Search Results (17)

This study explored the complications and prognosis of modified tibial plateau leveling osteotomy with tibial tuberosity transposition (mTPLO-TTT) for simultaneously correcting high-grade medial patellar luxation (MPL) and cranial cruciate ligament disease (CCLD) in small-breed dogs. This retrospective study evaluated patient data, lameness scores, radiographic outcomes, and complications over a median follow-up period of 10 weeks. Additionally, an owner interview was conducted 6 months postoperatively. Nine stifles from seven dogs were included in this study. All cases showed satisfactory patellar alignment and stability after surgery, with no major complications or reluxations. The lameness scores improved, and radiographic assessments confirmed implant stability and appropriate bone healing. Owner-reported outcomes at 6 months were also favorable. These findings suggest that simultaneous mTPLO-TTT is an effective surgical option for small-breed dogs with concurrent CCLD and Grade IV MPL. Full article

Objective: To review recent advancements in cranial cruciate ligament disease (CCLD) in dogs, focusing on diagnostic innovations and treatment options. Study Design: Literature review. Animals or Sample Population: Not applicable. Methods: Analysis of current literature on diagnostic tools and treatment techniques for CCLD, with emphasis on recent trends and advancements. Results: Enhanced diagnostic tools, such as Computed Tomography (CT), offer detailed anatomical insights, improving the accuracy of CCLD assessments. Treatment approaches include extra-articular techniques like lateral fabellar suture stabilization, intra-articular methods with natural and synthetic implants, and advanced surgical procedures such as Tibial Plateau Leveling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA), and arthroscopy. Recent trends favor combining techniques, such as TPLO with lateral fabellar sutures or arthroscopy with TPLO, to optimize outcomes. Intra-articular techniques, while promising, may face challenges related to graft choice and tunnel placement. Conclusions: A multifaceted approach integrating advanced diagnostics and tailored treatments enhances patient outcomes for CCLD. Ongoing advancements in both diagnostic and therapeutic strategies are crucial for effective management. Clinical Significance/Impact: This review highlights recent advancements and research in diagnostic and therapeutic strategies for CCLD, providing valuable insights for veterinary surgeons and researchers. The integration of these advanced approaches is essential for improving clinical outcomes in canine CCLD management. Full article

Emerging evidence in women supports the notion that pregnancy may reset disease resistance, thereby providing protection against subsequent adverse health outcomes, but this hypothesis has not been adequately explored in domestic dogs. Cranial cruciate ligament (CCL) rupture is a degenerative orthopedic disease that frequently affects pet dogs, and its risk has been associated with disruption of the reproductive hormone axis. Our research team is conducting a lifetime cohort study of purebred Rottweilers in North America that have lived 30% longer than breed-average. Detailed medical and reproductive histories of 33 nulliparous and 32 parous Rottweilers were generated from questionnaires and review of medical records. Interviews with owners of bitches in the nulliparous group served to limit selection bias, confirming that in no instance was the reason for nulliparity based upon the owner’s suspicion that a bitch had a heightened risk for CCL rupture. The risk of CCL rupture associated with parity and other exposure variables was estimated using multivariate logistic regression. Overall, CCL rupture was diagnosed in 17 of 65 (26%) bitches. Median age at first litter and CCL rupture were 3.6 and 6.5 years, respectively. Compared to nulliparous, parous bitches had a significant 94% reduction in CCL rupture risk adjusted for duration of ovary exposure, overweight body condition, dietary pattern, habitual physical activity, and work/sport activity [OR_adjusted (95% CI) = 0.06 (0.01–0.46); (p = 0.006)]. The observed parity-associated CCL rupture risk reduction remained robust in sensitivity analysis excluding six nulliparous bitches for which decision not to breed was based on diagnosis of hip or elbow dysplasia, conditions which may be genetically linked to CCL rupture [OR_adjusted (95% CI) = 0.08 (0.01–0.58); (p = 0.01)]. This work sets the stage for replication studies in other canine populations that should begin to explore the mechanistic basis for parity-associated CCL rupture risk reduction and to pursue other non-reproductive health outcomes in bitches whose incidence or severity may be parity-sensitive. Full article

