Outcomes and complications of a modified tibial tuberosity transposition technique in the treatment of medial patellar luxation in dogs.

OBJECTIVE: To report a modification of the tibial tuberosity transposition (m-TTT) technique used to treat medial patellar luxation (MPL) in dogs, and report its complications. STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Dogs (n = 235) undergoing MPL correction, using m-TTT (n = 300 stifles). METHODS: Medical records and client surveys were reviewed to determine complications associated with this technique and they were compared with previously reported complications using similar techniques. RESULTS: Short-term minor complications included low-grade reluxation (11 stifles, 3.6%), incisional seroma (nine stifles, 3%), pin-associated swelling (seven stifles, 2.3%), patellar desmitis (six stifles, 2%), superficial incisional infection (four stifles, 1.3%), pin migration (three stifles, 1%), tibial tuberosity (TT) fracture (two stifles, 0.6%), tibial tuberosity displacement and patella alta (one stifle, 0.3%), pin-associated discomfort (one stifle, 0.3%), trochlear block fracture (one stifle, 0.3%). Short-term major complications included pin migration (three stifles, 1%), incisional infection (two stifles, 0.6%), tibial tuberosity fracture (two stifles, 0.6%), and high grade reluxation (two stifles, 0.6%). Long-term follow-up examination data were available for 109/300 (36.3%) stifles. One minor complication and four major complications were documented. All long-term complications were due to pin migration. The overall major complication rate was 4.3% (13/300 stifles), with a minor complication rate of 15% (46/300 stifles). The owner survey indicated a 100% satisfaction rate. CONCLUSION: The m-TTT technique yielded acceptable complication rates, with high owner satisfaction. CLINICAL SIGNIFICANCE: The m-TTT should be considered as an alternative technique for treating dogs with MPL requiring a tibial tuberosity transposition.

Prospective Evaluation of a Citrate-Based Biomaterial Wedge for a Modified Maquet Procedure in the Treatment of Cranial Cruciate Ligament Rupture in Dogs.

OBJECTIVE: The aim of this study was to describe short- and mid-term outcomes, complications, implant bioabsorption and owner satisfaction for a modified Maquet procedure (MMP) in which a novel bioabsorbable citrate-based implant is used as the wedge component to treat cranial cruciate ligament rupture in client-owned dogs. STUDY DESIGN: Prospective clinical study of dogs (n = 13) undergoing MMP (n = 15). Intraoperative complications, postoperative complications, clinical follow-up using a 5-point lameness score and radiographs at 8 weeks and 6 months postoperatively were obtained. Mid-term outcome was assessed via physical examination, radiographs, canine orthopaedic index and owner satisfaction questionnaires. RESULTS: No catastrophic complications occurred. Major complications occurred in 3/15 stifles. All were surgical site infections and one case required implant removal. Minor complications occurred in 9/15 stifles. Non-displaced cortical hinge fractures were the most common minor complication, and these occurred intraoperatively (4/15) or postoperatively (2/15). Three dogs achieved full function, eight dogs acceptable function and the outcome was unacceptable in two dogs. Most owners were satisfied with the procedure (11/13). Complete implant bioabsorption was not confirmed on mid-term radiographs. CONCLUSION: The described MMP with a citrate-based implant can produce satisfactory mid-term results. However, the long-term outcome of this procedure must be evaluated and technical modifications need to be implemented prior to larger-scale use of this implant.

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.

