A. Langenbach & D. J. Marcellin-Little
(Slocum and Slocum 1993). It also acts as a guide during TPLO performed on dogs with CCL rupture and internal torsion of the tibia, varus or valgus tibial deformities. In our study, we felt that complete quadriceps alignment was not possible with the jig in place and we decided to perform the correction without the jig. While the absence of a jig could lead to iatrogenic axial or rotational malalignment, the very focus of this procedure was on realigning the tibia. We felt that the good long-term clinical outcome supported our realignment method. Using preoperative CT planning or intraoperative fluoroscopic image intensification could increase the precision of this tibial realignment method. TPLO performed without a jig did not appear to lead to axial or rotational malalignment in two recent reports (Bell and Ness 2007, Schmerbach and others 2007). The reported complication rate of TPLO has ranged from 19% to 28% (Pacchiana and others 2003, Priddy and others 2003, Stauffer and others 2006). The reported complication rate after MPL surgery in large breed dogs has been reported to be 29%, with 10% of patients having major complications such as patellar reluxation or implant failure (Gibbons and others 2006). The heaviest dog in our study had implant failure and patellar reluxation due to a traumatic event. This complication occurred during a fall that resulted in fibular fracture, fracture of the top three screws and reluxation of the patella. An additional surgical procedure was required to stabilise the stifle. The patient recovered and improved to a grade 2 lameness, three months after surgery. Proper client compliance with confinement is important after surgery. The use of a broad plate or the addition of a second plate could lower the likelihood of such mechanical failure in patients placing large loads on their operated legs in the early postoperative period. We now use broad plates on patients weighing more than 41 kg with tibiae that can accommodate the larger plate. One patient was referred for poor progress after extracapsular stabilisation of a CCL-deficient stifle joint. This patient also had an MPL. While MPL was not diagnosed in that patient before the origi102
nal surgery, it is likely that the MPL was developmental and did not result from the extracapsular stabilisation because of the distal portion of the femur had a varus angulation and because the wound closure of the fascia lata was intact when evaluated during the second surgery. It is possible, however, that MPL was secondary to the CCL stabilisation in that dog. MPL has been reported to result from CCL stabilisation (Arthurs and Langley-Hobbs 2007). In that report including 32 patients, MPL after CCL stabilisation was considered challenging and a variety of management methods were used. The reluxation rates ranged from 35% to 100% and were lower with tibial crest transposition, sulcoplasty and tibial realignment. The overall success rate was 79%. We cannot conclude whether the procedure evaluated in this report would be appropriate to manage patients with failed CCL stabilisation and MPL. We conclude from this report that MPL and CCL ruptures may be simultaneously managed in large dogs by externally rotating, by laterally translating and by abaxially displacing the principal portion of the tibia during the TPLO procedure. The geometric and mechanical features of this corrective surgery could be optimised using in vitro experiments. References ALAM, M. R., LEE, J. I., KANG, H. S., KIM, I. S., PARK, S. Y., LEE, K. C. & KIM, N. S. (2007) Frequency and distribution of patellar luxation in dogs. 134 cases (2000 to 2005). Veterinary and Comparative Orthopaedics and Traumatology 20, 59-64 ARAGON, C. L. & BUDSBERG, S. C. (2005) Applications of evidence-based medicine: cranial cruciate ligament injury repair in the dog. Veterinary Surgery 34, 93-98 ARTHURS, G. I. & LANGLEY-HOBBS, S. J. (2006) Complications associated with corrective surgery for patellar luxation in 109 dogs. Veterinary Surgery 35, 559-566 ARTHURS, G. I. & LANGLEY-HOBBS, S. J. (2007) Patellar luxation as a complication of surgical intervention for the management of cranial cruciate ligament rupture in dogs. A retrospective