This study aims to evaluate the morpho-functional change in the patellar ligament in dogs with cranial cruciate ligament disease. We hypothesized that it may show increased thickening and stiffness with increasing days from onset to diagnosis instead of trauma. Understanding this aspect has implications for the choice of timing for treating patients suffering from cranial cruciate ligament disease, as well as the contextualization of patellar ligament desmitis pictures after surgical treatment with tibial plateau leveling osteotomy or tibial tuberosity advancement. Thirty-three dogs affected by unilateral cranial cruciate disease were examined and divided into three groups based on the time elapsed from the onset of lameness to diagnosis: Group 1 (1–15 days), Group 2 (16–60 days), and Group 3 (over 60 days). Conventional B-mode ultrasonographic and elastosonographic examinations of the patellar ligament were performed without sedation for each dog. Upon ultrasonographic examination, all dogs showed modification in the echostructure of the patellar ligament. In addition, the patellar ligament tended to become harder with increasing days after disease, although there were no significant differences between groups. Our results show that as the time increases between the onset of cranial cruciate ligament disease and diagnosis and treatment, the patellar ligament progressively thickens and loses its elasticity. Full article

The aim of this study was to compare the degree of visibility of the lateral and medial menisci before and after tibial plateau leveling osteotomy (TPLO) on 3D-printed models created after laser scanning of the right tibia with menisci derived from a fresh cadaver of a 4-year-old adult male golden retriever. The models were produced of white polylactic acid, and the menisci were filled with light-curing red resin. The models showed a similar conformation as the natural specimen harvested from the cadaver, maintaining the same length and width, in addition to reproducing the anatomical structures. From the pre- and post-TPLO radiographs, it was possible to identify the anatomical structures corresponding to the tibial plateau. The preoperative tibial plateau angle was 26.2°, and the postoperative one ranged between 4.0° and 5.3° (4.6 ± 0.4°). In the bird’s-eye photo, the total number of red pixels in the lateral and the medial meniscus was 2,053,995 and 2,140,939, respectively. Before TPLO, only between 14% and 19% of the entire area of the menisci was visible, and the unhidden part of the entire area of the meniscus before TPLO did not differ significantly between the lateral (16.2 ± 1.6%) and the medial (16.4 ± 1.6%) meniscus (p = 0.351). The visible part of the entire meniscus area increased significantly after TPLO both in the lateral and medial menisci (p < 0.001)—mean difference ± SD of 30.3 ± 4.3% (CI 95%: 27.9%, 32.6%) and 36.4 ± 6.4% (CI 95%: 32.9%, 40.0%), respectively. In conclusion, the intraoperative examination and treatment of dog menisci are easier after TPLO. Full article

Osteoarthritis (OA) affects >500 million people globally, and this number is expected to increase. OA management primarily focuses on symptom alleviation, using non-steroidal anti-inflammatory drugs, including Celecoxib. However, such medication has serious side effects, emphasizing the need for disease-specific treatment. The meniscectomy and cranial cruciate ligament transection (CCLx)-treated beagle dog was used to investigate the efficacy of a modified-release formulation of SKI306X (SKCPT) from Clematis mandshurica, Prunella vulgaris, and Trichosanthes kirilowii in managing arthritis. SKCPT’s anti-inflammatory and analgesic properties have been assessed via stifle circumference, gait, incapacitance, histopathology, and ELISA tests. The different SKCPT concentrations and formulations also affected the outcome. SKCPT improved the gait, histopathological, and ELISA OA assessment parameters compared to the control group. Pro-inflammatory cytokines and matrix metalloproteinases were significantly lower in the SKCPT-treated groups than in the control group. This study found that SKCPT reduces arthritic lesions and improves abnormal gait. The 300 mg modified-release formulation was more efficacious than others, suggesting a promising approach for managing OA symptoms and addressing disease pathogenesis. A high active ingredient level and a release pattern make this formulation effective for twice-daily arthritis treatment. Full article

