique in the treatment of medial patellar luxation in dogs
- novel technique
- % major complication?
- O satisfaction?
- conclusion
Novel combination of a lateral displacement pin and a modified tension band construct with a single Kirschner wire.
Overall major complication rate was 4.3%
The owner survey indicated a 100% satisfaction rate.
Conclusion: The m-TTT technique yielded acceptable complication rates, with high owner satisfaction
Hawbecker VCOT 2023
Influence of Kirschner-Wire Insertion Angle on Construct Biomechanics following Tibial Tuberosity Osteotomy Fixation in Dogs
- groups
- % pin pull-out
- superior degree?
12 pairs of cadaver tibia assigned to either a transversely (0 degrees) or caudodistally (30 degrees) placed pair of K-wires after a tibial tuberosity osteotomy was performed
Tibial tuberosity avulsion and K-wire pull out occurred in 67% of constructs and did not differ b/w insertion angles
K-wires placed at 0 degrees were biomechanically superior in yield (1.6X), peak (1.3X) and failure forces (1.4X)
De la Puerta VCOT 2019
Prevalence, risk factors, and outcome of postop TT fractures in dogs undergoing triple tibial osteotomy surgery
- % TT fx
- conclusion
Postoperative tibial tuberosity fracture was identified in 25/113 (22%) stifles
Conclusion: a narrow CHW at distal cortical attachment of tibial crest had a strong association w/ development of postop TT fx; no other variables found ; patients that got TT fx & were conservatively managed did not have worse clinical outcome than patients that did not develop TT fx
Sanders JSAP 2019
Comparison of short-term complications between unilateral and single-session bilateral surgery for MPL in small/medium dogs
- % complications
- conclusion. comparison to previous study
The frequency of major complications was higher in bilateral group (23%) vs unilateral group (12%)
Conclusion: single session bilateral MPL sx associated with high complication rate vs unilateral. The lower complication rate in unilateral group contradicts previous studies.
Rossanese VCOT 2019 PQ
Complications following surgical correction of MPL in small-to-medium-size dogs
- % complications
- what reduced risk of complication?
- what increased?
37% complications
Preservation of the TT distal cortical attachment was associated with a reduced risk of implant-related complications
Whereas adding a medial release to the sx techniques was associated with an increase risk of medial patellar luxation
Agnello VCOT 2022
Arthroscopic caudal cruciate ligament damage in canine stifles with cranial cruciate ligament disease
- % CdCLr
- type of tear most common?
Caudal cruciate tearing in 94% of stifles
Longitudinal CdCL tearing was the most common form at 76%; of which, 45% were partial CdCL tears and 31% were full thickness
Lampart VSURG 2023
Evaluation of the accuracy and intra- and interobserver reliability of three manual laxity tests for canine cranial cruciate ligament rupture—An ex vivo kinetic and kinematic study
- what tests performed?
- conclusions?
Investigate the accuracy and intra- and interobserver reliability of the cranial drawer test (CD), tibial compression test (TCT), and the new tibial pivot compression test (TPCT) and to elucidate the ability to subjectively estimate cranial tibial translation (CTT) during testing - intact vs transected CCL
Veterinary manual laxity tests are accurate and reliable in acute CCLR. The TPCT might have potential for the assessment of subtle and rotational canine stifle instabilities.
Gilbert VRUS 2019
Stifle joint osteoarthritis at the time of diagnosis of CCL injury is higher in Boxers and in dogs weighing > 35 kg
- OA & weight?
- where was OA most common?
- Boxers & OA vs. other breeds?
Dogs weighing > 35 kg had a higher total OA score than those weighing < 35 kg
OA scores were highest at the apical patella, proximolateral tibia, and sesamoid bones corresponding to the proximal, lateral, and caudal aspects of the joint respectively
Boxer dogs had a higher total OA score than other breeds
Jeong Vet Sx 2021
Subsequent meniscus tears following tibial tuberosity advancement and tibial plateau leveling osteotomy in dogs with cranial cruciate ligament deficiency: an in vivo experimental study
- lameness scores?
- radiographic OA scores?
- meniscal pathology?
- articular cartilage damage?
Lameness scores were not different between TTA and TPLO limbs at any time point.
Radiographic osteoarthritis scores of TTA stifles were higher than TPLO stifles at 12 weeks postoperatively, but there was no difference between groups at 32 weeks postoperatively
Medial meniscal total gross pathology score was higher in TTA than TPLO stifles.
TTA stifles had more articular cartilage damage when compared with TPLO stifles at 32 weeks postoperatively
Geier Vet Sx 2021
Evaluation of the risk of patella fracture as the result of decreasing tibial plateau angle following tibial plateau leveling osteotomy
- final median post-op TPA?
