Ortho HL - Stifle journals Flashcards
Evers VS 2023 - Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture
What was the sensitivity and specificity of needle arthroscopy?
Sn 95%, Spec 100%
Katz VS 2022 - The significance of the meniscal flounce sign in canine stifle arthroscopy
What did lack of a meniscal flounce indicate?
Stifles with -ve meniscal flounce had meniscal tear
Katz VS 2022 - The significance of the meniscal flounce sign in canine stifle arthroscopy
What % of stifles with -ve flounce had meniscal tear?
What type of meniscal tears were present in the stifles which had a meniscal flounce?
93%
Radial tear
Cortes VS 2019 - Iatrogenic cartilage injury associated with the use of stainless-steel cannulas and silicone-guarded cannulas for canine stifle arthroscopy
What was the main finding?
Silicone-guarded arthroscope cannulas decreased iatrogenic cartilage injury
Tanegashima VCOT 2021 - Functional Anatomy of the Craniolateral and Caudomedial Bundles of the Caudal Cruciate Ligament in Beagle Dogs
What was the main finding?
(bonus q: what component is damaged IF you only get cranial drawer in flexion?)
Tension of CdM band was higher than CrL band throughout ROM.
CdM
Kopp JAVMA 2020 - Caudal cruciate ligament disease in three Basset Hounds
How were these cases managed?
1 dog managed with osteotomy to increase TPA, other 2 managed conservatively
Lampart VS 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 manual laxity test was developed? Describe how to perform it
Tibial pivot compression test
Husi VS 2023 - Comparative kinetic and kinematic evaluation of TPLO and TPLO combined with extra-articular lateral augmentation: A biomechanical study
What was the main finding?
Cranial tibial translation was 6 times larger in TPLO compared to intact when performing external Tibial pivot compression test and internal test.
Tests not different with TPLO and external lateral augmentation VS intact stifle.
Johnson VS 2022 - Outcome of cranial cruciate ligament replacement with an enhanced polyethylene terephthalate implant in the dog: A pilot clinical trial
What was the outcome @6m?
2/10 PET implant intact. 4 partial and torn in 3. 1x implant infection.
Mazdarani VS 2022 - Effect of center of rotation of angulation-based leveling osteotomy on ex vivo stifle joint stability following cranial cruciate ligament transection and medial meniscal release with and without a hamstring load
Which osteotomy was performed?
What biomechanical benefits did this osteotomy have?
CBLO
CBLO prevented CrTibTranslation except with the stifle at 140 degrees.
Peterson VS 2022 - Evaluation of a crescent saw guide for tibial plateau-leveling osteotomy: An ex vivo study
What benefit did use of the crescent saw guide give?
NONE - no difference
Peycke VS 2022 - Center of rotation of angulation-based leveling osteotomy for stifle stabilization in skeletally immature dogs
What complication was observed, what % of dogs were affected?
Valgus deformity secondary to plate screw engaging distolateral aspect of proximal tibial physis - required revision surgery
2/16 stifles (12.5%)
Whitney VS 2022 - Ex vivo biomechanical comparison of four Centre of Rotation Angulation Based Levelling Osteotomy fixation methods
Which of the constructs had the greatest construct stiffness and yield load?
No difference in construct stiffness
Yield load was greatest for plate/TBW/headless compression screw construct
Alexander VS 2021 - Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy
What was the main finding?
Radiographic findings resulted in changed recommendations in 4% of dogs without client concerns & without abnormalities on ortho examination.
Budsberg VS 2021 - Efficacy of postoperative antibiotic use after tibial plateau levelling osteotomy in dogs: A systematic review
What was the main finding?
No benefit of post-op AB usage
Geier VS 2021 - Evaluation of the risk of patella fracture as the result of decreasing tibial plateau angle following tibial plateau levelling osteotomy
How did the risk of patellar fracture differ with final TPA?
The odds of patellar fractures increased by 21.7% for every 1° decrease in final TPA.
Jeong VS 2021 - Subsequent meniscal tears following tibial tuberosity advancement and tibial plateau levelling osteotomy in dogs with cranial cruciate ligament deficiency: An in vivo experimental study
Which procedure was associated with a higher risk of late meniscal tears?
What % had meniscal tears at 32 weeks?
TTA
5/5 TTA (medial tear), 4/5 TTA (lateral tear)
Matchwick VS 2021 - A retrospective evaluation of complications associated with forkless tibial tuberosity advancement performed in primary care practice
How does a forkless TTA differ to a ‘normal’ TTA?
What was the overall complication rate?
What was the late meniscal rate?
Tibial tuberosity advancement was initially developed by using a tension band plate with angle stable forks to secure the osteotomized tibial crest. Forkless plates have since become available with two or three cortical screws in the tibial crest and have been reported to have complication rates similar to the fork-based design.
