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Vet Comp Orthop Traumatol 2024; 37(06): 273-278
DOI: 10.1055/s-0044-1787692
Original Research

Effect of Plate Inclination and Osteotomy Positioning on Rock-back following Tibial Plateau Levelling Osteotomy in Dogs

Euan J. Mclean 
1   Southpaws Specialty Surgery for Animals, Melbourne, Victoria, Australia
,
Merianna Foo
1   Southpaws Specialty Surgery for Animals, Melbourne, Victoria, Australia
,
Yan S. Toh
1   Southpaws Specialty Surgery for Animals, Melbourne, Victoria, Australia
,
Benjamin M. Kaye
1   Southpaws Specialty Surgery for Animals, Melbourne, Victoria, Australia
,
James O. Simcock
1   Southpaws Specialty Surgery for Animals, Melbourne, Victoria, Australia
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Abstract

Objective Rock-back is a reported complication following tibial plateau levelling osteotomy (TPLO), whereby tibial plateau angle (TPA) increases postoperatively. The mechanism of rock-back is not fully understood, although a recent ex vivo investigation demonstrated that osteotomy exit cut angle (ECA) and inclination of the plate in the sagittal plane might be risk factors. The purpose of this study was to explore these relationships in a clinical dog population. We hypothesized that dogs with rock-back would have a higher degree of plate inclination and downward ECA compared with those without rock-back.

Materials and Methods Medical records and radiographs of dogs that underwent TPLO between January 2021 and January 2022 were retrospectively reviewed. TPA was recorded preoperatively, postoperatively, and at follow-up. Plate inclination, ECA, and descriptive data were collected. Observers measuring TPA were blinded to other variables. Rock-back was defined as a change in TPA ≥ 2.

Results Ninety-five TPLO procedures met the inclusion criteria (n = 87 dogs). Rock-back was identified in 21% of TPLOs (n = 20/95). The mean increase in TPA in the rock-back group was 3.2 ± 2.6. Plate inclination and ECA were not correlated with the presence of rock-back. Descriptive variables did not have a significant correlation with rock-back.

Conclusion Plate inclination and ECA did not have a relationship with rock-back when defined as a postoperative TPA change ≥2 degrees, in this clinical retrospective study.

Keywords

TPLO - plateau angle - TPLO complications - rock-back

Note

Results from this research were presented at the Veterinary Orthopaedic Society conference in Big Sky, Montana, March 11–18, 2023.


Authors' Contribution

E.J.M. contributed to the conception and design of the study, retrospective review of clinical records, data acquisition, and drafted the manuscript. M.F. contributed to the design of the study, retrospective review of clinical records, and the statistical analysis of data. Y.S.T. contributed to the design of the study, retrospective review of clinical records, and data acquisition. J.O.S. and B.M.K. contributed to data acquisition and critical evaluation of the manuscript. All authors finally reviewed, approved, and submitted the manuscript.




