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Vet Comp Orthop Traumatol 2011; 24(05): 333-341
DOI: 10.3415/VCOT-10-07-0109
Original Research
Schattauer GmbH

Retrospective study of 476 tibial plateau levelling osteotomy procedures

Rate of subsequent ‘pivot shift’, meniscal tear and other complications
M. Gatineau
1   Centre Vétérinaire DVM, Montréal (Lachine), Québec, Canada
,
J. Dupuis
1   Centre Vétérinaire DVM, Montréal (Lachine), Québec, Canada
,
J. Planté
1   Centre Vétérinaire DVM, Montréal (Lachine), Québec, Canada
,
M. Moreau
2   Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Québec, Canada
› Author Affiliations
Further Information

Publication History

Received: 13 July 2010

Accepted: 01 June 2011

Publication Date:
17 December 2017 (online)

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Summary

Objective: To determine the rate of subsequent ‘pivot shift’, meniscal tear and risk factors associated with complications of tibial plateau levelling osteotomy (TPLO) and to assess clinical and owner perception outcome.

Study design: Retrospective study.

Sample population: Three hundred and forty-eight dogs that had undergone TPLO surgical procedures (n = 476 stifles).

Methods: Medical records were reviewed for the retrieval of information on breed, sex, age, body weight, clinical history, radiograph findings, pre- and postoperative tibial plateau angle, limb alignment, unilateral versus bilateral disease, condition of cranial cruciate ligament (CCL) and menisci, implant material, healing time and complications. Clinical and owner-assessed questionnaire outcomes were also recorded.

Results: Forty-six (9.7%) postoperative complications were reported. Twenty (4.2%) were classified as major complications requiring an additional surgical intervention, and 26 (5.5%) as minor complications. No risk factors associated with postoperative complications were identified. Ten (2.1%) subsequent meniscal injuries in the stifles with normal unaltered menisci at time of TPLO were reported with a median postoperative time of 9.5 months. Signs of postoperative ‘pivot shift’ were reported in 15 (3.1%) stifles. All stifles with a ‘pivot shift’ had a complete CCL rupture or a debrided partial CCL rupture a medial menisectomy was identified as a risk factor for a ‘pivot shift’ (p = 0.02). Dogs with intact medial meniscus had a significantly higher activity level (p <0.0001) and a shorter time to peak function (p = 0.02) than dogs that underwent menisectomy according to an owner questionnaire.

Conclusions: Dogs with TPLO and intact meniscus seemed to have a better and faster recovery than dogs with TPLO and menisectomy based on owner questionnaires. ‘Pivot shift’ was infrequent after TPLO surgery. All dogs with a ‘pivot shift’ had a complete CCL rupture or a debrided partial CCL rupture and menisectomy was identified as a risk factor for its occurrence.

Clinical relevance: Considering the relatively low rate of subsequent meniscal injury after TPLO, systematic medial meniscal release with TPLO may be unnecessary. The ‘pivot shift’ deserved further investigation to completely understand its mechanism, to identify its anatomic components and potential consequences on the stifle joint.

Keywords

Pivot shift - complication - meniscal tear - tibial plateau levelling osteotomy - stifle - canine

 