15% (7.5% major, 7.7% minor)
3%
McDougall VS 2021 - Timing of and risk factors for deep surgical site infection requiring implant removal following canine tibial plateau leveling osteotomy
What % had deep SSI requiring implant removal?
What factors increased the risk of implant removal?
3% (at median 279d PO)
Male and GSD
Olivencia-Morell VS 2021 - Evaluation of the clinical value of routine radiographic examination during convalescence for tibial plateau leveling osteotomy
What % had minor complications?
What% had complications significant enough to alter patient management?
49%
2%
Biskup VS 2020 - Long-term arthroscopic assessment of intra-articular allografts for treatment of spontaneous cranial cruciate ligament rupture in the dog
Where were the allografts harvested from?
At long-term arthroscopic assessment, what % showed graft survival?
DDFT allograft
45%
Clark VS 2020 - Influence of administration of antimicrobial medications after tibial plateau leveling osteotomy on surgical site infections: A retrospective study of 308 dogs
What factors were associated with SSI?
What was the main conclusion?
Prolonged duration of surgery and GA, increasing BW
PO AB were not protective against SSI
Cradic VS 2020 - Morphometric measurements to predict meniscal size in skeletally mature dogs for meniscal transplantation
What measurement was observed to be proportional to meniscal dimensions?
Hock to stifle length (length of tibia?)
Gleason VS 2020 - Meniscal click in cranial cruciate deficient stifles as a predictor of specific meniscal pathology
What was the presence of a meniscal click associated with?
Associated with a bucket handle tear (not other types)
Hagen VS 2020 - Contributing factors to surgical site infection after tibial plateau levelling osteotomy: a follow-up retrospective study
What was the SSI rate and what was the most common causative agent?
Give 2 protective factors identified in this study
SSI 11%, 28% of which were MRSP
PO AB and timing of pre-op AB (>60 mins prior to 1st incision)
Garcia VS 2020 - Subclinical bacteriuria and surgical site infections in dogs with cranial cruciate ligament disease
What was the main conclusion/finding of this paper?
Organisms isolated were different from those in urine
Moore VS 2020 - Extended long-term radiographic and functional comparison of tibial plateau levelling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog
What was the main radiographic finding?
What was the main functional finding?
OA progressed more after TTA (c.f. TPLO) and bilateral surgery
CBPI and COI better after TPLO (c.f. TTA)
Mullins VS 2020 - Effect of stifle flexion on the position of the cranial tibial artery relative to the proximal tibia in dogs
How did the proximity of the CTartery change upon flexion?
Flexion had no effect on the proximity of the CTA to the prox tibia
Schlag VS 2020 - Center of rotation of angulation-based leveling osteotomy combined with a coplanar cranial closing wedge ostectomy to manage cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angle
What is the definition of an eTPA?
How do you plan a CBLO?
> 34 degrees
First, theTPA line is drawn (illustrated in green). The distal mid-diaphyseal line (illustrated in blue) bisects the medullary cavity at the distal extent of the tibial crest and exits at Gerdy’s tubercle. The proximal mid-diaphyseal line (illustrated in red) starts at the cranial slope of the tibial eminence and crosses the TPA to form the proximal caudal tibial angle reflecting the final TPA. The intersection of the distal and proximal mid-diaphyseal lines represents the location of the CORA, and the angle formed represents the magnitude of the CORA (illustrated in yellow). Planning for resection of the cranial wedge uses two coplanar osteotomies, with the circular saw blades entered at the CORA. The osteotomies (illustrated in purple and orange) converge at the caudal tibial cortex and are separated at the cranial cortex by the amount of wedge resection (illustrated as shaded pink region) previously calculated (tangent of the number of degrees to be corrected with a CCWO × diameter of the bone at the CORA [illustrated in aqua]).
Schlag VS 2020 - Center of rotation of angulation-based leveling osteotomy combined with a coplanar cranial closing wedge ostectomy to manage cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angle
What was the complication rate?
What % had full or acceptable function?
6/28 - 21%
18/28 full function (68%), 3/28 acceptable (11%)
Terreros VS 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
Describe planning of modified CCWO
What was the rate of acceptable- excellent function at long term post-op?
The mechanical axis of the tibia and TPA were measured. Similarly to Christ et al,15 the desired wedge angle was calculated by subtracting 5 from the measured PA value with the objective of obtaining a postoperative TPA of 5(ACB angle). The first osteotomy line (AC) was drawn as a line parallel to the tibial plateau starting 1 mm distal to the point of insertion of the patellar ligament. The second osteotomy line(BD) was planned by using two criteria. First, the proposed osteotomy lines AC and BD were made to intersect at an angle equal to the desired wedge angle. The second criterion was to have an equal measure of lines AC and BD. The rationale for this second criterion was that matching of the proximal and distal segment would be obtained when the segments would be apposed, thereby maximizing bone apposition at the mated surfaces after rotation of the tibial plateau.
