Tibial Plateau Leveling Osteotomy (TPLO): clinical and radiographic long term follow-up

La rottura del legamento crociato craniale (LCCr) rappresenta una delle patologie ortopediche di più frequente riscontro clinico nella specie canina. Ne risultano affetti, in particolare, cani di taglia da medio-grande a gigante, soggetti in sovrappeso oppure molto attivi. Poiché la rottura del legamento crociato craniale esita in un processo osteoartrosico ad evoluzione progressiva, numerosi sono stati gli studi in merito ad eziopatogenesi e possibili risoluzioni chirurgiche di quest’affezione concretizzatesi, queste ultime, in proposte di tecniche di stabilizzazione del ginocchio intra- ed extracapsulari. Barclay Slocum ha sviluppato un modello biomeccanico articolare grazie al quale è stata chiarita la patogenesi del meccanismo di distorsione e di rottura del legamento crociato anteriore. La comprensione della biomeccanica del ginocchio ha, quindi, mostrato come il livellamento dell’inclinazione del plateau tibiale permetta di ristabilire l’equilibrio delle forze agenti sull’articolazione e di neutralizzare la spinta craniale della tibia, spesso responsabili del cedimento sia del legamento stesso, sia delle tecniche tradizionali realizzate per la sua ricostruzione. Questa tesi propone uno studio retrospettivo di 137 TPLO, con dati ottenuti da cartelle cliniche e radiogrammi. I risultati evidenziano un lieve, ma misurabile, incremento della gravità delle modificazioni radiografiche attribuite all’osteoartrosi in cani sottoposti a TPLO per il trattamento dell’incompetenza del LCCr. La valutazione clinica è stata effettuata utilizzando un questionario rivolto ai proprietari; è emerso un notevole miglioramento dell’utilizzo dell’arto rispetto alla condizione preoperatoria. La valutazione effettuata dal cliente non rispecchia la valutazione radiografica del grado di osteoartrosi. La TPLO è associata allo sviluppo di numerose complicanze, alcune delle quali richiedono una revisione chirurgica, la maggior parte un trattamento conservativo. Nonostante la TPLO presenti un maggior numero di complicanze rispetto ad altre tecniche utilizzate per il trattamento dell’incompetenza del LCCr, l’incidenza delle complicazioni maggiori è similare.Cranial cruciate ligament injuries are one of the most common orthopaedic diseases in dogs. This lesion is described, particularly, in medium-large and giant breeds, in very active and in overweight dogs. As cranial cruciate ligament (CCL) injury leads to progressive osteoarthritis and deterioration of limb function over time, many studies have been developed about pathogenesis and the possible surgical resolution of these lesions, suggesting two main types of reconstructive techniques, whose aim is stifle stabilization: intra-articular and extra-articular techniques. Barclay Slocum developed a biomechanical articular model that shows the mechanism throught which cranial cruciate ligament leads to distorsion and rupture. Stifle biomechanic understanding then explain how leveling the tibial plateau slope can restore knee biomechanical balance and neutralize the cranial tibial thrust, often responsibles of failure of both the cranial cruciate ligament itself and its reconstruction with traditional techniques. This thesis is a retrospective study of 137 tibial plateau leveling osteotomy (TPLO) with the data being obtained from medical records and a review of radiographs. Risulted suggested that there was a small, but measurable, increase in the severity of radiographic changes attribuited to osteoarthritis in the stifle joint of dogs that underwent TPLO because of cranial cruciate ligament insufficiency. Clinical function was assessed by using a previously reported client questionnaire. According to owner assessment, there was a significant improvement in function after TPLO when compared with the preoperative status. Improvement in function as measured by the client questionnaire did not significantly predict the radiographic osteoarthritis score. TPLO was associated with development of numerous complications, some of which required surgical correction. Most complications resolved with nonsurgical treatment. Although TPLO was associated with a greater number of complications than other CCL stabilization methods, the incidence of major complications was similar

Pelvic limb alignment measured by computed tomography in purebred English Bulldogs with medial patellar luxation

Objectives: The aim of the study was to describe the differences in pelvic limb alignment between healthy purebred English Bulldogs and those with medial patellar luxation through the measurement of femoral and tibial angles on computed tomography images in multiplanar reconstruction modality (MPRCT). Methods: Twenty-one purebred English Bulldogs were included and divided into two groups: one including healthy dogs (15 limbs) and the other including those with medial patellar luxation (24 limbs). Three different observers used MPR-CT to measure the following angles: anatomical lateral proximal femoral angle (aLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle of inclination of the femoral neck (AI), angle of anteversion (AA), mechanical medial proximal tibial angle (mMPTA), mechanical medial distal tibial angle (mMDTA), mechanical caudal distal tibial angle (mCdDTA), mechanical caudal proximal tibial angle (mCdPTA), and the tibial torsion angle (TTA). A Mann-Whitney U test was used to compare each variable in both groups. Results: The values for aLDFA and mLDFA in the medial patellar luxation population were significantly increased compared to healthy subjects (p <0.05). No significant differences were observed for the other variables. Clinical significance: In our population, an increased distal femoral varus was associated with medial patellar luxation. Our results could be useful to determine whether or not angular deformity of the femur is present and help determine the degree of correction necessary to restore alignment

Combining a joint health supplement with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture. An exploratory controlled trial

Canine cranial cruciate ligament rupture (CrCLR) is a very common pathology. Surgical stabilization is the first choice treatment, although it does not fully eliminate the increased risk of osteoarthritis. This preliminary study was carried out to explore whether a newly formulated joint health supplement would benefit metabolic, clinical and radiographic changes in dogs with CrCLR surgically treated with tibial plateau leveling osteotomy (TPLO). Besides chondroitin sulfate and glucosamine hydrochloride, the studied supplement contained anti-inflammatory and antioxidant ingredients, the main ones being N-palmitoylD-glucosamine (Glupamid) and quercetin. It was thus intended to target not only chondrodegenerative components of osteoarthritis, but also post-injury inflammatory response and oxidative stress of joint tissues. Thirteen dogs underwent TPLO and were randomly allocated to treatment (n = 6) and control groups (n = 7), the former receiving the joint supplement for 90 days. Lameness and radiographic osteoarthritis changes were scored before (i.e., baseline) and at 30 and 90 days post-surgery. Synovial fluid samples were collected from injured stifles at the same time points. Levels of representative metabolites were measured by proton nuclear magnetic resonance spectroscopy in a blinded fashion. In the metabolomic analysis, special attention was paid to lactate, due to its emerging recognition as a key marker of inflammation. In the last time period (from the 30th to the 90th day), lameness improved by a factor of 2.3 compared to control dogs. No significant difference was observed in the radiographic osteoarthritis score between groups. In the first postoperative month, lactate and creatine levels significantly dropped in treated compared to control dogs. Compared to surgery alone, combining the joint supplement with TPLO resulted in a trend to a better clinical outcome in the later time interval but did not influence osteoarthritis radiographic progression. A significantly better rebalance of joint microenvironment in the early time interval (baseline - 30 days) was shown by metabolomic analysis, thus suggesting that the study supplement could limit ongoing inflammatory responses. (C) 2017 Faculty of Veterinary Medicine, Cairo University. Production and hosting by Elsevier B.V