Download PDF
Tierarztl Prax Ausg K Kleintiere Heimtiere 2011; 39(05): 323-335
DOI: 10.1055/s-0038-1623596
Originalartikel
Schattauer GmbH

Lahmheits- und Osteoarthroseentwicklung nach Tibial Plateau Leveling Osteotomy (TPLO) und potenzielle prognostische Einflussfaktoren[*]

Eine retrospektive LangzeitstudieLameness and osteoarthritis following Tibial Plateau Leveling Osteotomy (TPLO) and potential prognostic predictorsA long-term retrospective study
K. M. Imholt
1   Klinik für Kleintiere der Stiftung Tierärztliche Hochschule Hannover
,
S. Möller
1   Klinik für Kleintiere der Stiftung Tierärztliche Hochschule Hannover
,
M. Fehr
2   Klinik für Heimtiere, Reptilien, Zier- und Wildvögel der Stiftung Tierärztliche Hochschule Hannover
,
A. Meyer-Lindenberg
3   Chirurgische und Gynäkologische Kleintierklinik der Ludwig-Maximilians-Universität München
› Author Affiliations
Further Information

Publication History

Eingegangen: 07 June 2011

Akzeptiert nach Revision: 08 July 2011

Publication Date:
05 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Gegenstand: Untersuchung von Lahmheits- und Arthroseentwicklung nach Tibial Plateau Leveling Osteotomy (TPLO) bei Hunden und Evaluierung potenzieller prognostischer Einflussfaktoren. Material und Methoden: Es erfolgte eine retrospektive Auswertung der Patientenakten von 119 Hunden (135 Kniegelenken). Das Therapieergebnis, aktueller Lahmheitsstatus, Arthrosegrad und Arthroseentwicklung wurden anhand der klinischen und röntgenologischen Befunde einer Kontrolluntersuchung sowie durch einen Besitzerfragebogen ausgewertet. Ergebnisse: 58 Hunde (66 Gelenke) konnten klinisch und röntgenologisch, 61 Hunde (69 Gelenke) nur mittels Fragebogen kontrolliert werden. Bis zu 6,8 Jahre nach der TPLO war das Lahmheitsergebnis in 90,4% der Fälle “sehr gut” bis “gut”. Es kam zu einem moderaten Fortschreiten der Arthrose. Patienten mit Totalruptur des vorderen Kreuzbandes wiesen häufiger Meniskusschäden auf als Patienten mit Teilruptur. Patienten, bei denen eine mediale Teilmeniskektomie erfolgte, zeigten häufiger “sehr gute” Langzeitergebnisse und seltener ein Fortschreiten der Arthrose als Hunde, deren Meniskus belassen oder bei denen ein Release durchgeführt wurde. Die Komplikationsrate lag bei 22,2%. Schlussfolgerung und klinische Relevanz: Die klinischen Langzeitergebnisse nach TPLO sind sehr zufriedenstellend. Eine Teilmeniskektomie kann helfen, spätere Meniskusoperationen zu verhindern, ohne das langfristige Lahmheitsergebnis oder die Arthroseentwicklung negativ zu beeinflussen. Durch eine vorangegangene Operation oder postoperative Komplikationen verschlechtert sich weder das langfristige Lahmheitsergebnis noch beschleunigt sich das Fortschreiten der Arthrose.

Summary

Objective: Evaluation of lameness and osteoarthritis (OA) progression following Tibial Plateau Leveling Osteotomy (TPLO) in dogs with naturally-occurring rupture of the cranial cruciate ligament (CCL) and investigation of factors with potential influence on long-term outcome. Material and methods: In a retrospective clinical study medical records of 119 client-owned dogs (135 operated stifle joints) and corresponding client-questionnaires were reviewed, collecting data on radiologic and surgery results, course of surgery and complications. In a check-up, orthopaedic examination and stifle radiographs were performed to assess status quo of OA, lameness, and progression of OA. Results: 58 dogs (66 stifle joints) could be examined clinically and radiologically, whereas 61 dogs (69 stifle joints) were re-checked by client-questionnaire only. Up to 6.8 years after TPLO surgery, in 90.4% of all cases lameness results were judged “excellent” (n = 84) or “good” (n = 38). In the long term, there was a moderate but significant progression of OA following TPLO surgery. Patients with totally ruptured CCL were significantly more likely to have meniscal injury than dogs with partially ruptured CCL. Dogs with partial meniscectomy had a significantly higher rate of “excellent” longterm clinical results and less frequently showed progression of OA compared to those having the meniscus released or left untouched.The overall complication rate was 22.2% (n = 30), with the type of complication having no influence on the long-term clinical outcome. Conclusions and clinical relevance: Regarding lameness, the long-term outcome following TPLO is very satisfying. Early surgical treatment of CCL rupture using TPLO can help to decrease the likelihood of OA progression. Partial medial meniscectomy may help to avoid repeated surgery due to subsequent meniscal injury without having a negative impact on long-term functional outcome or the progression of OA in the affected joint. Neither long-term clinical results, especially regarding lameness, nor OA were impaired by previous surgery prior to TPLO or the occurrence of complications associated with TPLO surgery.