15/16 (94%)
Yarnell VS 2019 - Proinflammatory polarization of stifle synovial macrophages in dogs with cruciate ligament rupture
What type of macrophage is ‘proinflammatory’?
M1 - proinflammatory phenotype of macrophages
Giansetto VCOT 2023 - Patellar Proximo-Distal Displacement following Modified Maquet Technique Is Not Predictive of Patellar Luxation
At which angle was the distal displacement of the patella most evident?
135 degrees
Worden VCOT 2023 - Radiographic Comparison of Virtual Surgical Corrective Options for Excessive Tibial Plateau Angle in the Dog
What 6 different tibial osteotomies were assessed?
Which tibial osteotomy resulted in minimal changes in the alignment of the sagittal plane?
TPLO w. CCWO, mCCWO, CCWO, Isosceles CCWO, coplanar-CBLO and neutral isosceles CCWO
TPLO with CCWO
Agnello VCOT 2022 - Arthroscopic Caudal Cruciate Ligament Damage in Canine Stifles with Cranial Cruciate Ligament Disease
What % of dogs had CdCL tearing in CrCL disease?
What types of tears were most common?
94%
Longitudinal
Cieciora VCOT 2022 - Ex Vivo Evaluation of the Cranial Tibial Artery and Its Compression through Fragment Rotation during Tibia Plateau Levelling Osteotomy: An Angiographic Three-Dimensional Reconstruction
What was the main finding of this paper?
Proximal fragment rotation after TPLO reduced cranial tibial artery size by 81%.
Kmieciak VCOT 2022 - Comparison of two stifle exploratory methods using mini-arthrotomy for diagnosis of canine medial meniscal pathology: An ex vivo study
What two techniques were compared?
What was the conclusion?
Stifle distractors or Hohmen/Senn
No difference between the two techniques
Schmutterer VCOT 2022 - Evaluation of Meniscal Load and Load Distribution in the Canine Stifle after Tibial Plateau Levelling Osteotomy with Postoperative Tibia Plateau Angles of 6 and 1 Degrees
How was the meniscal load affected by the TPLO w. 6 or 1 degree angles?
Contact force on both menisci reduced after TPLO w. TPA 1 degree
Shimda VCLT 2022 - Prophylactic Efficacy of Tibial Plateau Levelling Osteotomy for a Canine Model with Experimentally Induced Degeneration of the Cranial Cruciate Ligament
What was the main finding?
Protective benefit of a TPLO on a partial cruciate
CCL degeneration induced by creation of excessive TPA can be suppressed by reducing biomechanical load by performing TPLO.
Tomo VCOT 2022 - Evaluation of Hindlimb Deformity and Posture in Dogs with Grade 2 Medial Patellar Luxation during Awake Computed Tomography Imaging while Standing
What was the main finding?
No significant differences between bone morphology of dogs with/without Grade 2 MPL.
Laube VCOT 2021 - Prevalence and risk factors for bilateral meniscal tears identified during treatment for cranial cruciate ligament disease via tibial plateau levelling osteotomy in dogs
What % of dogs have bilateral meniscal tears (meniscal tear in both stifles)?
What factors increased the risk of bilateral meniscal tears?
48%
Rottweilers, smaller dogs and complete CCL rupture
Terreros VCOT 2021 - Prospective evaluation of a citrate-based biomaterial wedge for a modified maquet procedure in the treatment of cranial cruciate ligament rupture in dogs
What % had major complications (and what were they)?
What was the most common minor complication?
What was the rate of minor complications?
What was the acceptable/full function rate?
3/15 - 20%. SSI
non-displaced cortical hinge fracture
9/15 - 60%
85%
Cox VCOT 2020 - Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture
What was the SSI rate?
What % of SSI cases required removal of suture?
What factors were associated with SSI?
17%
53%
BW or induction using propofol
Fox VCOT 2020 - Average Tibial Plateau Angle of 3,922 Stifles Undergoing Surgical Stabilization for Cranial Cruciate Ligament Rupture
What was the average pre-op TPA?
What breeds had a lower TPA?
WHat breeds had a higher TPA?
29 degrees
Labrador, Cane corso, GSD, and Rottie
WHWT, Dobermann, Yorkshire Terrier, Bichon Frise
Knebel VCOT 2020 - Outcome after Tibial Plateau Levelling Osteotomy and Modified Maquet Procedure in Dogs with Cranial Cruciate Ligament Rupture
What was the difference between the outcome between TPLO and MMP?
Compared with controls, TPLO group reached greater % PVF and VI vs MMP group.