- odds of patella fracture?
Median final TPA for the reference group was 4.1°
The odds of patellar fractures increased by 22% for every 1° decrease in final TPA
Serratore Vet Sx 2018
Results & complications after removal of TTA cage for treatment of SSI: a retrospective study
- % post-op complications?
- % O report resolution of signs
Postop complications occurred in 40% dogs. 3 dogs developed major complications, including TT fracture
85% owners reported complete resolution of CS related to SSI and satisfied with outcome
Shimada VCOT 2022
Prophylactic efficacy of tibial plateau leveling osteotomy for a canine model with experimentally induced degeneration of the cranial cruciate ligament
- changes in CCL from eTPA?
- conclusion?
CrCLR collagen: ~85% are type I collagen (COL1) –> most resistant to tensile force
The eTPA (sham) group showed increases in AB-positive regions (proteoglycans), increases in EE-positive regions (elastic fibers) and decreases in COL1-positive regions (Collagen type I)
eTPA induced CrCL degeneration can be suppressed by reducing the biomechanical load on the CrCL by performing a TPLO
Schmutterer VCOT 2022
Evaluation of meniscus load and load distribution in the canine stifle after tibial plateau leveling osteotomy with postoperative tibia plateau angles of 6 and 1 degrees
- kinetics/kinematics after TPLO?
- lower contact force with 6 or 1 degree?
TPLO restores stifle kinematics and meniscal kinetics after transection of the CCL ex vivo.
The contact force on both menisci is reduced significantly after TPLO with a TPA of 1 degree.
Dalago VCOT 2023
Effect of Plate Type on Tibial Plateau Levelling and Medialization Osteotomy for Treatment of Cranial Cruciate Ligament Rupture and Concomitant Medial Patellar Luxation in Small Breed Dogs: An In Vitro Study
- mm translation for +4 and +6 plates?
- conclusion for dogs <10kg?
+4mm offset plate translated 2.93mm (+ 0.51)
+6mm offset plate translated 5.03mm (+ 0.47)
+4mm and +6mm offset Fixin plates can be used for TPLO-M in dogs b/w 5-10kg
+6mm plate should be used in caution in dogs <10kg since there may be insufficient bone apposition at the osteotomy site
Tinga JAVMA 2021
Femorotibial joint kinematics in nine dogs treated with lateral suture stabilization for complete cranial cruciate ligament rupture
- mm decreased translation?
- conclusion
Medial cranial tibial translation decreased 9.3mm preop to 7.5mm 6mo postop
stifle instability was only slightly mitigated at 6mo following LFTS performed w/ knotted nylon leader material in medium to large breed dogs w/ CCLR despite improvement in lameness
Murakami VCOT 2023
Examination of Proximodistal Patellar Position in Dogs with the Stifle at Full Extension
- % MPL dogs with patella alta?
- factors assoc w/ patella alta?
- conclusion
11/83 MPL stifles were categorized as functional patella alta (13%)
The factors associated with functional patella alta included a greater full extension angle of the stifle joint, longer patellar ligament, and shorter femoral trochlear length.
Mediolateral radiographs of the stifle joint in full extension are clinically important
Brioschi VCOT 2020 PQ
CT assessment of block recession trochleoplasty and partial parasagittal patellectomy in cats
evaluated what?
area of contact increased / decreased with what? PQ
change in depth of patellar recession?
change in patellar width?
conclusion?
investigate the effect of block recession trochleoplasty (BRT) with and without partial parasagittal patellectomy (PPP) on patellofemoral contact, depth of patellar recession and size of trochlea and patella.
area of contact between the patella and femoral trochlea was significantly reduced after BRT and then significantly increased after PPP.
The depth of patellar recession was unchanged after BRT, but then was significantly higher after PPP.
The patella was wider than the trochlea preoperatively and post-BRT and narrower post-PPP.
block recession trochleoplasty did not improve patellar recession and decreased patellofemoral contact area; following BRT, the patella rides the trochlear ridges and loses contact with the trochlear sulcus; BRT alone should not be done in cats, instead combine with PPP
Nagahiro VSURG 2023
Evaluation of the quadriceps muscle length to femoral length ratio in small breed dogs with medial patellar luxation
conclusion
Among small breed dogs, those with MPL grade IV had a shortened QML associated with femoral deformities
Brincin VSURG 2023
The value of routine radiographic follow up in the postoperative management of canine medial patellar luxation
conclusion
Routine radiographs at follow up did not influence postoperative management of most dogs after MPL surgery in the absence of abnormalities on clinical history or orthopedic examination.