Publication History

Received: 07 July 2023

Accepted: 16 May 2024

Article published online:
06 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Nanda A, Hans EC. Tibial plateau leveling osteotomy for cranial cruciate ligament rupture in canines: patient selection and reported outcomes. Vet Med (Auckl) 2019; 10: 249-255
    PubMedGoogle Scholar
  • 2 Warzee CC, Dejardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286
    CrossrefPubMedGoogle Scholar
  • 3 Moore EV, Weeren R, Paek M. Extended long-term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog. Vet Surg 2020; 49 (01) 146-154
    CrossrefPubMedGoogle Scholar
  • 4 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42 (03) 329-334
    CrossrefPubMedGoogle Scholar
  • 5 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38 (01) 1-22
    CrossrefPubMedGoogle Scholar
  • 6 Hulse D, Beale B, Kerwin S. Second look arthroscopic findings after tibial plateau leveling osteotomy. Vet Surg 2010; 39 (03) 350-354
    CrossrefPubMedGoogle Scholar
  • 7 Breiteneicher AH, Norby B, Schulz KS. et al. The effect of sliding humeral osteotomy (SHO) on frontal plane thoracic limb alignment: an ex vivo canine cadaveric study. Vet Surg 2016; 45 (08) 1095-1107
    CrossrefPubMedGoogle Scholar
  • 8 Haynes KH, Biskup J, Freeman A, Conzemius MG. Effect of tibial plateau angle on cranial cruciate ligament strain: an ex vivo study in the dog. Vet Surg 2015; 44 (01) 46-49
    CrossrefPubMedGoogle Scholar
  • 9 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23 (04) 777-795
    CrossrefPubMedGoogle Scholar
  • 10 Todorović AZ, Macanović MVL, Mitrović MB, Krstić NE, Bree HJJV, Gielen IMLV. The role of tibial plateau angle in canine cruciate ligament rupture-a review of the literature. Vet Comp Orthop Traumatol 2022; 35 (06) 351-361
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Robinson DA, Mason DR, Evans R, Conzemius MG. The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau leveling osteotomy in Labrador Retrievers. Vet Surg 2006; 35 (03) 294-299
    CrossrefPubMedGoogle Scholar
  • 12 Pacchiana PD, Morris E, Gillings SL, Jessen CR, Lipowitz AJ. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222 (02) 184-193
    CrossrefPubMedGoogle Scholar
  • 13 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39 (04) 460-474
    CrossrefPubMedGoogle Scholar
  • 14 Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42 (01) 44-50
    CrossrefPubMedGoogle Scholar
  • 15 Rutherford S, Bell JC, Ness MG. Fracture of the patella after TPLO in 6 dogs. Vet Surg 2012; 41 (07) 869-875
    CrossrefPubMedGoogle Scholar
  • 16 Souza ES, Minto BW, Sales Luis JP. et al. Rock back phenomenon in 32 dogs that underwent tibial plateau levelling osteotomy. Vet Med (Praha) 2021; 66 (02) 58-65
    CrossrefPubMedGoogle Scholar
  • 17 Bergh MS, Rajala-Schultz P, Johnson KA. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37 (04) 374-382
    CrossrefPubMedGoogle Scholar
  • 18 Taylor J, Langenbach A, Marcellin-Little DJ. Risk factors for fibular fracture after TPLO. Vet Surg 2011; 40 (06) 687-693
    CrossrefPubMedGoogle Scholar
  • 19 Kergosien DH, Barnhart MD, Kees CE. et al. Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy. Vet Surg 2004; 33 (05) 468-474
    CrossrefPubMedGoogle Scholar
  • 20 Moeller EM, Cross AR, Rapoff AJ. Change in tibial plateau angle after tibial plateau leveling osteotomy in dogs. Vet Surg 2006; 35 (05) 460-464
    CrossrefPubMedGoogle Scholar
  • 21 Leitner M, Pearce SG, Windolf M. et al. Comparison of locking and conventional screws for maintenance of tibial plateau positioning and biomechanical stability after locking tibial plateau leveling osteotomy plate fixation. Vet Surg 2008; 37 (04) 357-365
    CrossrefPubMedGoogle Scholar
  • 22 Bula E. Effect of Osteotomy and Plate Orientation on Tibial Plateau Rock-back following TPLO Using a Tibial Gap Model [thesis]. Michigan State University;; 2021
    Google Scholar
  • 23 Dismukes DI, Tomlinson JL, Fox DB, Cook JL, Song KJ. Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. Vet Surg 2007; 36 (07) 699-704
    CrossrefPubMedGoogle Scholar
  • 24 Reif U, Hulse DA, Hauptman JG. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31 (02) 147-154
    CrossrefPubMedGoogle Scholar
  • 25 Oh JK, Sahu D, Ahn YH. et al. Effect of fracture gap on stability of compression plate fixation: a finite element study. J Orthop Res 2010; 28 (04) 462-467
    CrossrefPubMedGoogle Scholar
  • 26 Markel MD, Muir P, Johnson KA. Area moment of inertia for comparison of implant cross-sectional geometry and bending stiffness. Vet Comp Orthop Traumatol 2018; 08 (03) 146-152
    PubMedGoogle Scholar
  • 27 Schell H, Epari DR, Kassi JP, Bragulla H, Bail HJ, Duda GN. The course of bone healing is influenced by the initial shear fixation stability. J Orthop Res 2005; 23 (05) 1022-1028
    CrossrefPubMedGoogle Scholar