No significant difference between TPLO/MMP in outcome, major complications or OA progression. (76 joints)
Vezzoni VCOT 2020 - Use of a Modified Tibial Plateau Levelling Osteotomy with Double Cut and Medial Crescentic Closing Wedge Osteotomy to Treat Dogs with Cranial Cruciate Ligament Rupture and Tibial Valgus Deformity
Describe the procedure
Correction angle = affected mMPTA - contralateral mMPTA. Wedge measured and marked on medial tibial cortex at D3 measurement site (caudal cortex), then 2nd cut made at angle to 1st.
Agnello VCOIT 2019 - Arthroscopic Articular Cartilage Scores of the Canine Stifle Joint with Naturally Occurring Cranial Cruciate Ligament Disease
What part of the joint had the most severe cartilage scores?
Proximal trochlear groove
De la Puerta VCOT 2019 - Prevalence, risk factors and outcomes of postoperative tibial tuberosity fractures in dogs undergoing triple tibial osteotomy surgery
Describe a TTO plan
What was the rate of TT fractures?
What was associated with an increased risk of TT fracture?
How was the TT fracture managed?
See pic
22% (25/113)
Post-op cortical hinge width of LESS than 5.5mm
Conservative management
Livet VCOT 2019 - Comparison of outcomes associated with tibial plateau levelling osteotomy and a modified technique for tibial tuberosity advancement for the treatment of cranial cruciate ligament disease in dogs: a randomized clinical study
What was the modified TTA technique reported?
What was the difference in outcome?
TTA rapid
No difference in complication rate or gait parameters @ 6m PO
McGregor VCOT 2019 - A Retrospective Study Using the String of Pearls Tibial Plateau Levelling Osteotomy Locking Plate for the Treatment of Cranial Cruciate Ligament Disease
What was the complication rate?
What was observations were made by authors about SOP TPLO plate?
How did the SOP TPLO plate compare to other TPLO locking plates?
25%
Difficulty with screw placement & optimal plate positioning + no option for compression.
Lower grade bone union at 6-8 weeks post-op (lower than other TPLO plates)
Tanegashima VCOT 2019 - Functional anatomy of the craniomedial and caudolateral bundles of the cranial cruciate ligament in Beagle dogs
Which part of the cranial cruciate ligament is tense throughout stifle ROM?
Craniomedial
Colthurst JSAP 2022 - Comparison of incidence of medial meniscal injury in small dogs (≤15 kg) and medium-to-large dogs (>15 kg) with naturally occurring cranial cruciate ligament disease undergoing tibial plateau levelling osteotomy: 580 stifles (2015-2019)
What was the rate of meniscal tears?
What factors were associated with the identification of meniscal tears?
37% large dogs, 38% small dogs
Degree of CCL rupture and use of arthroscopy
1.8% small breed (long term) 8% large breed
Boge JFMS 2020 - Cranial cruciate ligament disease in cats: an epidemiological retrospective study of 50 cats (2011–2016)
What % became bilateral?
What treatment had a lower FMPI score?
What was the rate of concurrent meniscal injury and post-op complications?
14%
Conservative management
47% meniscal, 27% PO complications
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
What was the ‘novel’ extracapsular suture?
What was the biomechanical difference between the two techniques?
MiniTightrope (Arthrex)
Both neutralised excessive CrTT. No difference in external rotation between techniques.
Stoneburner JAVMA 2022 - Conservative nonsurgical treatment for cranial cruciate ligament disease can be an effective management strategy in cats based on validated owner-based subjective assessment in some cases
What was the owner reported rate of good-excellent outcome?
94%
Banks VS 2024 - A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases
What was associated with an increased risk of under-correction?
When ostectomy was distalised >7.5mm
Keider VS 2024 - Caudal pole meniscectomy through an arthroscopic caudomedial portal in dogs: A cadaveric study
How was the caudomedial portal created?
What damage was observed in the collateral/caudal cruciate?
A 20G 70 mm needle inserted 1 cm caudal to the most prominent medial tibial condyle. Percutaneous transillumination
NONE
Knudsen VS 2024 - Diagnosis of medial meniscal lesions in the canine stifle using multidetector computed tomographic positive-contrast arthrography
What was the sens/spec for CT arthrography?
0.62-1.00 Sens and 0.70-0.96 Spec
>1.5 total –> CT arthrography useful
Sanders VS 2024 - Influence of antiseptic lavage during tibial plateau leveling osteotomies on surgical site infection in 1422 dogs
What was the influence of antiseptic lavage?
How did single session bilateral TPLO affect the infection odds?
What factors affected SSI rate?
NO BENEFIT
Increased infection odds by 2.5x
Single session bilateral TPLO increased infection odds by 2.5x
BW (increased by 11% for every 5kg), post-op AB decreased risk
Story VS 2024 - Morphologic impact of four surgical techniques to correct excessive tibial plateau angle in dogs: A theoretical radiographic analysis
What 4 surgical techniques were compared?
TPA correction was best in which groups?
Tibial shortening was identified in which groups?
Which group had the greatest mechanical shift?