Eskelinen VCOT 2022
Tibial tuberosity transposition fixation with a locking plate during medial patellar luxation surgery: an ex vivo mechanical study
- which failed lower load?
- Pin TBW failure?
- Plate Pin TBW failure?
- conclusion
Pin-TBW failed at lower load than Plate-pin-TBW (342N vs 469N)
All Pin-TBW failed by fracture and Plate-Pin-TBW failed by patellar ligament rupture
Plate-pin stiffer than PTBW
Blackford-Winders VCOT 2021
Comparison of semi-cylindrical recession trochleoplasty and trochlear block recession for the treatment of canine medial patellar luxation: a pilot study
- % complications?
- reluxation?
- conclusion
No technical errors or complications in SCRT group, 3/10 TBR fractured intraop
No patellar reluxation at 8wks with either technique
Conclusion: short-outcomes similar b/w techniques w/ regards to reluxation and limb function. SCRT subjectively easier to perform esp in small dogs. SCRT is acceptable method of trocheloplasty
Giansetto VCOT 2023
Patellar Proximo-Distal Displacement following Modified Maquet Technique Is Not Predictive of Patellar Luxation
conclusion
patellar baja is clearly induced by the Modified Maquet Technique, but only 1/137 (0.7%) case had a luxation
Peycke Vet Sx 2022
Center of rotation of angulation-based leveling osteotomy for stifle stabilization in skeletally immature dogs
- mean pre + post TPA?
- list the 3 major complications
- function at final FU?
Mean tibial plateau angle (TPA) was 26° preoperatively, 9° postoperatively
Two dogs developed a valgus deformity secondary to a plate screw engaging the distolateral aspect of the proximal tibial physis
One dog developed 10° recurvatum of the proximal tibia secondary to inadvertent over rotation of the tibial plateau (TPA 3°)
At a mean time of 23 months following surgery, all dogs continued to have full function
Terreros Vet Sx 2020
Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: complications, owner satisfaction, and midterm to long-term outcomes
- pre + post TPA?
- % complications
- functional outcomes?
- OA?
TPA 42 pre-op to 5 post-op
No catastrophic complications, 11% major, and 22% minor
Functional midterm or long-term outcomes were excellent in 8 dogs, acceptable in 7 dogs, and unacceptable in 1 dog (total of 16 dogs)
Progression of arthritis noted on all midterm and long-term follow-up radiographs
Won VRUS 2020
Association of meniscal injury to joint space width on standard TPLO lateral radiographic projections of the canine stifle
main finding
Based on receiver operator characteristic curve analysis, joint space widths measuring less than 3.43 mm may indicate a meniscal tear, with a corresponding 89.5% specificity and 40.5% sensitivity in dogs weighing 31 kg.
Roses VCOT 2022
Rotation of the Tibial Plateau Segment to Control Arterial Hemorrhage during Tibial Plateau Levelling Osteotomy: A Cadaveric Experimental Study and Nine Clinical Cases
conclusion
Rotation and compression of proximal tibial segment followed by closure of the pes using a 3-loop pulley successfully controlled arterial bleeding without any need for further arterial ligation
Fitzpatrick Vet Sx 2021
Custom-build constrained uniaxial and rotating hinge total knee replacement in cats: clinical application, design principles, surgical technique and clinical outcome
- implants used
- outcomes
- conclusion
Three generations of implant used (G1, G2, and G3)
- G1 and G2 constrained uniaxial hinged (UH) implants
- Generation 3 was a semiconstrained rotating hinge (RH) implant
One cat had a catastrophic outcome, 3 cats had good outcomes, five cats had excellent outcomes
Additional research is required to fully evaluate implant suitability
Colthrust_JSAP 2022
Comparison of incidence of medial meniscal injury in small dogs (≤15 kg) & medium-to-large dogs (>15 kg)
with naturally occurring cranial cruciate ligament disease undergoing TPLO: 580 stifles (2015-2019)
- diff b/w small + large breeds?
- what raises suspicion of meniscal tear?
No significant difference exists in medial meniscal tear rate between small & medium-to-large dogs either at index surgery or subsequently.
The index of suspicion of concurrent medial meniscal tears should be higher in dogs w/ complete tear of the cranial cruciate ligament but a partial tear does not preclude meniscal pathology
Laube VCOT 2020
Prevalence and risk factors for bilateral meniscus tears identified during treatment for cranial cruciate ligament disease vs tibial plateau leveling osteotomy in dogs
- prevalence bilateral meniscal tear?