The aim of this study was to evaluate the effects of autologous microfragmented adipose tissue (MFAT) applied after mechanical fragmentation and assess these effects radiographically in bone healing in dogs subjected to tibial plateau levelling osteotomy (TPLO). Twenty dogs with unilateral cranial cruciate ligament disease were enrolled and randomly assigned to the treatment group (MFAT) or the control group (NT). The MFAT group underwent TPLO and autologous MFAT intra-articular administration, while the NT group underwent TPLO alone. Adipose tissue was collected from the thigh region, and MFAT was obtained by mechanical fragmentation at the end of the surgery. The patients were subjected to X-ray examination preoperatively, immediately postoperatively (T0), and at 4 (T1) and 8 (T2) weeks postoperatively. Two radiographic scores that had previously been described for the evaluation of bone healing after TPLO were used. A 12-point scoring system (from 0 = no healing to 12 = complete remodelling) was used at T0, T1, and T2, while a 5-point scoring system (from 0 = no healing to 4 = 76–100% of healing) was used at T1 and T2. The median healing scores were significantly higher at T1 and T2 for the MFAT group compared with the NT group for the 12-point (p < 0.05) and 5-point (p < 0.05) scoring systems. The intra-articular injection of autologous microfragmented adipose tissue can accelerate bone healing after TPLO without complications. Full article

In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients’ owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons’ training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options. Full article

The spontaneous rupture of the cranial cruciate ligament in dogs remains a pathoetiologic puzzle. Despite much progress in research over the past years, the systemic and local mechanisms leading to ligament degeneration and structural failure remain largely obscure. This scoping review focuses on pathogenesis and aims at summarizing and interpreting today’s knowledge on causes of canine cruciate ligament rupture, i.e., the multifactorial mechanisms leading to degenerative stifle joint disease with collagen matrix degeneration and structural failures. Thus, the initial view of traumatic ligament rupture, fostered by “wear and tear”, has clearly been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus, the term “cranial cruciate ligament disease” has been coined and is generally accepted. In addition, cruciate ligament rupture in people shares some similarities with the lesion in dogs; therefore, the review also includes comparative studies. The methods used were based on the PRISMA-ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Full article

Background: The cranial cruciate ligament rupture is one of the most common orthopaedic diseases encountered in dogs. Surgical techniques have been developed to stabilize the stifle, with an overall accepted benefit of tibial osteotomies among which is the tibial tuberosity advancement (TTA). Prior to surgery, the required TTA must be determined on a strict lateral radiographical view of the affected stifle with femur and tibia at an angle of 135° as initially recommended. This value, initially determined in only two dog breeds, has been considered the mean standard value of the canine stifle angle during the mid-stance phase. Methods: We sought to determine if this particular stifle angle around mid-stance phase was similar among multiple dog breeds. We built up a custom-made radiographic system for stifle angle measurement in standing dogs. Results: A mean value of stifle angle of 145° was obtained. Mean stifle angle at mid-stance phase in a healthy dog is regularly higher than 135° and is likely breed and individual dependent. Conclusions: The pre-operative measurement of the required TTA made on stifles in 145° extension, a value close to full physiological extension could contribute to decreasing the incidence of late post-operative meniscal lesion, consecutive to underestimation of TTA. Full article

Cranial cruciate ligament disease (CCLD) is one of the most frequent causes of hindlimb lameness in dogs. Tibial tuberosity advancement (TTA) is a common surgery performed for CCLD. A modified, simplified technique (TTA Rapid) is also reported to have very good clinical outcomes. In this paper, we report a modified TTA Rapid technique to treat a CCLD in a dog with an amputated contralateral hindlimb. A 5-year-old mixed breed dog presented with amputated right hindlimb and difficulty walking. Pain and positive drawer sign were present at manipulation of left stifle joint. Radiographic findings of the stifle joint confirmed the presence of moderate osteoarthritis associated with CCLD, and modified TTA Rapid procedure was performed. Recovery from surgery was uneventful, and the dog was able to stand by his own by the second day postoperative. At three months follow-up evaluation, the dog was free of lameness and the osteotomy site was completely healed. This paper describes the first modified TTA rapid osteotomy technique performed in a dog with a contralateral amputated hindlimb. Full article

