Tibial Plateau Leveling Osteotomy in small and large breed dogs: a comparative retrospective study of complications and outcomes

Abstract

Objective To compare complication rates and outcomes of small and large breed dogs that had locking plate Tibial Plateau Leveling Osteotomy (TPLO) performed due to cranial cruciate ligament disease during the same time period at a single institution and identify potential influencing factors.

Material and methods 136 cases with TPLO performed at a single institution between January 2013 and December 2015 were retrospectively reviewed. Dogs were grouped by plate sizes (2.0, 2.4, 2.7, 3.5 and 3.5 broad) and by small breeds (2.0–2.7 plate sizes) and large breeds (3.5 plates). Potential influencing factors on lameness and complications were recorded from the database and measured on radiographs and statistically compared.

Results Small dogs experienced fewer complications than large dogs (10% vs. 22%) and not a single major complication. Small dogs were significantly less lame at recheck and at long-term follow-up. Progression of bone healing had an influence on the lameness grade of dogs at recheck after TPLO. Distance of the most proximal screw from the joint was identified as a risk factor for implant failure. The width of the patella ligament correlated with body weight and uniformly increased 2.4 times after TPLO.

Conclusions TPLO in small breed dogs has a lower overall complication rate than in large breed dogs. The TPLO plate should always be placed as close to the joint as possible to reduce the risk of implant failure.

Clinical relevance TPLO can be recommended as treatment for cranial cruciate ligament rupture (CCLR) in dogs of all sizes.

Zusammenfassung

Gegenstand und Ziel Ziel dieser Studie war der Vergleich der Komplikationen sowie der Ergebnisse bei kleinen und großen Hunden nach Umstellungsosteotomie nach Slocum (TPLO) zur Behandlung eines kranialen Kreuzbandrisses. Außerdem sollten mögliche Einflussfaktoren auf Komplikationen und Ergebnisse identifiziert werden.

Material und Methoden 136 Fälle, bei denen an einer Institution zwischen Januar 2013 und Dezember 2015 eine TPLO durchgeführt worden war, wurden retrospektiv untersucht. Die Hunde wurden nach den verwendeten Plattengrößen in Gruppen eingeteilt (2,0, 2,4, 2,7, 3,5 und 3,5 broad). „Kleine Hunde” wurden als solche mit Plattengrößen von 2,0–2,7 mm definiert und „große Hunde” als solche mit 3,5 mm Platten. Potenzielle Einflussfaktoren auf Lahmheit und Komplikationen wurden aus den Karteikarten entnommen, an Röntgenbildern gemessen und im Anschluss statistisch aufbereitet.

Ergebnisse Kleine Hunde erlitten insgesamt weniger Komplikationen (10% vs. 22%) und in keinem einzigen Fall eine schwere Komplikation. Sie waren außerdem signifikant weniger lahm bei der ersten Kontrolluntersuchung sowie nach Langzeit-Follow-up. Der Fortschritt der Knochenheilung bei der ersten Kontrolluntersuchung beeinflusste den Lahmheitsgrad aller Hunde zu diesem Zeitpunkt. Die Distanz der obersten Schraube zum Gelenksspalt stellte sich als Risikofaktor für Implantatversagen heraus. Die Dicke des Patellarbandes korrelierte mit dem Körpergewicht und nahm einheitlich 2,4-fach nach TPLO zu.

Schlussfolgerungen Die TPLO beim kleinen Hund hat eine geringere Gesamtkomplikationsrate als beim großen Hund. Die TPLO-Platte sollte immer so nah wie möglich am Gelenk platziert werden, um das Risiko eines Implantatversagens zu minimieren.

Klinische Relevanz Die TPLO eignet sich als Standardmethode zur Behandlung des vorderen Kreuzbandrisses bei Hunden aller Größen.

Key words

TPLO - small breed dogs - implant failure - Synthes TPLO plates - patella ligament width - cranial cruciate ligament disease

Schlüsselwörter

TPLO - kleine Hunde - Implantatversagen - Synthes TPLO Platten - Patellarligamentdicke - kranialer Kreuzbandriss

