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Randy J Boudrieau - One of the best experts on this subject based on the ideXlab platform.
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novel tplo alignment jig saw guide reproduces freehand and ideal Osteotomy positions
PLOS ONE, 2016Co-Authors: Abigail D Mariano, Michael P Kowaleski, Randy J BoudrieauAbstract:Objectives To evaluate the ability of an alignment jig/saw guide to reproduce appropriate Osteotomy positions in the tibial plateau leveling Osteotomy (TPLO) in the dog. Methods Lateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand Osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005–Dec 2007 and Nov 2013–Nov 2015 were reviewed. The freehand Osteotomy position was compared to potential Osteotomy positions using the alignment jig/saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the Osteotomy performed. The guide-to-Osteotomy fit was categorized by the distance between the actual Osteotomy and proposed saw guide Osteotomy at its greatest offset (≤1 mm = excellent; ≤2 mm = good; ≤3 mm = satisfactory; >3 mm = poor). Results Sixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3–4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-Osteotomy fit (P = 0.021 and P = 0.047, respectively). Clinical Significance The alignment jig/saw guide can be used to reproduce appropriate freehand Osteotomy position for TPLO. Furthermore, an ideal Osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.
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combination tibial plateau leveling Osteotomy and transverse corrective Osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs
Veterinary Surgery, 2011Co-Authors: Jennifer L Weh, Michael P Kowaleski, Randy J BoudrieauAbstract:Objective: To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling Osteotomy (TPLO) and transverse corrective Osteotomy. Study Design: Cases series. Animals: Dogs (n=12; 19 stifle joints). Methods: Medical records of dogs that had combination TPLO and transverse corrective Osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective Osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Results: Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88–96°) and 96.1° (range, 94–101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained. Conclusions: Long-term clinical outcome of combination TPLO and transverse corrective Osteotomy was excellent, and had a high owner satisfaction. Healing times were comparable to standard TPLO with a similar complication rate.
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tibial plateau leveling Osteotomy or tibial tuberosity advancement
Veterinary Surgery, 2009Co-Authors: Randy J BoudrieauAbstract:Objective— To review the proposed biomechanical basis of the tibial plateau leveling Osteotomy (TPLO) and tibial tuberosity advancement (TTA) and recommendations for these techniques. Study Design— Literature review. Methods— Literature search through Ovid Medline Plus, Pub Med, CAB Abstracts, and conference proceedings abstracts (August 1983 to March 2008). Results— TPLO and TTA stabilize the cranial cruciate ligament (CrCL) deficient stifle joint neutralizing tibiofemoral shear forces by altering the geometry of the proximal aspect of the tibia. Stability is attained by placing the joint in a functionally greater flexion angle so that the patellar tendon angle (PTA) remains ≤90°. Both procedures target slightly differing endpoints, the significance of which is unknown. Many of the biomechanical variables investigated appear to favor the TTA; however, TPLO appears to have more clinical versatility. The clinical ramifications of these differences remain to be determined but the reported results for both procedures are comparable. Only the early results of these techniques have been reported, which is reflected in the relatively high number of complications associated with the early learning curve for both procedures. Conclusions— There are many similarities between TPLO and TTA although it remains to be fully elucidated if either procedure is superior and under what conditions. Clinical Relevance— TPLO and TTA are effective at returning dogs with a CrCL-deficient stifle joint to good limb function. Surgeon discretion and case selection drive selection of TPLO or TTA based mostly on anecdotal evidence and personal experience.
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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
Veterinary Surgery, 2006Co-Authors: Miriam B Talaat, Michael P Kowaleski, Randy J BoudrieauAbstract:Objective To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling Osteotomy and cranial closing wedge Osteotomy (TPLO/CCWO). Study design Retrospective clinical study. Animals Fifteen client-owned dogs (18 stifle joints). Methods Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. Results Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. Conclusions Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. Clinical relevance TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.
