Comparison of Five Radiographic Scoring Systems for Assessment of Bone Healing after Tibial Plateau Levelling Osteotomy in Dogs

Introduction: Accurate assessment of bone healing following an osteotomy procedure is vital in determining both clinical treatment as well as research purposes. To date, it is unknown which scoring system provides the most accurate assessment of osteotomy changes after tibial plateau levelling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing after TPLO over time.

Materials and Methods: A randomized, blinded, prospective study was conducted using similarly positioned post-operative TPLO radiographs from four dogs taken immediately post-operatively, at 6-weeks post-operatively, and at 8-weeks post-operatively. Ten reviewers assessed the radiographs. Five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week post-operatively were compared with 8-week post-operatively. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score).

Results: Each system was utilized 104 times, resulting in a total of 520 scores. The VAS system identified 76% of sets correctly (the most), 15% unchanged (the least), and 9% incorrectly.

Discussion/Conclusion: The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. Given its large scale, it also resulted in a larger number of incorrect scores.

Acknowledgements: There was no proprietary interest or funding provided for this project.

Publication History

Article published online:
26 October 2022