Schlüsselwörter

Kreuzbandriss - Hund - Arthrose - Prognose - TPLO

Key words

Cranial cruciate ligament rupture - dog - osteoarthritis - prognosis - TPLO

* Frau Prof. Dr. Ulrike Matis gewidmet.


 

  • Literatur

  • 1 Alt F. Vergleichende Untersuchungen zur Therapie der Ruptur des Ligamentum cruciatum craniale beim Hund mit drei verschiedenen extraartikulären Operationsverfahren. Diss med vet; Stiftung Tierärztliche Hochschule: 2000
    Google Scholar
  • 2 Au KK, Gordon-Evans WJ, Dunning D, O’Dell-Anderson KJ, Knap KE, Griffon D, Johnson AL. Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization. Vet Surg 2010; 39 (02) 173-180.
    CrossrefPubMedGoogle Scholar
  • 3 Ballagas AJ, Montgomery RD, Henderson RA, Gillette R. Pre- and postoperative force plate analysis of dogs with experimentally transected cranial cruciate ligaments treated using tibial plateau leveling osteotomy. Vet Surg 2004; 33 (02) 187-190.
    CrossrefPubMedGoogle Scholar
  • 4 Baroni E, Matthias RR, Marcellin-Little DJ, Vezzoni A, Stebbins ME. Comparison of radiographic assessments of the tibial plateau slope in dogs. Am J Vet Res 2003; 64 (05) 586-589.
    CrossrefPubMedGoogle Scholar
  • 5 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 1991; 32 (03) 111-117.
    CrossrefPubMedGoogle Scholar
  • 6 Böddeker J. Evaluierung des Therapieerfolgs zweier chirurgischer Interventionen am rupturierten Ligamentum cruciatum craniale beim Hund anhand der vergleichenden Untersuchung ganganalytischer Parameter. Diss med vet; Stiftung Tierärztliche Hochschule: 2010
    Google Scholar
  • 7 Böttcher P, Fischer C, Werner H, Grevel V, Oechtering G. Kniegelenkstabilität nach lateraler Fadenzügelung mit Ethibond Excel®: frühzeitige Destabilisierung nach passiver Gelenkbewegung. Tierärztl Prax 2010; 38 (K): 61-69.
    PubMedGoogle Scholar
  • 8 Boyd DJ, Miller CW, Etue SM, Monteith G. Radiographic and functional evaluation of dogs at least 1 year after tibial plateau leveling osteotomy. Can Vet J 2007; 48 (04) 392-396.
    PubMedGoogle Scholar
  • 9 Chauvet AE, Johnson AL, Pijanowski GJ, Homco L, Smith RD. Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: a retrospective study. J Am Anim Hosp Assoc 1996; 32 (03) 247-255.
    CrossrefPubMedGoogle Scholar
  • 10 Cook JL. The current status of treatment for large meniscal defects. Clin Orthop Rel Res 2005; 435: 88-95.
    PubMedGoogle Scholar
  • 11 Cook JL, Luther JK, Beetem J, Karnes J, Cook CR. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39 (03) 315-323.
    CrossrefPubMedGoogle Scholar
  • 12 de Rooster H, Vangheluwe L, van Bree H, Ledoux M, Van Langenhove L. Biomechanical properties of braided polyester tapes intended for use as intraarticular cranial cruciate ligament prostheses in dogs. Am J Vet Res 2001; 62 (01) 48-53.
    CrossrefPubMedGoogle Scholar
  • 13 de Rooster H, de Bruin T, van Bree H. Morphologic and functional features of the canine cruciate ligaments. Vet Surg 2006; 35 (08) 769-780.
    CrossrefPubMedGoogle Scholar
  • 14 Duerr FM, Duncan CG, Savicky RS, Park RD, Egger EL, Palmer RH. Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37 (01) 49-62.
    CrossrefPubMedGoogle Scholar
  • 15 Duval JM, Budsberg SC, Flo GL, Sammarco JL. Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs. J Am Vet Med Assoc 1999; 215 (06) 811-814.
    PubMedGoogle Scholar
  • 16 Evers P, Kramek BA, Wallace LJ, Johnston GR, King V. Clinical and radiographic evaluation of intertrochanteric osteotomy in dogs: a retrospective study of 18 dogs. Vet Surg 1997; 26 (03) 217-222.
    CrossrefPubMedGoogle Scholar
  • 17 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 39 (04) 460-474.