Group A: CBLO & CCWO, B: TPLO & CCWO, C: mCCWO, D: proximal tibial neutral wedge osteotomy (PTNWO)
CBLO + CCWO (A) and PTNWO (D)
TPLO + CCWO
CBLO + CCWO
Rocheleau VS 2024 - Short-term outcomes of 43 dogs treated with arthroscopic suturing for meniscal tears associated with cranial cruciate ligament disease
What was the complication rate?
What was the rate of successful repairs?
What additional surgical procedures should be performed?
34%
38/44 (86%)
TPLO and lateral suture
Evers VS 2023 - Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture
What was the sens/spec for detection of meniscal tears?
Sens 95% spec 100% of needle arthroscopy for meniscal tears (normal arthroscopy given as gold standard)
visibility of meniscus lower, probing lateral meniscus harder, procedure time was shorter.
No difference in lameness scores before and after NA
McLean VCOT 2024 - Effect of Plate Inclination and Osteotomy Positioning on Rock-back following Tibial Plateau Levelling Osteotomy in Dogs
What % of TPLOs get rockback?
What was the mean increase in TPA?
21% of TPLOs
3.2 degrees
Plate inclination and exit cut angle not linked to rockback
Dallago 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
What plates are used and what offsets do they have?
What translation is achieved by each plate?
Fixin plates (+2, +4, +6)
+4mm - 2.93mm
+6mm - 5.03mm
Alvarez VCOT 2024 - In Vitro Assessment of Compression Patterns Using Different Methods to Achieve Interfragmentary Compression during Tibial Plateau Levelling Osteotomy
What method resulted in the most even distribution of high interfragmentary compression forces?
Pointed reduction forceps and compression screw - resulted in most even distribution of high interfragmentary compression forces.
Addition of kern forceps marginally increased cranial compression but decreased caudal compression
Looi VCOT 2023 - Effects of Angled Dynamic Compression Holes in a Tibial Plateau Levelling Osteotomy Plate on Cranially Directed Fragment Displacement
What biomechanical difference is seen between the two plates?
What is effect of these biomechanical differences?
No change in TPA
No change in prox-distal displacement
Greater craniocaudal displacement
Reduced intrafragmentary distance (more compression) across osteotomy
Schmutterer VCOT 2023 - Meniscal Load and Load Distribution in the Canine Stifle after Modified Tibial Tuberosity Advancement with 9 mm and 12 mm Cranialization of the Tibial Tuberosity in Different Standing Angles
What was the biomechanical difference between 9mm TTA and 12mm TTA?
TTA with 12mm cranialization sufficiently restored stifle kinematics in 135 & 145 degrees but 9mm TTA failed to at 135.
Pacheco JAVMA 2023 - Cranial tibial translation measurements for radiographic diagnosis of cranial cruciate ligament rupture in dogs
What novel variable was identified to help diagnose cruciate ligament rupture?
What value is deemed to be indicative of CCL rupture?
DPOI ratio (the linear distance between the points of CCL origin and insertion compared with and without tibial compression)
> 1.18
MacCormick JAVMA 2023 - Use of a jumbo plate in dogs greater than 50 kg following tibial plateau leveling osteotomy does not prevent increase in tibial plateau angle through convalescence
What was the rate of post-op complications?
45.8%
Upchurch JSAP 2024 - Two doses of subcutaneous methadone for postoperative analgesia in dogs undergoing tibial plateau levelling osteotomies
What was the conclusion of this study?
Two doses of methadone at either 0.25 or 0.5 mg/kg administered via subcutaneous injections pre-operatively and 4 hours later, along with 4.4 mg/kg carprofen subcutaneously 8 hours after the first methadone dose appear to provide sufficient pain control for up to 12 hours in dogs undergoing tibial plateau levelling osteotomy.
Pye JSAP 2023 - Determining predictive metabolomic biomarkers of meniscal injury in dogs with cranial cruciate ligament rupture
What biomarkers were identified?
Increase in nuclear magnetic resonance mobile lipids (mbile lipid-CH3, mobile lipid -n(CH3)3 and mobile unsaturate lipid)
Franklin JSAP 2023 - Complications and postoperative non-steroidal anti-inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment
What three extracapsular repairs were reviewed?
What factors were associated with a higher rate of major complications?
What was the risk of requiring long-term NSAIDs for a 15kg patient?
Fabellotibial suture, Tightrope and Ligafiba Isotoggle
Young dogs (1 yr) and >15kg
The predicted risk of requiring repeated non-steroidal anti-inflammatory drug prescriptions in the 18-month postoperative period for an 15 kg patient was 37% to 39%
Peress VCOT 2021 - Comparison of Intra- and Postoperative Complications between Bilateral Simultaneous and Staged Tibial Plateau Levelling Osteotomy with Arthroscopy in 176 Cases
What is the complication rate for staged vs simultaneous TPLOs?