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sarcoma of the proximal portion of the tibia in a dog 5 5 years after tibial plateau leveling Osteotomy
Javma-journal of The American Veterinary Medical Association, 2005Co-Authors: Randy J Boudrieau, Robert J Mccarthy, Richard D SissonAbstract:Osseous neoplasia was identified in the proximal portion of the tibia and distal portion of the femur in an 11.75-year-old spayed female German Shepherd Dog. A tibial plateau leveling Osteotomy, followed by application of a metal plate, had been performed on the affected limb 5.5 years earlier. Areas of osteolysis and periosteal proliferation were seen radiographically, with an intense area of osteolysis directly beneath the metal plate. Histologically, the tumor was identified as a poorly differentiated sarcoma. Extracellular and intracellular debris was seen histologically, and energy-dispersive x-ray analysis confirmed that this debris was metallic. On visual examination, areas of the underside of the metal plate that had been in contact with bone had a dull, roughened appearance, and scanning electron microscopy of these areas revealed multiple corrosion pits. The plate was strongly magnetic, suggesting that it contained ferrite, and metallographic examination of the plate revealed substantial differences in the chemical makeup of various parts of the plate. Microstructure analysis revealed that the plate consisted of an austenite matrix with a large fraction of ferrite. The plate was determined to be a cast 316L stainless steel implant, but it did not meet American Society for Testing Materials standards for implant-grade materials. The possibility that implant corrosion might have played a role in tumor development is of concern; however, a definitive association was not established.
Michael P Kowaleski - One of the best experts on this subject based on the ideXlab platform.
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novel tplo alignment jig saw guide reproduces freehand and ideal Osteotomy positions
PLOS ONE, 2016Co-Authors: Abigail D Mariano, Michael P Kowaleski, Randy J BoudrieauAbstract:Objectives To evaluate the ability of an alignment jig/saw guide to reproduce appropriate Osteotomy positions in the tibial plateau leveling Osteotomy (TPLO) in the dog. Methods Lateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand Osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005–Dec 2007 and Nov 2013–Nov 2015 were reviewed. The freehand Osteotomy position was compared to potential Osteotomy positions using the alignment jig/saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the Osteotomy performed. The guide-to-Osteotomy fit was categorized by the distance between the actual Osteotomy and proposed saw guide Osteotomy at its greatest offset (≤1 mm = excellent; ≤2 mm = good; ≤3 mm = satisfactory; >3 mm = poor). Results Sixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3–4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-Osteotomy fit (P = 0.021 and P = 0.047, respectively). Clinical Significance The alignment jig/saw guide can be used to reproduce appropriate freehand Osteotomy position for TPLO. Furthermore, an ideal Osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.
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combination tibial plateau leveling Osteotomy and transverse corrective Osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs
Veterinary Surgery, 2011Co-Authors: Jennifer L Weh, Michael P Kowaleski, Randy J BoudrieauAbstract:Objective: To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling Osteotomy (TPLO) and transverse corrective Osteotomy. Study Design: Cases series. Animals: Dogs (n=12; 19 stifle joints). Methods: Medical records of dogs that had combination TPLO and transverse corrective Osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective Osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Results: Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88–96°) and 96.1° (range, 94–101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained. Conclusions: Long-term clinical outcome of combination TPLO and transverse corrective Osteotomy was excellent, and had a high owner satisfaction. Healing times were comparable to standard TPLO with a similar complication rate.
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tibial osteotomies for cranial cruciate ligament insufficiency in dogs
Veterinary Surgery, 2008Co-Authors: Daniel D Lewis, Antonio Pozzi, Michael P KowaleskiAbstract:Objective— To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial Osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs. Study Design— Literature review. Methods— Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007). Results— Reported tibial Osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge Osteotomy [CTWO], tibial plateau leveling Osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular Osteotomy, chevron wedge Osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial Osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial Osteotomy procedure. Conclusions— Currently available data does not allow accurate comparisons between different tibial Osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal Osteotomy technique, and whether these procedures are superior to other stabilization methods. Clinical Relevance— Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial Osteotomy techniques.