    PubMedGoogle Scholar
  • 18 Flo GL. Meniscal injuries. Vet Clin North Am Small Anim Pract 1993; 23 (04) 831-843.
    CrossrefPubMedGoogle Scholar
  • 19 Galloway RH, Lester SJ. Histopathological evaluation of canine stifle joint synovial membrane collected at the time of repair of cranial cruciate ligament rupture. J Am Anim Hosp Assoc 1995; 31 (04) 289-294.
    CrossrefPubMedGoogle Scholar
  • 20 Hayashi K, Manley PA, Muir P. Cranial cruciate ligament pathophysiology in dogs with cruciate disease: a review. J Am Anim Hosp Assoc 2004; 40 (05) 385-390.
    CrossrefPubMedGoogle Scholar
  • 21 Hurley CR, Hammer DL, Shott S. Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001–2005). J Am Vet Med Assoc 2007; 230 (11) 1674-1679.
    CrossrefPubMedGoogle Scholar
  • 22 Innes JF, Barr AR. Clinical natural history of the postsurgical cruciate deficient canine stifle joint: year 1. J Small Anim Pract 1998; 39 (07) 325-332.
    CrossrefPubMedGoogle Scholar
  • 23 Innes JF, Barr AR. Can owners assess outcome following treatment of canine cruciate ligament deficiency?. J Small Anim Pract 1998; 39 (08) 373-378.
    CrossrefPubMedGoogle Scholar
  • 24 Innes JF, Bacon D, Lynch C, Pollard A. Long-term outcome of surgery for dogs with cranial cruciate ligament deficiency. Vet Rec 2000; 147 (12) 325-328.
    CrossrefPubMedGoogle Scholar
  • 25 Jackson J, Vasseur PB, Griffey S, Walls CM, Kass PH. Pathologic changes in grossly normal menisci in dogs with rupture of the cranial cruciate ligament. J Am Vet Med Assoc 2001; 218 (08) 1281-1284.
    CrossrefPubMedGoogle Scholar
  • 26 Jandi A, Kahlon S, Sandhu B. eds. Effect of duration of cranial cruciate ligament pathology on medial meniscal damage - Prospective study of 917 stifle joints surgically treated with tibial plateau leveling osteotomy. 36th Annual Conference of the Veterinary Orthopedic Society; Steamboat Springs; Colorado: 2009
    Google Scholar
  • 27 Jandi AS, Schulman AJ. Incidence of motion loss of the stifle joint in dogs with naturally occurring cranial cruciate ligament rupture surgically treated with tibial plateau leveling osteotomy: longitudinal clinical study of 412 cases. Vet Surg 2007; 36 (02) 114-121.
    CrossrefPubMedGoogle Scholar
  • 28 Jerram RM, Walker AM. Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment. N Z Vet J 2003; 51 (04) 149-158.
    CrossrefPubMedGoogle Scholar
  • 29 Jerram RM, Walker AM, Warman CG. Proximal tibial intraarticular ostectomy for treatment of canine cranial cruciate ligament injury. Vet Surg 2005; 34 (03) 196-205.
    CrossrefPubMedGoogle Scholar
  • 30 Johnson J, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 07: 56-69.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Johnson JM, Johnson AL. Cranial cruciate ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Vet Clin North Am Small Anim Pract 1993; 23 (04) 717-733.
    CrossrefPubMedGoogle Scholar
  • 32 Johnson KA, Francis DJ, Manley PA, Chu Q, Caterson B. Comparison of the effects of caudal pole hemi-meniscectomy and complete medial meniscectomy in the canine stifle joint. Am J Vet Res 2004; 65 (08) 1053-1060.
    CrossrefPubMedGoogle Scholar
  • 33 Klocke NW, Snyder PW, Widmer WR, Zhong W, McCabe GP, Breur GJ. Detection of synovial macrophages in the joint capsule of dogs with naturally occurring rupture of the cranial cruciate ligament. Am J Vet Res 2005; 66 (03) 493-499.
    CrossrefPubMedGoogle Scholar
  • 34 Kloene P. Therapieergebnisse bei Hunden mit einer (Teil-)Ruptur des Ligamentum cruciatum craniale nach Arthroskopie und minimal invasiver lateraler Fadenzügelung sowie nach Tibial Plateau Leveling Osteotomy (TPLO) Diss med vet. Stiftung Tierärztliche Hochschule: 2005