Publication History

Received: 26 September 2021

Accepted: 03 November 2022

Article published online:
14 March 2023

• References

• 1 Comerford E, Forster K, Gorton K. et al. Management of cranial cruciate ligament rupture in small dogs: a questionnaire study. Vet Comp Orthop Traumatol 2013; 26: 493-497
• 2 Duerr FM, Martin KW, Rishniw M. et al. Treatment of canine cranial cruciate ligament disease. A survey of AVCS diplomats and primary care veterinarians. Vet Comp Orthop Traumatol 2014; 27: 478-483
• 3 Garnett SD, Daye RM.. Short-term complications associated with TPLO in dogs using 2.0 and 2.7 mm plates. J Am Anim Hosp Assoc 2014; 50: 396-404
• 4 Nelson SA, Krotscheck U, Rawlinson J. et al. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42: 38-50
• 5 Bergh MS, Peirone B.. Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2012; 25: 349-358
• 6 Beer P, Bockstahler B, Schnabl-Feichter E.. Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review. Tierarztl Prax Ausg K Kleintiere Heimtiere 2018; Aug 46: 223-235
• 7 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
• 8 Witte PG, Scott HW.. Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate. Vet Surg 2014; 43: 549-557
• 9 Berger B, Knebel J, Steigmeier-Raith S. et al. Long-term outcome after surgical treatment of cranial cruciate ligament rupture in small breed dogs. Comparison of tibial plateau leveling osteotomy and extra-articular stifle stabilization. Tierarztl Prax Ausg K Kleintiere Heimtiere 2015; 43: 373-380
• 10 Cosenza G, Reif U, Martini FM.. Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates. A clinical and radiographic retrospective assessment. Vet Comp Orthop Traumatol 2015; 28: 347-354
• 11 Barnes DC, Trinterud T, Owen MR. et al. Short-term outcome and complications of TPLO using anatomically contoured locking compression plates in small/medium-breed dogs with "excessive" tibial plateau angle. J Small Anim Pract 2016; 57: 305-310
• 12 Knight R, Danielski A.. Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°. Vet Rec 2018; 182: 461
• 13 Kowaleski M, Boudrieau R, Pozzi A.. Stifle Joint. In: Veterinary Surgery Small Animal. 1st edn. Eds Tobias K and Johnston S. Saunders, St. Louis; MO, USA.: 906-998
• 14 Neal BA, Ting D, Bonczynski JJ. et al. Evaluation of meniscal click for detecting meniscal tears in stifles with cranial cruciate ligament disease. Vet Surg 2015; Feb 44: 191-194
• 15 Hayes GM, Langley-Hobbs SJ, Jeffery ND.. Risk factors for medial meniscal injury in association with cranial cruciate ligament rupture. J Small Anim Pract 2010; Dec 51: 630-634
• 16 Kowaleski MP, McCarthy RJ.. Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial slope. Vet Comp Orthop Traumatol 2004; 17: 30-34
• 17 Roy RG, Wallace LJ, Johnston GR. et al. A retrospective evaluation of stifle osteoarthritis in dogs with bilateral medial patellar luxation and unilateral surgical repair. Vet Surg 1992; 21: 475-479
• 18 Hammer RR, Hammerby S, Lindholm B.. Accuracy of radiologic assessment of tibial shaft fracture union in humans. Clin Orthop Relat Res 1985; 199: 233-238
• 19 Brunnberg L. Lahmheitsdiagnostik beim Hund. 1. Aufl. Berlin: Parey;; 1998
• 20 Tuttle TA, Manley PA.. Risk factors associated with fibular fracture after tibial plateau leveling osteotomy. Vet Surg 2009; 38: 355-360
• 21 Taylor J, Langenbach A, Marcellin-Little DJ.. Risk factors for fibular fracture after TPLO. Vet Surg 2011; 40: 687-693
• 22 Bergh MS, Rajala-Schultz P, Johnson KA.. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37: 374-382
• 23 Fitzpatrick N, Solano MA.. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474
• 24 Coletti TJ, Anderson M, Gorse MJ. et al. Complications associated with tibial plateau leveling osteotomy: a retrospective of 1519 procedures. Can Vet J 2014; 55: 249-254
• 25 Carey K, Aiken SW, DiResta GR. et al. Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy 94 cases (2000–2003). Vet Comp Orthop Traumatol 2005; 18: 235-242
• 26 Grawe B, Le T, Williamson S, Archdeacon A, Zardiackas L.. Fracture fixation with two locking screws versus three non-locking screws: A biomechanical comparison in a normal and an osteoporotic bone model. Bone Joint Res 2012; Jun 1 1: 118-124
• 27 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
• 28 Vasseur PB.. Clinical results following nonoperative management for rupture of the cranial cruciate ligament in dogs. Vet Surg 1984; 13: 243-246
• 29 Amimoto H, Koreeda T, Ochi Y. et al. Force Plate Gait Analysis and Clinical Results after Tibial Plateau Levelling Osteotomy for Cranial Cruciate Ligament Rupture in Small Breed Dogs. Vet Comp Orthop Traumatol 2020; May 33: 183-188
• 30 Mattern KL, Berry CR, Peck JN. et al. Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau leveling osteotomy. Vet Radiol Ultrasound 2006; 47: 185-191
• 31 Conkling AL, Fagin B, Daye RM.. Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology. Vet Surg 2010; 39: 475-481
• 32 Krotscheck U, Thompson MS, Ryan KK. et al. Comparison of TPA, bone healing, and intra-articular screw placement using conventional nonlocked application of surgeon-contoured versus locked application of precontoured TPLO plates in dogs. Vet Surg 2012; 41: 931-937
• 33 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: 357-365
• 34 Kloc PA, Kowaleski MP, Litsky AS. et al. Biomechanical comparison of two alternative tibial plateau leveling osteotomy plates with the original standard in an axially loaded gap model: an in vitro study. Vet Surg 2009; 38: 40-48
• 35 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
• 36 Baltzer WI, Owen R, Bridges J.. Survey of Handlers of 158 Police Dogs in New Zealand: Functional Assessment and Canine Orthopedic Index. Front Vet Sci 2019; 6: 85
• 37 Alves JC, Santos A, Jorge P. et al. Clinical and diagnostic imaging findings in police working dogs referred for hip osteoarthritis. BMC Vet Res 2020; 16: 425