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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
Veterinary Surgery, 2006Co-Authors: Miriam B Talaat, Michael P Kowaleski, Randy J BoudrieauAbstract:Objective To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling Osteotomy and cranial closing wedge Osteotomy (TPLO/CCWO). Study design Retrospective clinical study. Animals Fifteen client-owned dogs (18 stifle joints). Methods Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. Results Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. Conclusions Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. Clinical relevance TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.
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effect of medial meniscal release on tibial translation after tibial plateau leveling Osteotomy
Veterinary Surgery, 2006Co-Authors: Antonio Pozzi, Detlef Apelt, Cheyney Meadows, Michael P Kowaleski, Chad M Andrews, Kenneth A JohnsonAbstract:Objective— To evaluate the biomechanical effects of medial meniscal release (MMR) and medial, caudal pole hemimeniscectomy (MCH) on joint stability in the cranial cruciate ligament (CCL)-deficient canine stifle before and after tibial plateau leveling Osteotomy (TPLO). Study Design— Experimental study. Animals— Thirty-one dogs. Methods— In experiment 1, 16 pairs of normal hindlimbs randomly assigned to an intact or transected CCL group were studied to determine the magnitude of tibial translation after MMR and MCH under 20% body weight load using radiographic imaging of radio-opaque markers. In experiment 2, 15 pairs of CCL-deficient hindlimbs were randomly assigned to a TPLO or sham TPLO group. The remainder of the experiment was performed as described for experiment 1. The effect of CCL transection, MMR, MCH and TPLO were analyzed using 2-way repeated measures ANOVA; P<.05 was considered significant. Results— We found a greater effect of MMR on tibial translation in transected CCL stifles than in intact stifles (P=.0016). We found no further effect of MCH after MMR (P>.05). We found a greater effect of MMR in sham TPLO than TPLO stifles (P=.0013) but no further effect of MCH after MMR (P>.05). Conclusions— By resisting tibial translation the medial meniscus might be at greater risk of tearing in CCL-deficient stifles. TPLO may spare the medial meniscus by neutralizing the tibial thrust and eliminating the wedge effect of the medial meniscus. Clinical Relevance— MMR may not be indicated in the CCL-deficient stifle stabilized by TPLO.
Antonio Pozzi - One of the best experts on this subject based on the ideXlab platform.
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femorotibial kinematics in dogs treated with tibial plateau leveling Osteotomy for cranial cruciate ligament insufficiency an in vivo fluoroscopic analysis during walking
Veterinary Surgery, 2020Co-Authors: Selena Tinga, Scott A Banks, Antonio Pozzi, Stephen Jones, Brian H Park, Matthew Burtch, Daniel D LewisAbstract:Objective To determine the ability of tibial plateau leveling Osteotomy (TPLO) to address abnormal femorotibial kinematics caused by cranial cruciate ligament (CCL) rupture during walking in dogs. Study design Prospective, clinical. Animals Sixteen dogs (20-40 kg) with unilateral complete CCL rupture. Methods Lateral view fluoroscopy was performed during treadmill walking preoperatively and 6 months after TPLO. Digital three-dimensional (3D) models of the femora and tibiae were created from computed tomographic (CT) images. Gait cycles were analyzed by using a 3D-to-2D image registration process. Craniocaudal translation, internal/external rotation, and flexion/extension of the femorotibial joint were compared between preoperative and 6-month postoperative time points for the affected stifle and 6-month postoperative unaffected contralateral (control) stifles. Results In the overall population, 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. However, five of 16 TPLO-treated stifles had 4.1 ± 0.3 mm of cranial tibial subluxation during mid-to-late stance phase, whereas 10 of 16 TPLO-treated stifles had 4.3 ± 0.4 mm of caudal tibial subluxation throughout the gait cycle. Overall, postoperative axial rotational and flexion/extension patterns were not different from control, but stifles with caudal tibial subluxation had more external tibial rotation during mid-to-late stance phase compared with stifles with cranial tibial subluxation. Conclusion TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking. Clinical significance Tibial plateau leveling Osteotomy reduces cranial tibial subluxation during walking, but persistent instability is common.