study of 32 cases. Veterinary and Comparative Orthopaedics and Traumatology 20, 204-210 BARONI, E., MATTHIAS, R. R., MARCELLIN-LITTLE, D. J., VEZZONI, A. & STEBBINS, M. E. (2003) Comparison of radiographic assessments of the tibial plateau slope in dogs. American Journal of Veterinary Research 64, 586-589 BELL, J. C. & NESS, M. G. (2007) Does use of a jig influence the precision of tibial plateau leveling osteotomy surgery? Veterinary Surgery 36, 228-233 BOUDRIEAU, R. J., MCCARTHY, R. J., SPRECHER, C. M., KUNZLER, T. P., KEATING, J. H. & MILZ, S. (2006) Material properties of and tissue reaction to the Slocum TPLO plate. American Journal of Veterinary Research 67, 1258-1265
BUCIUTO, R., UHLIN, B., HAMMERBY, S. & HAMMER, R. (1998) RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures. A randomized study of 233 patients with 1-year follow-up. Acta Orthopaedica Scandinavica 69, 25-28 DEANGELIS, M. & HOHN, R. B. (1970) Evaluation of surgical correction of canine patellar luxation in 142 cases. Journal of the American Veterinary Medical Association 156, 587-594 DOVERSPIKE, M., VASSEUR, P. B., HARB, M. F. & WALLS, C. M. (1993) Contralateral cranial cruciate ligament rupture: Incidence in 114 dogs. Journal of the American Animal Hospital Association 29, 167-170 DUDLEY, R. M., KOWALESKI, M. P., DROST, W. T. & DYCE, J. (2006) Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Veterinary Radiology & Ultrasound 47, 546-552 GIBBONS, S. E., MACIAS, C., TONZING, M. A., PINCHBECK, G. L. & MCKEE, W. M. (2006) Patellar luxation in 70 large breed dogs. Journal of Small Animal Practice 47, 3-9 HAYES, A. G., BOUDRIEAU, R. J. & HUNGERFORD, L. L. (1994) Frequency and distribution of medial and lateral patellar luxation in dogs: 124 cases (1982– 1992). Journal of the American Veterinary Medical Association 205, 716-720 HULSE, D. & HYMAN, B. (1991) Biomechanics of fracture fixation failure. Veterinary Clinics of North America: Small Animal Practice 21, 647-667 IMPELLIZERI, J. A., TETRICK, M. A. & MUIR, P. (2000) effect of weight reduction on clinical signs of lameness in dogs with hup osteoarthritis, Journal of the American Veterinary Medical Association 216, 1089-1091 JOHNSON, A. L., PROBST, C. W., DECAMP, C. E., ROSENSTEIN, D. S., HAUPTMAN, J. G., WEAVER, B. T. & KERN, T. L. (2001) Comparison of trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model. Veterinary Surgery 30, 140-150 JOHNSON, A. L., PROBST, C. W., DECAMP, C. E., ROSENSTEIN, D. S., HAUPTMAN, J. G. & KERN, T. L. (2002) Vertical position of the patella in the stifle joint of clinically normal large-breed dogs. American Journal of Veterinary Research 63, 42-46 KERGOSIEN, D. H., BARNHART, M. D., KEES, C. E., DANIELSON, B. G., BROURMAN, J. D., DEHOFF, W. D. & SCHERTEL, E. R. (2004) Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy. Veterinary Surgery 33, 468-474 KIM, S. E., POZZI, A., KOWALESKI, M. P. & LEWIS, D. D. (2008) Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Veterinary Surgery 37, 111-125 MARCELLIN-LITTLE, D. J., HARRYSSON, O. L. & CANSIZOGLU, O. (2008) In vitro evaluation of a custom cutting jig and custom plate for canine tibial plateau leveling. American Journal of Veterinary Research 69, 961-966 PACCHIANA, P. D., MORRIS, E., GILLINGS, S. L., JESSEN, C. R. & LIPOWITZ, A. J. (2003) Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998–2001). Journal of the American Veterinary Medical Association 222, 184-193 POWERS, M. Y., MARTINEZ, S. A., LINCOLN, J. D., TEMPLE, C. J. & ARNAIZ, A. (2005) Prevalence of cranial cruciate ligament rupture in a population of dogs with lameness previously attributed to hip dysplasia: 369 cases (1994–2003). Journal of the American Veterinary Medical Association 227, 1109-1111 PRAYSON, M. J., DATTA, D. K. & MARSHALL, M. P. (2001) Mechanical comparison of endosteal substitution and lateral plate fixation in supracondylar fractures of the femur. Journal of Orthopaedic Trauma 15, 96-100 PRIDDY, N. H. II, TOMLINSON, J. L., DODAM, J. R. & HORNBOSTEL, J. E. (2003) 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). Journal of the American Veterinary Medical Association 222, 1726-1732
Journal of Small Animal Practice • Vol 51 • February 2010 • © 2010 British Small Animal Veterinary Association