OBJECTIVE: To report midterm to long-term outcomes of dogs with cranial cruciate ligament (CCL) rupture and excessive tibial plateau angles (TPA) treated with a modified cranial closing wedge osteotomy (m-CCWO). STUDY DESIGN: Retrospective case series. STUDY POPULATION: Dogs (n = 21) with CCL rupture and excessive TPA treated with m-CCWO (n = 28). METHODS: Medical records, midterm and long-term follow-up radiographic examination records, Canine Orthopedic Index data, and owner surveys were reviewed to determine functional outcomes, owner satisfaction, and complications associated with the technique. RESULTS: Tibial plateau angle decreased from 42.3° ± 4.8° preoperatively to 4.8° ± 3.3° after m-CCWO. No catastrophic complications occurred, while major and minor complications occurred in three of 28 and six of 28 stifles, respectively. Canine Orthopedic Index scores and owner surveys were available in 16 of 21 dogs at a median of 608 days postoperatively (range 279-1225). Functional midterm or long-term outcomes for these dogs treated with m-CCWO were excellent in eight dogs, acceptable in seven dogs, and unacceptable in one dog. Progression of osteoarthritis was noted on all midterm and long-term follow-up radiographs. All owners but one were satisfied. CONCLUSION: Modified cranial closing wedge osteotomy was associated with an acceptable morbidity and resulted in satisfactory functional outcomes in most dogs of this series. CLINICAL SIGNIFICANCE: Modified cranial closing wedge osteotomy should be considered as an alternative to treat CCL rupture in dogs with excessive TPA.

A prospective, randomized, double-blinded, placebo-controlled clinical study on postoperative antibiotherapy in 150 arthroscopy-assisted tibial plateau leveling osteotomies in dogs.

OBJECTIVE: To determine the influence of a 7-day course of postoperative antibiotherapy (cefpodoxime) on surgical site infections (SSI) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical study. SAMPLE POPULATION: One hundred fifty client-owned dogs, with consent. METHODS: Dogs undergoing arthroscopy-assisted TPLO were randomly assigned to 1 of 2 groups, the placebo group receiving perioperative cefazolin and 7 days of placebo medication after surgery or the treatment group receiving perioperative cefazolin and 7 days of postoperative cefpodoxime. Twenty-seven factors were analyzed for association with SSI by using univariate analysis, Fisher's exact test, or Wilcoxon rank-sum test. RESULTS: SSI rates did not differ (P = .34) between the placebo group (17%; 95% confidence level [CL] 7.94%-26.43%) and the treatment group (11% SSI; 95% CL 3.98%-18.88%). The probability that > 23% of dogs would benefit from postoperative antibiotherapy was less than 5%. The only association between the factors tested in this study and SSI involved the body weight (kg), with each 1 unit increase in kilogram weight increasing the odds of developing an SSI by 4.7%. CONCLUSION: Although the wide CL may be consistent with a type II error, a 7-day course of cefpodoxime after arthroscopy-assisted TPLO did not influence postoperative SSI in the population tested here. In addition, only a small proportion of dogs would benefit from postoperative antibiotherapy under the conditions of our study. CLINICAL SIGNIFICANCE: These results should prompt surgeons to reconsider systematic antibiotherapy after TPLO and justify additional studies to determine whether dogs predisposed to infection could benefit from such an approach.

A modified Maquet-tibial tuberosity advancement technique for treatment of canine cranial cruciate ligament disease: Short term outcome and complications.

OBJECTIVE: To describe and report the outcomes of a novel modified Maquet-tibial tuberosity advancement (mTTA) technique in dogs with naturally occurring cranial cruciate ligament (CCL) rupture, compared to a traditional tibial tuberosity advancement (tTTA) technique. STUDY DESIGN: Descriptive report and retrospective clinical cohort study. SAMPLE POPULATION: Dogs (n = 70) treated via tibial tuberosity advancement (TTA). METHODS: Medical records (2013-2015) of dogs treated for CCL rupture via TTA were reviewed for: signalment, findings on physical examination, procedure (tTTA or mTTA), radiographs, complications, and outcome. Radiographs were retrospectively evaluated for patellar tendon thickness, evidence of tibial crest fractures, and implant placement. Intraoperative and postoperative complications and outcome were compared between procedures. RESULTS: A total of 70 cases met inclusion criteria, 35 of each procedure (tTTA or mTTA). The mTTA procedure was successfully performed with good clinical and radiographic outcomes. The only difference in outcomes detected between groups is that dogs were more lame 2 weeks after tTTA than mTTA group. CONCLUSION: The mTTA technique represents a safe, repeatable alternative to the tTTA, with similar outcome and complication rates.