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Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja.
Schweizer Archiv fur Tierheilkunde, 2017Co-Authors: Simona Vincenti, Sebastian Christoph Knell, Antonio PozziAbstract:Caudal cruciate ligament injury can be a complication following tibial plateau leveling Osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge Osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge Osteotomy of 23 degree and a fibular ostectomy were performed. The Osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the Osteotomy site and no implant failure. The diaphyseal CORA based Osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.
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effect of tibial plateau leveling Osteotomy on femorotibial subluxation in vivo analysis during standing
Veterinary Surgery, 2012Co-Authors: Stanley E Kim, Daniel Lewis, Antonio PozziAbstract:Objective To assess the effect of tibial plateau leveling Osteotomy (TPLO) on femorotibial subluxation during standing in dogs with cranial cruciate ligament (CrCL) insufficiency. Study Design Prospective clinical study. Animals Fifteen dogs weighing 20–45 kg with unilateral complete CrCL insufficiency. Methods Force-platform analysis, and lateral weight-bearing radiographs of the affected stifle were acquired preoperatively, 1, 3, and 6 months postoperatively. The distance between the origin and insertion of the CrCL (CrCLd) was measured on each radiograph and compared between time points using ANOVA. Lateral radiographs of the non-weight-bearing affected stifle and weight-bearing contralateral normal stifle were acquired preoperatively, and CrCLd was compared with a paired t-test. Dogs were grouped according to medial meniscal status (intact or hemimeniscectomy) and CrCLd was compared within each group using ANOVA. Results No difference was observed in CrCLd between the non-weight-bearing affected stifle and the contralateral stifle (P = .994). That is, femorotibial joint alignment in the affected stifle when non-weight-bearing was considered normal. Preoperatively in the affected stifle, CrCLd during weight-bearing was 6.3 ± 2.4 mm longer than normal (P < .001). Postoperative weight-bearing CrCLd in dogs with intact menisci at all time points was not statistically different from normal; CrCLd at 1 (P = .014) and 6 months (P = .005) postoperatively was longer than normal in dogs with hemimeniscectomy. Conclusions TPLO does not consistently resolve femorotibial subluxation during standing in dogs with CrCL insufficiency. The medial meniscus appears to be an important contributor to stability in stifles treated by TPLO.
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effect of cold compression therapy on postoperative pain swelling range of motion and lameness after tibial plateau leveling Osteotomy in dogs
Javma-journal of The American Veterinary Medical Association, 2011Co-Authors: Kevin A Drygas, Antonio Pozzi, Scott R Mcclure, Robert L Goring, Sheilah A Robertson, Chong WangAbstract:Objective—To evaluate the effect of cold compression therapy (CCT) on postoperative pain, lameness, range of motion of the stifle joint, and swelling following tibial plateau leveling Osteotomy (TPLO) in dogs. Design—Randomized, blinded, placebo-controlled clinical trial. Animals—34 client-owned dogs with unilateral deficiency of a cranial cruciate ligament undergoing TPLO. Procedures—Dogs were assigned to 2 groups. Group 1 (n = 17 dogs) received CCT in the 24-hour period following TPLO. Group 2 (n = 17 dogs) received no CCT. Degree of lameness, range of motion, and circumference of the stifle joint were measured before surgery and 1,14, and 28 days after surgery. A modified composite Glasgow pain scale, visual analogue scale, and pain threshold score were used to evaluate signs of pain before surgery and 1,14, and 28 days after surgery. Logistic regression and linear regression analysis were used to compare the measured variables. Results—No complications were observed, and all dogs tolerated CCT. Use of...