What is the MAJOR complication rate for staged vs simultaneous TPLOs?
Does this agree with previous literature?
Simultaneous 47%, staged 19%
Major - Simultaneous 10%, staged 4%
TT fractures in 2% of simultaneous group, none of staged group.
NO - Kelsey VCOT 2019 - no sig.difference between staged/simultaneous but much lower case numbers.
Kelsey VCOT 2019 - Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study
What was the difference in the complication rate between simultaneous and staged?
Simultaneous 18%, Staged 33%
This was not significant
Clough VS 2022 - Combined center of rotation of angulation-based leveling osteotomy and tibial tuberosity transposition: An ex vivo mechanical study
What was the main finding?
No difference in mean load to failure was identified between CBLO-TTT (897 N) and CBLO alone (943 N).
There was also no difference in the mean load to failure between the CBLO-TTT (928 N) and TTT alone (1046 N).
Hackett VCOT 2021 - Comparison of Outcome and Complications in Dogs Weighing Less Than 12 kg Undergoing Miniature Tibial Tuberosity Transposition and Advancement versus Extracapsular Stabilization with Tibial Tuberosity Transposition for Cranial Cruciate Ligament Disease with Concomitant Medial Patellar Luxation
What was the difference in outcome between TTT/TTA and LatSut w. TTT groups?
How was the TTA modified to increase the TT bone stock?
No sig difference in overall outcome
The osteotomy was notched at the distal aspect to both increase tuberosity bone stock to accommodate the cranial aspect of the tibial tuberosity advancement plate and to decrease the risk of creating a stress riser with the distal plate screw holes
Hackett VCOT 2021 - Complications and Long-Term Outcomes after Combined Tibial Plateau Leveling Osteotomy and Tibial Tuberosity Transposition for Treatment of Concurrent Cranial Cruciate Ligament Rupture and Grade III or IV Medial Patellar Luxation
What was the rate of complete resolution of the MPL?
What was the major complication rate?
23/24 - 96%
4/24 major complications (3x SSI and 1x recurrent MPL) - 17%
Anderson VCOT 2024 - Permanent Iatrogenic Fibular Nerve Injury following Tibial Plateau Levelling Osteotomy
What were the signs of fibular never injury?
What did all the cases of fibular nerve injury have in common?
Cranial tibial muscle atrophy, absent hock flexion, mild lameness
Drill tract on the caudal aspect of the tibia, immediately distal to the tibial osteotomy
Worden VCOT 2023 - Radiographic Comparison of Virtual Surgical Corrective Options for Excessive Tibial Plateau Angle in the Dog
What surgical corrective option has the least affect on the tibial geometry?
TPLO/CCWO
Murphy VCOT 2024 - The Prevalence and Risk Factors of Contralateral Cranial Cruciate Ligament Rupture in Medium-to- Large (>15kg) Breed Dogs 8 Years of Age or Older
What % of dogs that experience CCLR @ 8tyo will rupture contralateral side?
What risk factors are associated with an increased likelihood of a contralateral CCLR?
19%
Breed (Golden Retriever, Labrador), decreasing age
Hamilton JSAP 2020 - The natural history of canine occult Grade II medial patellar luxation: an observational study
What % of dogs required surgery or developed chronic pain?
50%
Beer VCOT 2023 - Comparison of Hindlimb Conformation in Cats with and without Medial Patellar Luxation
What hindlimb conformation was observed in cats with MPL?
Both high and low-grades –> medialization of the tibial tuberosity and a shallow trochlear groove. Authors suggest that TTT is likely only necessary in grade 3 and 4 cats.
High grade - decreased proximal femoral anteversion and aLDFA relative to a normal cat population
Decreased aLDFA suggests that cats with medial patellarluxation do not suffer from distal femoral varus
Mills JSAP 2020 - Treatment of feline patellar luxation with polyethylene sulcal ridge prostheses
What is the prosthesis called?
How does its position differ in cats (c.f. dogs)?
RidgeStop implant
Positioned more abaxially in cats vs dogs due to typically shallow trochlear sulcus.
Brioschi VCOT 2020 - Computed Tomographic Assessment of Block Recession Trochleoplasty and Partial Parasagittal Patellectomy in Cats
What was the main finding?
Area of contact between patella & femoral trochlea significantly reduced & depth of patellar recession unchanged after block recession trochleoplasty.
AOC was then significantly increased after partial parasagittal patellectomy.
Nagahiro VCOT 2020 - Segmental Femoral Ostectomy for the Reconstruction of Femoropatellar Joint in Dogs with Grade IV Medial Patellar Luxation
Describe the procedure briefly
What was the mean resected femoral length?
What was the outcome?
See pic
14% of femoral length
Stability and congruity of femoropatellar joint was markedly improved
Sasaki VCOT 2023 - Measurement of Femoral Trochlear Morphology in Dogs Using Ultrasonography
How were the measurements taken?