- odds higher for __?
- % chance of meniscal tear if ID’d in first side?
Prevalence of bilateral meniscal tears was 48.0%
The odds for bilateral meniscal tears were higher:
- Rottweilers (OR: 4.5)
- Older dogs (OR: 1.2 per year)
- Smaller dogs (2% increase in odds per 0.45 kg decrease in weight)
- Stifles with complete cranial cruciate ligament tears (OR: 21.1)
When a meniscal tear is identified in the first stifle, the chance of tear in the other stifle is 72%
Tomo VCOT 2022
Evaluation of hindlimb deformity and posture in dogs with grade 2 medial patellar luxation during awake computed tomography imaging while standing
- findings from luxated group?
- conclusion?
In luxated group, saw external rotation of femur, internal rotation of tibia/foot, external rotation of tarsal joint, large stifle joint convergence angle, genu varum and toe-in standing were observed
Conclusion: Grade 2 MPL dogs have no bone deformities but have abnormal posture when the patella is luxated
Feldmane Vet Sx 2021
Proximodistal and caudocranial position of the insertion of the patellar ligament on the tibial tuberosity and patellar ligament length of normal stifles and stifles with grade II medial patellar luxation in small breed dogs
- only difference found?
- conclusion?
The only difference identified in this study consisted of a more proximal position of the patellar ligament insertion in the stifles of small-breed dogs with grade II MPL
The more proximal position of the patellar ligament insertion will result in a more proximal position of the patella in the trochlear groove and may contribute to the development of MPL. Potentially, this will also affect the risk of recurrence of MPL after surgical treatment
Walker VSURG 2022
Evaluation of a modified radiographic union scale for tibial fractures scoring system (mRUST) in staged bilateral tibial plateau leveling osteotomy procedures and comparison of first and second side radiographic bone healing
- mRUST grades
- inter + intra rater numbers for both
1= no callus
2 = callus
3 = bridging callus
4 = remodeled, fx not visible
The TPLO mRUST scoring system improved inter-rater reliability (but not intra-rater) compared to subjective evaluation of radiographic union
subjective evaluation’s intra-rater reliability was 0.72 and inter-rater reliability was 0.33
TPLO mRUST scoring system intra-rater reliability was 0.73 and inter-rater reliability was 0.56
Adrian Vet Sx 2019
Gait and electromyographic alterations due to early onset of injury and eventual rupture of the CCL in dogs: a pilot study
- change in hip ROM
- change in stifle? tarsus?
- PVF, PVI?
After MRFE-induced injury, average hip joint range of motion during stance decreased w/ the untreated pelvic limb
After CCLR, stifle flexion angles decreased w/I the tx limb at 8 wks and w/I the untreated PL at all time points, whereas average tarsal joint ROM decreased in the treated limb and increased in the untreated limb
Peak vertical GRF and impulse decreased within the treated limb
Ferrell Vet Sx 2019 PQ
Impact of postop antibiotics on rates of infection and implant removal after tibial tuberosity advancement in 1768 canine stifles
- % post op infn?
- % that had implant removal?
- diff in infn rate bw post-op abx?
- post-op abx increased risk for what?
- conclusion?
- infection risk when abx used? PQ
Postoperative infections diagnosed in 82 / 1768 (4.6%) stifles
Implants were removed from 32 (39%) stifles, with plate and screw removal only in 23 (72%) stifles
The rate of infection did not differ between dogs with or without postoperative antibiotic therapy
However, dogs receiving postoperative abx therapy were at risk for developing an oxacillin-resistant infection
Oxacillin-resistant infections were associated w/ a requirement for implant removal to achieve resolution vs. other types of bacterial infections
Conclusion – no benefit in giving postop abx post- TTA
*infection risk w post-op abx? rate of infection did not change but at risk for developing oxacillin R infn & requirement for implant removal
Clark Vet Sx 2020 PQ
Influence of administration of antimicrobial medications after TPLO on SSI: A retrospective study of 308 dogs
- what was associated with deep SSI and resistant infn?
- what was associated with Superficial, deep SSIs, and abx R?
- factors associated with superficial SSI?
- conclusion re post-op abx?
Body weight correlated with deep SSI and resistant infections
Prolonged duration of sx and anesthesia were SA with superficial SSI, deep SSI, and abx resistance
Surgeons influenced deep SSI
Factors associated with diagnosis of superficial SSI included duration of surgery and 2nd side TPLO
Conclusion: Previously reported predisposing factors for infection were confirmed, but postoperative administration of antimicrobial medications was not protective against SSI nor did it predispose to antibiotic resistance in our clinical setting.