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effect of cranial cruciate ligament deficiency tibial plateau leveling Osteotomy and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion
Veterinary Surgery, 2010Co-Authors: Antonio Pozzi, Scott A Banks, Bryan P Conrad, Daniel D LewisAbstract:Objective: To assess contact mechanics and 3-dimensional (3-D) joint alignment in cranial cruciate ligament (CCL)-deficient stifles before and after tibial plateau leveling Osteotomy (TPLO) and tibial tuberosity advancement (TTA) with the stifle in 90° of flexion. Study Design: In vitro biomechanical study. Sample Population: Cadaveric pelvic limb pairs (n=8) from dogs weighing 28–35 kg. Methods: Contralateral limbs were assigned to receive TPLO or TTA. Digital pressure sensors were used to measure femorotibial contact area, peak and mean contact pressure, and peak pressure location with the limb under a load of 30% body weight and stifle flexion angle of 90°. 3-D poses were obtained using a Microscribe digitizer. Specimens were tested under normal, CCL deficient, and treatment conditions. Results: Significant disturbances in alignment were not observed after CCL transection, although medial contact area was 10% smaller than normal (P=.003). There were no significant differences in contact mechanics or alignment between normal and TTA conditions; TPLO induced 6° varus angulation (P<.001), 26% decrease in lateral peak pressure (P=.027), and 18% increase in medial mean pressure (P=.008) when compared with normal. Conclusion: Cranial tibial subluxation is nominal in CCL-deficient stifles loaded in flexion. Stifle alignment and contact mechanics are not altered by TTA, whereas TPLO causes mild varus and a subsequent increase in medial compartment loading. Clinical Relevance: Cranial tibial subluxation of CCL-deficient stifles may not occur during postures that load the stifle in flexion. The significance of minor changes in loading patterns after TPLO is unknown.
Daniel D Lewis - One of the best experts on this subject based on the ideXlab platform.
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femorotibial kinematics in dogs treated with tibial plateau leveling Osteotomy for cranial cruciate ligament insufficiency an in vivo fluoroscopic analysis during walking
Veterinary Surgery, 2020Co-Authors: Selena Tinga, Scott A Banks, Antonio Pozzi, Stephen Jones, Brian H Park, Matthew Burtch, Daniel D LewisAbstract:Objective To determine the ability of tibial plateau leveling Osteotomy (TPLO) to address abnormal femorotibial kinematics caused by cranial cruciate ligament (CCL) rupture during walking in dogs. Study design Prospective, clinical. Animals Sixteen dogs (20-40 kg) with unilateral complete CCL rupture. Methods Lateral view fluoroscopy was performed during treadmill walking preoperatively and 6 months after TPLO. Digital three-dimensional (3D) models of the femora and tibiae were created from computed tomographic (CT) images. Gait cycles were analyzed by using a 3D-to-2D image registration process. Craniocaudal translation, internal/external rotation, and flexion/extension of the femorotibial joint were compared between preoperative and 6-month postoperative time points for the affected stifle and 6-month postoperative unaffected contralateral (control) stifles. Results In the overall population, 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. However, five of 16 TPLO-treated stifles had 4.1 ± 0.3 mm of cranial tibial subluxation during mid-to-late stance phase, whereas 10 of 16 TPLO-treated stifles had 4.3 ± 0.4 mm of caudal tibial subluxation throughout the gait cycle. Overall, postoperative axial rotational and flexion/extension patterns were not different from control, but stifles with caudal tibial subluxation had more external tibial rotation during mid-to-late stance phase compared with stifles with cranial tibial subluxation. Conclusion TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking. Clinical significance Tibial plateau leveling Osteotomy reduces cranial tibial subluxation during walking, but persistent instability is common.