What was observed as the dogs matured/grew?
Sulcus angle (SA) was determined - the angle between the medial and lateral facets. Smaller the angle - the deeper the trochlea groove
Authors measured it from cartilaginous border and osseous border
Angle progressively decreased for osseous SA until 6m, cartilaginous SA did not change. The contour of the articular cartilage surface of the femoral trochlea is already determined early in life, and ossification of the articular cartilage of the femoral trochlea proceeds until 6 months of age.
Longo VS 2022 - Three-dimensional volume rendering planning, surgical treatment, and clinical outcomes for femoral and tibial detorsional osteotomies in dogs
Briefly describe the planning process.
How did authors decide on amount of rotation?
What % of cases had full/acceptable function?
What was the major complication rate, and what was the most common major complication?
See pic
The target torsion angle was set based on the contralateral normal torsion angle or, when the contralateral side was also affected, on the reference torsion angle values. The cortical arch length (amount to be rotated (mm)) is calculated with the formula (2 x π x R [corrective torsion angle/360])
17/18 (94%)
2/22 (9%) - iatrogenic femoral internal torsion
Longo VS 2023 - Computed tomographic measurements of the femoral trochlea in dogs with and without medial patellar luxation
Which measurement was the only one to be deemed reliable?
What ‘cutoffs’ were used to determine if a dog should have a trochleaplasty?
Femoral Trochlea Groove Angle (FTGA)
A FTGA <134 degree (small breed) and < 128 degree (medium/large breed) may be considered as a cut-off for trochleoplasty decision-making.
Nagahiro VS 2023 - Evaluation of the quadriceps muscle length to femoral length ratio in small breed dogs with medial patellar luxation
How did the QML differ in dogs with MPL?
Small breed dogs w. gr 4 MPL had a shortened QML (due to femoral deformities)
Ocal VCOT 2020 - Comparison of Insall-Salvati index and its modification in normal dogs from four different body weight groups
What does the Insall-Salvati index measure?
How is it usually calculated?
What is the modification suggested by these authors and why do they suggest this modification?
Insall-Salvati (IS) is one of the indices used to measure patellar proximodistal position and identify patella alta and baja on lateral stifle radiographs.
The IS index is calculated by dividing the caudal patellar ligament length by the patellar length. The caudal patellar ligament length is measured between the apex of the patella to the insertion on the tibial tuberosity with a small notch along the caudal aspect of the ligament.
The cranial ligament length is measured. The caudal notch is not always determined because the variations in the tibial tuberosity and tibial crest are common
Carrera VCOT 2024 - Early Surgical Management of Medial Patellar Luxation in Juvenile Dogs
What was the most common surgery performed in this population?
DFO and TTT
Dumitru VCOT 2023 - Partial Parasagittal Patellectomy in Dogs: A Retrospective Case Series of 19 Dogs
What other procedures were performed concurrently?
What was the long term outcome in these cases?
TTT, Block sulcoplasty
No reluxation and good to excellent in all cases
Brincin VS 2023 - The value of routine radiographic follow up in the postoperative management of canine medial patellar luxation
What % of cases had a change in recommendations if owner/vet had no concerns?
3%
Dogs that were presented for routine follow up after unilateral MPL surgery without owner concerns, lameness, analgesic treatment or a history of unplanned visits, and for which examination by a surgical specialist was unremarkable, were unlikely to benefit from radiographs
Blackford VCOT 2021 - Comparison of Semi-Cylindrical Recession Trochleoplasty and Trochlear Block Recession for the Treatment of canine MPL: A Pilot study.
What was the difference in outcome between techniques?
Which technique was subjectively easier to perform?
No difference in outcome
Semi-cylindrical trochleoplasty
Ericksen JAVMA 2023 - Dome trochleoplasty for correction of patella alta and patella luxation in dogs > 20 kg
Briefly describe this technique
What was the complication rate?
See pic. Osteotomy was secured with divergent K wires
50% (43% major complications)
Nicetto VCOT 2024 - Trochlear Ridge Prostheses for Reshaping Femoral Trochlear Ridges in Dogs with Patellar Luxation
Describe the process of implantation?
In what % of cases was it used as the sole surgical procedure?
At final follow up - full function was observed in what % of cases?
What was the major complication rate, and what was the most common major complication?
See pic
40%
95%
1/60 (2%) - reluxation
Cortina VS 2023 - Outcomes and complications of a modified tibial tuberosity transposition technique in the treatment of medial patellar luxation in dogs
Describe the modification to the TTT described by the authors
What was the major complication associated with this procedure?
What were the reported major and minor complication rates associated with this procedure?
Application of a lateral holding pin
Pin migration (not reluxation!)
4% major, 15% minor
Onis VCOT 2023 - Evaluation of Surgical Technique and Clinical Results of a Procedure-Specific Fixation Method for Tibial Tuberosity Transposition in Dogs: 37 Cases
Describe the ‘Procedure-Specific Fixation Method’ and what is the name of the implant?