  • References

  • 1 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: 777-795.
    CrossrefPubMedGoogle Scholar
  • 2 Slocum B, Devine-Slocum T. Tibial plateau leveling osteotomy for cranial cruciate ligament rupture. In Bojrab MJ. editor. Current Techniques in Small Animal Surgery. 4th ed.. Baltimore, MD; Williams & Wilkins; 1998. pg 1209-1215.
    Google Scholar
  • 3 Priddy NH, Tomlinson JL, Dodam JR. et al Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997–2001). J Am Vet Med Assoc 2003; 222: 1726-1732.
    CrossrefPubMedGoogle Scholar
  • 4 Pacchiana PD, Morris E, Gillings SL. et al 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: 184-193.
    CrossrefPubMedGoogle Scholar
  • 5 Stauffer KD, Tuttle TA, Elkins AD. et al Complications associated with 696 tibial plateau leveling osteotomies (2001–2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
    CrossrefPubMedGoogle Scholar
  • 6 Barnhart MD. Results of single-session bilateral tibial plateau leveling osteotomies as a treatment for bilateral ruptured cranial cruciate ligaments in dogs: 25 cases (2000–2001). J Am Anim Hosp Assoc 2003; 39: 573-578.
    CrossrefPubMedGoogle Scholar
  • 7 Thieman KM, Tomlinson JL, Fox DB. et al Effect of meniscal release on rate of subsequent meniscal tears and owners-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35: 705-710.
    CrossrefPubMedGoogle Scholar
  • 8 Pozzi A, Hildreth BE, Rajala-Schultz PJ. 3rd Comparison of arthroscopy and arthrotomy for diagnosis of medial meniscal pathology: an ex vivo study. Vet Surg 2008; 37: 749-755.
    CrossrefPubMedGoogle Scholar
  • 9 Kennedy SC, Dunning D, Bischoff MG. et al The effect of axial and abaxial release on meniscal displacement in the dog. Vet Comp Orthop Traumatol 2005; 18: 227-234.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Pozzi A, Kowaleski MP, Apelt D. et al Effect of medial meniscal release on tibial translation after tibial plateau leveling osteotomy. Vet Surg 2006; 35: 486-494.
    CrossrefPubMedGoogle Scholar
  • 11 Johnson KA, Francis DJ, Manley PA. et al Comparison of the effects of caudal pole hemi-menisectomy and complete medial menisectomy in the canine stifle joint. Am J Vet Res 2004; 65: 1053-1060.
    CrossrefPubMedGoogle Scholar
  • 12 Schulz K. Cranial cruciate ligament rupture. In Fossum TW. editor. Small Animal Surgery. 3rd ed.. St Louis; Mosby; 2007. pg 1254-1276.
    Google Scholar
  • 13 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
    CrossrefPubMedGoogle Scholar
  • 14 Slocum B, Slocum TD.. TPLO-Course. [Instructions from Lab Course]. Slocum Enterprises Inc.; Eugene, OR; March 2000
    Google Scholar
  • 15 Tomlinson J, Fox D, Cook JL. et al Measurement of femoral angles in four dog breeds. Vet Surg 2007; 36: 593-598.
    CrossrefPubMedGoogle Scholar
  • 16 Dismukes ID, Tomlinson JL, Fox DB. et al Radio-graphic measurement of the proximal and distal mechanical joint angles in the canine tibia. Vet Surg 2007; 36: 699-704.
    CrossrefPubMedGoogle Scholar
  • 17 Dismukes ID, Fox DB, Tomlinson JL. et al Determination of pelvic limb alignment in the large-breed dog: a cadaveric radiographic study in the frontal plane. Vet Surg 2008; 27: 674-682.
    PubMedGoogle Scholar
  • 18 Lambert RJ, Wendelburg KL. Determination of the mechanical medial proximal tibial angle using a tangential radiographic technique. Vet Surg 2010; 39: 181-186.
    CrossrefPubMedGoogle Scholar
  • 19 Doverspike M, Vasseur PB, Hard MF. et al Contra-lateral cranial cruciate ligament rupture : incidence in 114 dogs. J Am Anim Hosp Assoc 1993; 29: 167-170.
    PubMedGoogle Scholar
  • 20 Pond MJ, Campbell JR. The canine stifle joint. I. Rupture of the anterior cruciate ligament. An assessment of conservative and surgical treatment. J Small Anim Pract 1972; 13: 1-10.
    CrossrefPubMedGoogle Scholar
  • 21 Haaland PJ, Sjöström L. Luxation of the long digital extensor tendon as a complication to tibial plateau leveling osteotomy. Vet Comp Orthop Traumatol 2005; 20: 224-226.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Schwarz PD. Tibial plateau leveling osteotomy (TPLO): a prospective clinical comparative study. In Proceedings of the Annual Meeting of the American College of Veterinary Surgeons. 1999. San Francisco, USA.; Pg. 379-380.
    Google Scholar
  • 23 Watt P. Tibial plateau leveling. Aust Vet J 2000; 78: 385-386.
    CrossrefPubMedGoogle Scholar
  • 24 Duerr FM, Duncan CG, Savicky RS. et al Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37: 49-62.
    CrossrefPubMedGoogle Scholar
  • 25 Frey TN, Hoelzler MG, Scavelli TD. et al Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005–2006). J Am Vet Med Assoc 2010; 236: 88-94.
    CrossrefPubMedGoogle Scholar
  • 26 Brown DC, Conzemius MG, Shofer F. et al Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997; 210: 1302-1306.
    PubMedGoogle Scholar
  • 27 Vasseur PB, Levy J, Dowd E. et al Surgical wound-infection rates in dogs and cats: data from a teaching hospital. Vet Surg 1998; 17: 60-64.
    PubMedGoogle Scholar
  • 28 Whittem TL, Johnson AL, Smith CW. et al Effect of perioperative prophylactic antimicrobial treatment in dogs undergoing elective orthopedic surgery. J Am Vet Med Assoc 1999; 215: 212-216.
    PubMedGoogle Scholar
  • 29 Weese JS, Halling KB. Perioperative administration of antimicrobials associated with elective surgery for cranial cruciate ligament rupture in dogs: 83 cases (2003–2005). J Am Vet Med Assoc 2006; 229: 92-95.