Short-term complications associated with TPLO in dogs using 2.0 and 2.7 mm plates.

The purpose of this study was to evaluate short-term complications associated with the tibial plateau leveling osteotomy (TPLO) procedure in dogs of small and medium sizes. These study findings could then be compared with similar studies in dogs of all sizes. Ninety-eight procedures (82 dogs) using 2 or 2.7 mm TPLO plates were included spanning a 6 yr period with a minimum of an 8 wk follow-up period. The overall complication rate was 36%. Complications were grouped into three categories: intraoperative (2%), those occurring up to 2 wk postoperatively (11%), and those occurring >2 wk postoperatively (30%). Radiographic evidence of delayed healing of the TPLO osteotomy site was the most common complication in the dogs (9%), none of which had clinical signs attributed to delayed healing. Other common complications included patellar tendon thickening (8%) and tibial tuberosity fracture (6%). Seven percent of the complications were considered major (requiring additional surgical intervention). Fifty-two percent of complications did not require treatment. Short-term complications should not dissuade an experienced surgeon from performing the TPLO procedure in small- and medium-sized dogs.

A prospective evaluation of CT in acutely paraparetic chondrodystrophic dogs.

The clinical usefulness of computed tomography (CT) as a sole diagnostic modality in identifying disc lesion(s) in chondrodystrophic breeds presenting with acute signs of intervertebral disc disease (IVDD) is incompletely characterized. CT was used prospectively to determine the validity of this tool. Neurologic examinations and CT scans were performed on all dogs at presentation. Surgical decompression was based on those findings. Clinical follow-up examinations were performed on days 1 and 14 postsurgically. CT detected a lesion consistent with clinical findings in 63 of 69 cases (91%). All 63 dogs with Hansen type I IVDD lesions were identified on CT alone. The surgeon and radiologist agreed on lesion level in 72 of 78 lesions (92%) and lateralization in 71 of 78 lesions (91%). Improvement in neurologic grade was documented in 60 of 69 dogs (87%) by 14 days. CT imaging can be used as a single imaging modality in chondrodystrophic dogs presenting with acute paresis. CT used in this manner is a reliable and noninvasive tool for detecting spinal compression secondary to IVDD in chondrodystrophic dogs.

Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology.

OBJECTIVE: To compare the effects of locking and conventional screws on postoperative tibial plateau angle (TPA), osteotomy healing, and complication rate after tibial plateau leveling osteotomy (TPLO) in dogs treated for naturally occurring cranial cruciate ligament (CCL) rupture. STUDY DESIGN: Prospective clinical study. STUDY POPULATION: Dogs (n=118) with CCL rupture. METHODS: Dogs (> or =20 kg) with unilateral CCL rupture and sufficient bone stock for TPLO and use of a 3.5-mm-broad or -narrow TPLO plate were sequentially allocated to have plate fixation with locking or conventional screws. Data analyzed included breed, age, sex, body weight, body condition score, limb operated, implants used, meniscal status, operative time, and days to recheck. Preoperative, immediate postoperative, and 8-week recheck mediolateral radiographs were reviewed, and TPA, complications, and healing status were evaluated. RESULTS: Stifles in the locking screw group had significantly less change in postoperative TPA than stifles in the conventional screw group. Locking screw fixation also had significantly higher grades of osteotomy healing, assessed on a mediolateral radiographic view. CONCLUSIONS: TPLO plates secured with locking screws are acceptable when compared with those secured with conventional screws; osteotomy healing is improved and TPA better conserved when using locking screws. CLINICAL RELEVANCE: Locking screw fixation serves to increase stabilization of TPA during TPLO healing and provides improved radiographic evidence of osteotomy healing.