(1) Background: Several surgical techniques were described for the treatment of cranial cruciate ligament rupture in dogs. This report aims to critically review the available literature focused on preoperative planning, surgical procedure, follow-up, and complications of cranial cruciate ligament rupture treated by tibial tuberosity advancement techniques; (2) Methods: three bibliographic databases: PubMed, Google Scholar, and Scopus were used for a board search of TTAT (canine OR dog). Five GRADE recommendations according to Grading of Recommendations Assessment, Development and Evaluation and Joanna Briggs Institute Critical Appraisal Checklists were applied to the studies included. Data regarding preoperative planning (a measure of advancement), meniscal disease (meniscectomy, meniscal release, and late meniscal tears), and postoperative patellar tendon angle were recorded. Time frame, outcome, and complications were classified according to Cook’s guidelines; (3) Results: from 471 reports yielded, only 30 met the inclusion criteria. The common tangent method was the most commonly reported measurement technique for preoperative planning. The 40.21% of stifles presented meniscal tears at surgery, while 4.28% suffered late meniscal tears. In short-, mid-and long-term follow-ups examined showed a full/acceptable function was shown in >90% of cases. Among all new generation techniques, minor complications were reported in 33.5% of cases and major complications in 10.67%; (4) Conclusions: Compared to traditional TTA, new generation TTAT resulted effective in the treatment of cranial cruciate ligament failure, showing a lower rate of late meniscal injury but a higher rate of minor complications. Full article

The etiology of spontaneous cranial cruciate ligament rupture in dogs is unknown despite being one of the most impacting orthopedic diseases in dogs. Numerous studies have contributed to the understanding of a multifactorial pathogenesis, this, however, without identifying a pivotal link to explain progressive collagen degeneration and osteoarthritic changes. In human medicine, recent reports have identified relaxin as a triggering factor in ligament ruptures in knee and metacarpal joints. We thus hypothesized that relaxin might also play a role in canine cruciate ligament rupture. Relaxin’s primarily known property is connective tissue remodeling through collagenolysis. We therefore investigated relaxin and its cognate receptors LGR7/LGR8 in 18 dogs with cranial cruciate ligament disease (CCLD) and compared them to a group of dogs with normal stifle joints. Applying immunohistochemistry (IHC), double immunofluorescence (dIF), and western blot analysis (WB), we found strong and significantly increased expression of both relaxin and its receptors in ruptured cruciate ligaments, and in synovial membranes. Pattern of immuno-staining on dIF strongly suggests relaxin binding to primed receptors and activation of signaling properties, which in turn may have affected collagen matrix metabolism. Thus, in canine cranial cruciate ligament disease, relaxin/receptor signaling may be a primary trigger for collagen fiber degradation and collagen lysis, eventually followed by ligament rupture. Full article

Persistent stifle instability is a recognized complication following tibial tuberosity advancement techniques (TTAT). The aim of this study is to report the feasibility and outcome of tibial plateau leveling techniques (TPLT) to treat dogs with persistent lameness, suspected to be secondary to persistent stifle instability, following (TTAT). Medical records of dogs presented for persistent lameness after TTAT were reviewed. Preoperative data included orthopedic examination, lameness score and radiographs. Inclusion criteria included performance of a surgery to address persistent lameness and suspected instability. Short-term follow up data included orthopedic examination and radiographs of the stifle. Long-term follow up was based on postoperative Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Seven dogs were included in the study. Mean subjective preoperative lameness score was 3 ± 1.53. Mean preoperative patellar ligament angle relative to the tibial plateau (PLA^TP) was 94° and mean tibial plateau angle (TPA) was 28°. Six dogs had tibial plateau leveling osteotomy and one had modified cranial closing wedge ostectomy. Mean postoperative PLA^TP was 79° and mean TPA was 5°. Mean subjective lameness score at follow up was 0.57 ± 0.49. Minor complications were present in 2 dogs and major complication in 1 dog. Mean LOAD questionnaire score was 6.6/52. TPLT can be performed after TTAT and may improve clinical function and stability in these cases in which persistent instability is suspected. Full article

The assessment of limb conformations in veterinary orthopedics is a significant tool used to determine the quantitative degree of limb malalignments. As in human medicine, various studies have been undertaken in veterinary medicine to determine the values in different dog breeds and to determine the values in healthy and diseased dogs. The objectives of this systematic review were to evaluate the reported values in these articles separately, to compile the standard values, and to compare the values between dogs with and without various orthopedic diseases. All of the articles included in this systematic review were collected by screening the Scopus, PubMed/Medline, and Web of Science databases. The articles were evaluated according to the measured alignments, imaging methods, dog breeds, and the health status of the dogs. Each alignment was investigated separately, and the results are summarized. Twenty-nine studies were included in this systematic review. According to the studies, in the frontal plane, distal femoral alignments, as well as proximal and distal tibial alignments, corresponded to the severity of the medial patellar luxation. The difference between affected and non-affected dogs with cranial cruciate ligament disease was limited to the proximal tibial alignments in the sagittal plane. Full article