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effect of cranial cruciate ligament deficiency tibial plateau leveling Osteotomy and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion
Veterinary Surgery, 2010Co-Authors: Antonio Pozzi, Scott A Banks, Bryan P Conrad, Daniel D LewisAbstract:Objective: To assess contact mechanics and 3-dimensional (3-D) joint alignment in cranial cruciate ligament (CCL)-deficient stifles before and after tibial plateau leveling Osteotomy (TPLO) and tibial tuberosity advancement (TTA) with the stifle in 90° of flexion. Study Design: In vitro biomechanical study. Sample Population: Cadaveric pelvic limb pairs (n=8) from dogs weighing 28–35 kg. Methods: Contralateral limbs were assigned to receive TPLO or TTA. Digital pressure sensors were used to measure femorotibial contact area, peak and mean contact pressure, and peak pressure location with the limb under a load of 30% body weight and stifle flexion angle of 90°. 3-D poses were obtained using a Microscribe digitizer. Specimens were tested under normal, CCL deficient, and treatment conditions. Results: Significant disturbances in alignment were not observed after CCL transection, although medial contact area was 10% smaller than normal (P=.003). There were no significant differences in contact mechanics or alignment between normal and TTA conditions; TPLO induced 6° varus angulation (P<.001), 26% decrease in lateral peak pressure (P=.027), and 18% increase in medial mean pressure (P=.008) when compared with normal. Conclusion: Cranial tibial subluxation is nominal in CCL-deficient stifles loaded in flexion. Stifle alignment and contact mechanics are not altered by TTA, whereas TPLO causes mild varus and a subsequent increase in medial compartment loading. Clinical Relevance: Cranial tibial subluxation of CCL-deficient stifles may not occur during postures that load the stifle in flexion. The significance of minor changes in loading patterns after TPLO is unknown.
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effect of tibial plateau leveling Osteotomy on femorotibial contact mechanics and stifle kinematics
Veterinary Surgery, 2009Co-Authors: Antonio Pozzi, Scott A Banks, Bryan P Conrad, Daniel D LewisAbstract:Objective— To evaluate the effects of tibial plateau leveling Osteotomy (TPLO) on femorotibial contact mechanics and 3-dimensional (3D) kinematics in cranial cruciate ligament (CrCL)-deficient stifles of dogs. Study Design— In vitro biomechanical study. Animals— Unpaired pelvic limbs from 8 dogs, weighing 28–35 kg. Methods— Digital pressure sensors placed subjacent to the menisci were used to measure femorotibial contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. Three-dimensional static poses of the stifle were obtained using a Microscribe digitizing arm. Each specimen was tested under normal, CrCL-deficient, and TPLO-treated conditions. Repeated measures analysis of variance with a Tukey post hoc test (P<.05) was used for statistical comparison. Results— Significant disturbances to all measured contact mechanical variables were evident after CrCL transection, which corresponded to marked cranial tibial subluxation and increased internal tibial rotation in the CrCL-deficient stifle. No significant differences in 3D femorotibial alignment were observed between normal and TPLO-treated stifles; however, femorotibial contact area remained significantly smaller and peak contact pressures in both medial and lateral stifle compartments were positioned more caudally on the tibial plateau, when compared with normal. Conclusion— Whereas TPLO eliminates craniocaudal stifle instability during simulated weight bearing, the procedure fails to concurrently restore femorotibial contact mechanics to normal. Clinical Relevance— Progression of stifle osteoarthritis in dogs treated with TPLO may be partly the result of abnormal stifle contact mechanics induced by altering the orientation of the proximal tibial articulating surface.
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tibial osteotomies for cranial cruciate ligament insufficiency in dogs
Veterinary Surgery, 2008Co-Authors: Daniel D Lewis, Antonio Pozzi, Michael P KowaleskiAbstract:Objective— To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial Osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs. Study Design— Literature review. Methods— Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007). Results— Reported tibial Osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge Osteotomy [CTWO], tibial plateau leveling Osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular Osteotomy, chevron wedge Osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial Osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial Osteotomy procedure. Conclusions— Currently available data does not allow accurate comparisons between different tibial Osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal Osteotomy technique, and whether these procedures are superior to other stabilization methods. Clinical Relevance— Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial Osteotomy techniques.
