<p>Tibial Plateau Leveling Osteotomy for Cranial Cruciate Ligament Rupture in Canines: Patient Selection and Reported Outcomes</p>

Abstract

Cranial cruciate ligament (CCL) rupture is one of the most common causes of pelvic limb lameness in dogs. In a CCL deficient stifle, joint lameness develops from cranial tibial translation in relation to the distal femoral condyles. The tibial plateau leveling osteotomy (TPLO) is a well-described surgical procedure that neutralizes tibiofemoral shear force by altering the tibial plateau via a proximal tibial osteotomy, and subsequently restores normal limb function. Current literature for the TPLO was reviewed and used to describe the optimal patient selection and to report clinical outcome with the TPLO in comparison to other surgical options for CCL rupture. The clinical outcomes reported to date, particularly those utilizing objective outcome data, support the TPLO as being able to consistently return dogs to normal limb function with a low risk for long-term morbidity. The TPLO procedure was found to be widely applicable to dogs ranging from small breed to large and giant breed, and does not appear to have some of the limitations that exist with alternative surgical options. This review concludes that the TPLO is an excellent treatment option for any dog with CCL rupture due to the excellent long-term outcome and high rate of owner satisfaction previously reported. Despite these conclusions, it is important to remember that treatment selection for CCL rupture remains dependent on multiple considerations including patient factors, surgeon experience, and costs.

Modified tibial plateau levelling osteotomy to treat lateral patellar luxation and cranial cruciate ligament deficiency in a dog

“…Several modifications and adaptations have improved the effectiveness of the technique. 6 It has been used successfully for the treatment of CCL deficiency in dogs for the past three decades. A combined surgical technique that addresses PL and CCL deficiency in a single procedure allows both conditions to be treated simultaneously with a reduction in surgical trauma and recovery.…”

Rock back phenomenon in 32 dogs that underwent tibial plateau levelling osteotomy

“…is dependent on the tilt angle of the tibial plateau; therefore, in this procedure, a proximal tibial circular osteotomy is performed, after which the tibiofemoral shear force is neutralised during the gait, establishing an angle of the tibial plateau (TPA) suitable for the dynamic joint stabilisation (Stine et al 2018;Nanda and Hans 2019).…”

“…A tibial plateau levelling osteotomy (TPLO) represents the best way to treat CCLD, despite more than 5 decades since the first surgical treatment described for this condition (Barnes et al 2019;Nanda and Hans 2019;Clark et al 2020;Vezzoni et al 2020). The magnitude of the cranial tibial impulse Veterinarni Medicina, 66, 2021 (02): 58-65 https://doi.org/10.17221/128/2020-VETMED (0° to 14°) (Warzee et al 2001;Reif et al 2002;Nanda and Hans 2019).…”

“…The postoperative TPA value is considered fundamental for the success of the procedure, and there should not be any excess rotation or an insufficient rotation (Nanda and Hans 2019). It is also known that the TPA achieved in the immediate postoperative period can undergo changes until the osteotomy of the TPLO consolidates.…”

“…It is also known that the TPA achieved in the immediate postoperative period can undergo changes until the osteotomy of the TPLO consolidates. This phenomenon has been called the "rock back" phenomenon (Bergh et al 2008;Taylor et al 2011;Nanda and Hans 2019). This alteration is defined as the movement of the segment of the tibial plateau that occurs along the osteotomy line, causing an increase in the TPA of ≥5°, between the immediate postoperative period and the subsequent control radiographs (Duerr et al 2008;Moeller et al 2010).…”