Tibial-plateau-leveling osteotomy

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TPLO, or tibial-plateau-leveling osteotomy, is a surgery performed on dogs to stabilize the stifle joint after ruptures of the cranial cruciate ligament (analogous to the anterior cruciate ligament [ACL] in humans, and sometimes colloquially called the same).

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In the vast majority of dogs, the cranial cruciate ligament (CrCL) ruptures as a result of long-term degeneration, whereby the fibres within the ligament weaken over time. The precise cause of this is not known, but genetic factors are probably most important, with certain breeds being predisposed (including Labradors, Rottweilers, Boxers, West Highland White Terriers and Newfoundlands). Supporting evidence for a genetic cause was primarily obtained by assessment of family lines, coupled with the knowledge that many animals will rupture the CrCL in both knees, often relatively early in life. Other factors such as obesity, individual conformation, hormonal imbalance and certain inflammatory conditions of the joint may also play a role. [1]

The cranial cruciate ligament runs from the cranial mid part of the tibial intercondylar eminence to the lateral condyle of the femur. Normally, the CrCL prevents caudal (backward) movement of the Femur relative to the Tibia. Due to selective breeding the tibial plateau slope has become sloped too far backwards so there is a constant stress on the Cranial cruciate ligament. Over time this leads to a degenerative rupture. When it ruptures, the joint becomes unstable which causes pain and can lead to chronic progressive arthritis in the stifle if untreated. [2]

In a TPLO procedure, the tibial plateau, the portion of the tibia adjoining the stifle, is cut and rotated so that its slope changes to approximately 5 degrees from the horizontal plane. [3] This prevents the femur from sliding down the slope of the tibial plateau when the dog puts weight on its knee. This surgery generally results in faster recovery times compared to other procedures to stabilize the knee. Most dogs (over 90%) are expected to regain a very active and athletic lifestyle with no post-operative complications and without the need for any long-term pain relieving medication.

Alternative procedures

A systematic review of the evidence has shown that "…functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture." [4]

Related Research Articles

Knee Region around the kneecap

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum. The operation is done under a general anaesthetic.

Posterior cruciate ligament One of four major ligaments of the knee

The posterior cruciate ligament (PCL) is a ligament in each knee of humans and various other animals. It works as a counterpart to the anterior cruciate ligament (ACL). It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.

Anterior cruciate ligament Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are also called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate translates to cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an “X”. It is composed of strong, fibrous material and assists in controlling excessive motion. This is done by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most injured ligament of the four located in the knee.

Popliteal artery Continuation of the femoral artery that supplies the lower leg

The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries.

Luxating patella Medical condition

A luxating patella, sometimes called a trick knee, is a condition in which the patella, or kneecap, dislocates or moves out of its normal location.

Dog anatomy Studies of the visible part of a canine

Dog anatomy comprises the anatomical studies of the visible parts of the body of a domestic dog. Details of structures vary tremendously from breed to breed, more than in any other animal species, wild or domesticated, as dogs are highly variable in height and weight. The smallest known adult dog was a Yorkshire Terrier that stood only 6.3 cm (2.5 in) at the shoulder, 9.5 cm (3.7 in) in length along the head and body, and weighed only 113 grams (4.0 oz). The heaviest dog was an English Mastiff named Zorba which weighed 314 pounds (142 kg). The tallest known adult dog is a Great Dane that stands 106.7 cm (42.0 in) at the shoulder.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

Stifle joint

The stifle joint is a complex joint in the hind limbs of quadruped mammals such as the sheep, horse or dog. It is the equivalent of the human knee and is often the largest synovial joint in the animal's body. The stifle joint joins three bones: the femur, patella, and tibia. The joint consists of three smaller ones: the femoropatellar joint, medial femorotibial joint, and lateral femorotibial joint.

Cruciate ligament

Cruciate ligaments are pairs of ligaments arranged like a letter X. They occur in several joints of the body, such as the knee joint and the atlanto-axial joint. In a fashion similar to the cords in a toy Jacob's ladder, the crossed ligaments stabilize the joint while allowing a very large range of motion.

Unhappy triad Medical condition

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

Tibial Tuberosity Advancement (TTA) is an orthopedic procedure to repair deficient cranial cruciate ligaments in dogs. It has also been used in cats. This procedure was developed by Dr. Slobodan Tepic and Professor Pierre Montavon at the School of Veterinary Medicine, University of Zurich, in Zurich, Switzerland beginning in the late 1990s.

The triple tibial osteotomy is a surgical procedure used to treat dogs that have completely or partially ruptured the cranial cruciate ligament in one or both of their stifles. The cranial cruciate ligament connects the femur with the tibia, which functions to stabilise the canine stifle joint from the forces put on it during exercise and weight bearing.

Tightrope CCL is a veterinary orthopedic surgical method developed to provide a minimally invasive procedure for extracapsular stabilization of the canine cranial cruciate ligament-deficient stifle joint. The cranial cruciate ligament (CrCL) stabilizes the dog knee much like the anterior cruciate ligament (ACL) does in humans.

Discoid meniscus

Discoid meniscus is a rare human anatomic variant that usually affects the lateral meniscus of the knee. Usually a person with this anomaly has no complaints; however, it may present as pain, swelling, or a snapping sound heard from the affected knee. Strong suggestive findings on magnetic resonance imaging includes a thickened meniscal body seen on more than two contiguous sagittal slices.

A bumper fracture is a fracture of the lateral tibial plateau caused by the bumper of a car coming into contact with the outer side of the knee when a person is standing. Specifically, it is caused by a forced valgus applied to the knee. This causes the lateral part of the distal femur and the lateral tibial plateau to come into contact, compressing the tibial plateau and causing the tibia to fracture. The name of the injury is because it was described as being caused by the impact of a car bumper on the lateral side of the knee while the foot is planted on the ground, although this mechanism is only seen in about 25% of tibial plateau fractures.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

Tibial plateau fracture Medical condition

A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.

The anterolateral ligament (ALL) is a ligament on the lateral aspect of the human knee, anterior to the fibular collateral ligament.

Simitri Stable in Stride is a three part modular surgical implant used during surgery performed on dogs to stabilize the stifle joint (knee) after rupture of the cranial cruciate ligament (CrCL) which is analogous to the anterior cruciate ligament (ACL) in humans.

References

  1. "Cruciate Ligament Disease in the Dog".
  2. Cranial Cruciate Ligament (CrCL) Failure: canine and feline (cat and dog) veterinary factsheets
  3. Slocum, Barclay; Slocum, Theresa Devine (1993). "Tibial Plateau Leveling Osteotomy for Repair of Cranial Cruciate Ligament Rupture in the Canine". Veterinary Clinics of North America: Small Animal Practice. 23 (4): 777–95. doi:10.1016/S0195-5616(93)50082-7. PMID   8337790.
  4. Bergh, Mary Sarah; Sullivan, Carly; Ferrell, Christopher L; Troy, Jarrod; Budsberg, Steven C (2014). "Systematic Review of Surgical Treatments for Cranial Cruciate Ligament Disease in Dogs". Journal of the American Animal Hospital Association . 50 (5): 315–21. doi:10.5326/JAAHA-MS-6356. PMID   25028440.