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comparison of lateral fabellar suture and tibial plateau leveling Osteotomy techniques for treatment of dogs with cranial cruciate ligament disease
Javma-journal of The American Veterinary Medical Association, 2013Co-Authors: Wanda J Gordonevans, Carrie L Bubb, Kim M Knap, Meghan Sullivan, Dominique J. Griffon, Richard B EvansAbstract:Objective—To compare 1-year outcomes after lateral fabellar suture stabilization (LFS) and tibial plateau leveling Osteotomy (TPLO) for the treatment of dogs with cranial cruciate ligament disease. Design—Randomized blinded controlled clinical trial. Animals—80 dogs with naturally occurring unilateral cranial cruciate ligament disease. Procedures—All dogs were randomly assigned to undergo LFS (n = 40) or TPLO (40). Clinical data collected included age, weight, body condition score, history information, stifle joint instability, radiographic findings, surgical findings, and complications. Outcome measures were determined prior to surgery and at 6 and 12 weeks and 6 and 12 months after surgery, including values of pressure platform gait analysis variables, Canine Brief Pain Inventory scores, owner satisfaction ratings, thigh circumference, and stifle joint goniometry values. Results—Signalment and data for possible confounding variables were similar between groups. Peak vertical force of affected hind limbs...
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Comparison of the analgesic efficacy of perioperative firocoxib and tramadol administration in dogs undergoing tibial plateau leveling Osteotomy.
Journal of the American Veterinary Medical Association, 2013Co-Authors: Diana Davila, Richard B Evans, Thomas P. Keeshen, Michael G. ConzemiusAbstract:Objective—To evaluate the effects of perioperative oral administration of tramadol, firocoxib, and a tramadol-firocoxib combination on signs of pain and limb function after tibial plateau leveling Osteotomy in dogs. Design—Randomized, blinded, prospective clinical trial. Animals—30 adult client-owned dogs with unilateral cranial cruciate ligament disease. Procedures—Dogs were allocated into 3 treatment groups (tramadol, firocoxib, and a tramadol-firocoxib combination). Signs of pain (short-form Glasgow composite measure pain scale), serum cortisol concentrations, and limb function (pressure platform gait analysis) were recorded at several time points before surgery and through 3 days after surgery. Outcome measures were compared among groups. Results—A significantly greater number of dogs in the tramadol group (8/10 dogs) had a pain score > 6 after surgery, compared with the other groups. No significant differences were detected in the pain scores between the firocoxib and the tramadol-firocoxib combinati...
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effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs
Javma-journal of The American Veterinary Medical Association, 2005Co-Authors: Michael G. Conzemius, Richard B Evans, Faulkner M Besancon, Wanda J Gordon, Christopher L Horstman, William D Hoefle, Mary Ann Nieves, Stanley D WagnerAbstract:Objective—To determine the outcome and effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament (RCCL) and injury to the medial meniscus in Labrador Retrievers. Study Design—Prospective clinical study. Animals—131 Labrador Retrievers with unilateral RCCL and injury to the medial meniscus and 17 clinically normal Labrador Retrievers. Procedure—Affected dogs had partial or complete medial meniscectomy and lateral suture stabilization (LSS), intracapsular stabilization (ICS), or tibial plateau leveling Osteotomy (TPLO). Limb function was measured before surgery and 2 and 6 months after surgery. Treated dogs were evaluated to determine the probability that they could be differentiated from clinically normal dogs and tested to determine the likelihood that they achieved improvement. Results—No difference was found between LSS or TPLO groups, but dogs treated with ICS had significantly lower ground reaction forces at 2 and 6 months. Compared with clinically normal...