    CrossrefPubMedGoogle Scholar
  • 30 Eugster S, Schawalder P, Gaschen F. et al A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 2004; 33: 542-550.
    CrossrefPubMedGoogle Scholar
  • 31 Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project. Am J Surg 2005; 189: 395-404.
    CrossrefPubMedGoogle Scholar
  • 32 Cockshutt J. Principles of surgical asepsis. In Slatter D. editor. Textbook of small animal surgery. 3rd ed.. Philadelphia: WB Saunders Company; 2003. pg 149-155.
    Google Scholar
  • 33 Ralphs SC, Whitney WO. Arthroscopic evaluation of menisci in dogs with cranial cruciate ligament injuries: 100 cases (1999–2000). J Am Vet Med Assoc 2002; 221: 1601-1604.
    CrossrefPubMedGoogle Scholar
  • 34 Kuan S, Smith B, Black A. Tibial wedge osteotomy: complications of 300 surgical procedures. Aus Vet J 2009; 87: 438-444.
    CrossrefPubMedGoogle Scholar
  • 35 Moles AD, Hill TP, Glyde M. Triple tibial osteotomy for treatment of the canine cranial cruciate ligament-deficient stifle joint. Vet Comp Orthop Traumatol 2009; 22: 473-478.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 1991; 32: 111-117.
    CrossrefPubMedGoogle Scholar
  • 37 Elkins AD, Pechman R, Kearney MT. et al A retrospective study evaluating the degree of degenerative joint disease in the stifle of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533-540.
    PubMedGoogle Scholar
  • 38 Mahn MM, Cook JL, Cook CR. et al Arthroscopic verification of ultrasonographic diagnosis of meniscal pathology in dogs. Vet Surg 2005; 34: 318-323.
    CrossrefPubMedGoogle Scholar
  • 39 Flo GL. Classification of meniscal lesions in 26 consecutive canine menisectomies. J Am Anim Hosp Assoc 1983; 19: 335-340.
    PubMedGoogle Scholar
  • 40 Trumble TN, Billinghurst RC, Bendele AM. et al Evaluation of changes in vertical ground reaction forces as indicators of meniscal damage after transection of the cranial cruciate ligament in dogs. Am J Vet Res 2006; 66: 156-163.
    PubMedGoogle Scholar
  • 41 Guastella DB, Fox DB, Cook JL. Tibial plateau angle in four common canine breeds with cranial cruciate ligament rupture, and its relationship to meniscal tears. Vet Comp Orthop Traumatol 2006; 21: 125-128.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997–2005). J Am Vet Med Assoc 2009; 234: 229-235.
    CrossrefPubMedGoogle Scholar
  • 43 Metelman LA, Schwarz PD, Salman M. et al An evaluation of three different cranial cruciate ligament surgical stabilization procedures as they relate to postoperative meniscal injuries. Vet Comp Orthop Traumatol 1995; 8: 118-123.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Ertelt J, Fehr M. Cranial cruciate ligament repair in dogs with and without meniscal lesions treated by different minimally invasive methods. Vet Comp Orthop Traumatol 2009; 22: 21-26.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Hoffmann DE, Miller JM, Ober CP. et al Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Lavafer S, Miller NA, Stubbs WP. et al Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
    CrossrefPubMedGoogle Scholar
  • 47 Jerram RM, Walker AM, Warman CG. Proximal tibial intraarticular ostectomy for treatment of canine cranial cruciate ligament injury. Vet Comp Orthop Traumatol 2005; 34: 196-205.
    PubMedGoogle Scholar
  • 48 Jackson J, Vasseur PB, Griffey S. et al Pathologic changes in grossly normal menisci in dogs with rupture of the cranial cruciate ligament. J Am Vet Med Assoc 2001; 218: 1281-1284.
    CrossrefPubMedGoogle Scholar
  • 49 Pozzi A, Litsky SA, Field J. et al Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2008; 21: 8-14.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Luther JK, Cook CR, Cook JL. Meniscal release in cruciate ligament intact stifles causes lameness and medial compartiment cartilage pathology in dogs 12 weeks postoperatively. Vet Surg 2009; 38: 520-529.
    CrossrefPubMedGoogle Scholar
  • 51 Matis U, Brahm-Jorda T, Jorda C. et al Radio-graphic evaluation of the progession of osteoarthritis after tibial plateau leveling osteotomy in 93 dogs. Vet Comp Orthop Traumatol 2005; 2: A32
    PubMedGoogle Scholar
  • 52 Hulse D, Beale B, Kerwin S. Second look arthroscopic findings after tibial plateau leveling osteotomy. Vet Surg 2010; 39: 350-354.
    CrossrefPubMedGoogle Scholar
  • 53 Wheeler JL, Cross AR, Gingrich W. In vitro effects of osteotomy angle and rotation during the tibial plateau-leveling osteotomy procedure. Vet Surg 2003; 32: 371-377.
    CrossrefPubMedGoogle Scholar
  • 54 Kim SE, Pozzi A, Banks SA. et al Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion. Vet Surg 2010; 39: 363-370.
    CrossrefPubMedGoogle Scholar
  • 55 Warzee CC, Dejardin LM, Arnoczky SP. et al 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: 278-286.
    CrossrefPubMedGoogle Scholar
  • 56 Korvick DL, Pijanowski GJ, Schaeffer DJ. Three-dimensional kinematics of the intact and cranial cruciate ligament-deficient stifle of dogs. J Biomech 1994; 27: 77-87.
    CrossrefPubMedGoogle Scholar
  • 57 Cook JL. The current status of treatment for large meniscal defects. Clin Orthop Rel Res 2005; 435: 88-95.
    PubMedGoogle Scholar
  • 58 Waxman AS, Robinson DA, Evans RB. et al Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness. Vet Surg 2008; 37: 241-246.
    CrossrefPubMedGoogle Scholar