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).

Surgery medical specialty

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.

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.

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 degrees and 90 degrees of knee flexion. The ACL is the most injured ligament of the four located in the knee.

Contents

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.

Tibia larger of the two bones of the leg below the knee for vertebrates

The tibia, also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates, and it connects the knee with the ankle bones. The tibia is found on the medial side of the leg next to the fibula and closer to the median plane or centre-line. The tibia is connected to the fibula by the interosseous membrane of the leg, forming a type of fibrous joint called a syndesmosis with very little movement. The tibia is named for the flute tibia. It is the second largest bone in the human body next to the femur. The leg bones are the strongest long bones as they support the rest of the body.

Femur most proximal bone of the leg for tetrapode vertebrates, longest bone for humans

The femur or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap forming the knee joint. By most measures the femur is the strongest bone in the body. The femur is also the longest bone in the human body.

Alternative procedures

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.

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.

The triple tibial osteotomy (TTO) 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 (CrCL) is a ligament connecting the femur with the tibia, which functions to stabilise the canine stifle joint from the forces put on it during exercise and weight bearing.

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 joint between the thigh and lower leg

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

The posterior cruciate ligament is one of the four major ligaments of the knee. 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.

Lachman test clinical test to diagnose knee ligament injury

The Lachman test is a clinical test used to diagnose injury of the anterior cruciate ligament (ACL). It is recognized as reliable, sensitive, and usually superior to the anterior drawer test.

Luxating patella

Luxating patella is a condition in which the patella, or kneecap, dislocates or moves out of its normal location.

The drawer test is used in the initial clinical assessment of suspected rupture of the cruciate ligaments in the knee. The patient should be supine with the hips flexed to 45 degrees, the knees flexed to 90 degrees and the feet flat on table. The examiner positions himself by sitting on the examination table in front of the involved knee and grasping the tibia just below the joint line of the knee. The thumbs are placed along the joint line on either side of the patellar tendon. The tibia is then drawn forward anteriorly. An increased amount of anterior tibial translation compared with the opposite limb or lack of a firm end-point may indicate either a sprain of the anteromedial bundle or complete tear of the ACL. If the tibia pulls forward or backward more than normal, the test is considered positive. Excessive displacement of the tibia anteriorly suggests that the ACL is injured, whereas excessive posterior displacement of the tibia may indicate injury of the posterior cruciate ligament.

Dog anatomy studies of the visible parts of the body of a canine

Dog anatomy comprises the anatomical studies of the visible parts of the body of a canine. 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 largest known adult dog was an English Mastiff which weighed 155.6 kg (343 lb) and was 250 cm (98 in) from the snout to the tail. 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.

Cruciate ligament type of ligament shaped like an X

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.

Anterior cruciate ligament injury ligament injury near the knee

Anterior cruciate ligament injury is when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete tear. Symptoms include pain, a popping sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

Patellar ligament

The patellar ligament is the distal portion of the common tendon of the quadriceps femoris, which is continued from the patella to the tibial tuberosity. It is also sometimes called the patellar tendon as it is a continuation of the quadriceps tendon.

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.

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.

Posterior cruciate ligament injury

The function of the posterior cruciate ligament (PCL) is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. Common causes of PCL injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee, both instances displacing the tibia posterior to the femur.

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.