What was the major and minor complication rate?
Rapid luxation plating system - see pic (involves plates and spacers)
8% major, 35% minor - No implant-related complications or tibial tuberosity avulsions or fractures were seen.
Eskelinen VCOT 2023 - Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study
How did use of this plate compare biomechanically to pin -TBW?
Plate-pin/Plate-pin-TBW resisted higher loads than Pin-TBW constructs.
Hawbecker VCOT 2023 - Influence of Kirschner-Wire Insertion Angle on Construct Biomechanics following Tibial Tuberosity Osteotomy Fixation in Dogs
What was the conclusion of this paper?
K wires placed transversely were biomechanically superior (without TBW) to those placed in caudodistal (30 degree) orientation
Increased yield force 1.6x, peak force 1.3x and failure force 1.4x
Rossanese VOCT 2019 - Complications Following Surgical Correction of Medial Patellar Luxation in Small-to-Medium-Size Dogs
What was the complication rate? (minor and major)
Which TTT stabilisation technique was associated with more complications?
What would reduce risk of implant-related complications?
What increased risk of complications?
37% total (12% minor and 25% major)
NONE - no stat. significance was observed
Preservation of TT distal cortical attachment
Caudoproximal K wire direction (contrary to Hawbecker paper) and performing medial release
Zide VCOT 2020 - A Cadaveric Evaluation of Pin and Tension Band Configuration Strength for Tibial Tuberosity Osteotomy Fixation
What were the findings of this paper?
No effect of pins being vertically vs horizontally aligned in TT.
Tension band constructs were significantly stronger than pin-only constructs - similar load to failure as control tibias.
Feldmane VS 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
How did the position of the insertion of the patellar ligament differ between normal and gr2 MPL dogs?
Gr2 MPL had a more proximal patellar ligament insertion (c.f. unaffected dogs)
McCagherty VCOT 2020 - Effect of stifle flexion angle on the repeatability of real-time elastosonography of the patellar ligament in medium- to large-breed dogs
What do the authors suggest to limit variability in elastosonography?
Should be performed with the dog standing
Cinti VCOT 2022 - A New Generation of Osteochondral Autograft Transfer System for the Treatment of Osteochondritis Dissecans of the Femoral Condyle: Clinical Experience in 18 Dogs
What system was utilised?
What was the major complication rate?
What was long term outcome (3m)?
COR precision targeting system (Synthes)
0%
14/18 (78%) of dogs had no lameness
Allberg VCT 2020 - Measurement of patellar proximodistal positioning with limited joint-angle sensitivity
What landmarks are utilised to measure proximodistal positioning of patellar?
Caudal aspect of femoral condyles, caudal aspect of tibial plateau, apex of patella
Relatively unaffected by joint flexion/extension
Lee JFMS 2023 - Biomechanical evaluation of three fixation methods in a feline transverse patella fracture model
What was the strongest fixation technique?
Circumferential and figure-of-8 Fiberwire fixation
McKay VS 2023 - Biomechanical evaluation of three adjunctive methods of orthopedic tension band-wire fixation to augment simulated patella tendon repairs in dogs
What 3 fixation techniques were performed?
Which was the strongest?
Locking loop and epitendinous pattern. 18G 316L wire anchored to tibial crest placed either 1) transpatellar 2) suprapatellar or 3) combined TBW augmentation
Combined TBW (transpatellar and suprapatellar) augmentation
Fitzpatrick VS 2021 - Custom-built constrained uniaxial and rotating hinge total knee replacement in cats: Clinical application, design principles, surgical technique, and clinical outcome
Out of 9 cases, how many had a catastrophic outcome?
1 catastrophic outcome - patellar ligament rupture & arthrodesis.
3 good outcomes, 5 excellent outcomes.
3rd gen implants semi-constrained with some internal/external rotation allowed + hydroxyapatite surface for bone on-growth.
Coppola JFMS 2022 - Traumatic stifle injury in 72 cats: a multicentre retrospective study
What was the most common injury observed?
What post-op immobilisation and injury was associated with a poorer outcome?
What was the overall good-excellent outcome?
What was the short term complication rate?
Both cruciate ligaments ruptured and lateral collateral
Transarticular pin was associated with a poorer outcome and higher risk of complications. Other postop immobilisation/no immobilisation not related to outcome.
Medial meniscal injury was associated with a poorer outcome.
62%
63%
Pownall VS 2021 - The influence of the choice of pre-emptive analgesia on long-term postsurgical pain after tibial plateau leveling osteotomy in dogs
What % of dogs were identified to have chronic pain post-tplo?
What was identified to be a risk factor for chronic pain?
What pre-emptive analgesia was associated with chronic pain?
41%
Increased weight
None