    Google Scholar
  • 35 Krayer M, Rytz U, Oevermann A, Doherr MG, Forterre F, Zurbriggen A, Spreng DE. Apoptosis of ligamentous cells of the cranial cruciate ligament from stable stifle joints of dogs with partial cranial cruciate ligament rupture. Am J Vet Res 2008; 69 (05) 625-630.
    CrossrefPubMedGoogle Scholar
  • 36 Lazar TP, Berry CR, deHaan JJ, Peck JN, Correa M. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34 (02) 133-141.
    CrossrefPubMedGoogle Scholar
  • 37 Leighton RL. Preferred method of repair of cranial cruciate ligament rupture in dogs: a survey of ACVS diplomates specializing in canine orthopedics. Vet Surg 1999; 28 (03) 194.
    CrossrefPubMedGoogle Scholar
  • 38 Lineberger JA, Allen DA, Wilson ER, Tobias TA, Shaiken LG, Shiroma JT, Biller DS, Lehenbauer TW. Comparison of radiographic arthritic changes associated with two variations of tibial plateau leveling osteotomy. Vet Comp Orthop Traumatol 2005; 18 (01) 13-17.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Moeller EM, Allen DA, Wilson ER, Lineberger JA, Lehenbauer T. Long-term outcomes of thigh circumference, stifle range-of-motion, and lameness after unilateral tibial plateau levelling osteotomy. Vet Comp Orthop Traumatol 2010; 23 (01) 37-42.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res 2006; 67 (03) 529-536.
    CrossrefPubMedGoogle Scholar
  • 41 Moore KW, Read RA. Cranial cruciate ligament rupture in the dog - a retrospective study comparing surgical techniques. Aust Vet J 1995; 72 (08) 281-285.
    CrossrefPubMedGoogle Scholar
  • 42 Pacchiana PD, Morris E, Gillings SL, Jessen CR, Lipowitz AJ. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998–2001). J Am Vet Med Assoc 2003; 222 (02) 184-193.
    CrossrefPubMedGoogle Scholar
  • 43 Pond MJ, Campbell JR. The canine stifle joint. I. Rupture of the anterior cruciate ligament. An assessment of conservative and surgical treatment. J Small Anim Pract 1972; 13 (01) 1-10.
    CrossrefPubMedGoogle Scholar
  • 44 Pozzi A, Litsky AS, Field J, Apelt D, Meadows C, Johnson KA. Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2008; 21 (01) 8-14.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Priddy 2nd NH, Tomlinson JL, Dodam JR, Hornbostel JE. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997–2001). J Am Vet Med Assoc 2003; 222 (12) 1726-1732.
    CrossrefPubMedGoogle Scholar
  • 46 Rayward RM, Thomson DG, Davies JV, Innes JF, Whitelock RG. Progression of osteoarthritis following TPLO surgery: a prospective radiographic study of 40 dogs. J Small Anim Pract 2004; 45 (02) 92-97.
    CrossrefPubMedGoogle Scholar
  • 47 Shahar R, Milgram J. Biomechanics of tibial plateau leveling of the canine cruciate-deficient stifle joint: a theoretical model. Vet Surg 2006; 35 (02) 144-149.
    CrossrefPubMedGoogle Scholar
  • 48 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184 (05) 564-569.
    PubMedGoogle Scholar
  • 49 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23 (04) 777-795.
    CrossrefPubMedGoogle Scholar
  • 50 Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau leveling osteotomies (2001–2003). J Am Anim Hosp Assoc 2006; 42 (01) 44-50.
    CrossrefPubMedGoogle Scholar
  • 51 Thieman KM, Tomlinson JL, Fox DB, Cook C, Cook JL. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35 (08) 705-710.
    CrossrefPubMedGoogle Scholar
  • 52 Timmermann C, Meyer-Lindenberg A, Nolte I. [Meniscus injuries in dogs with rupture of the cruciate ligament]. Dtsch Tierärztl Wochenschr 1998; 105 (10) 374-377.
    PubMedGoogle Scholar
  • 53 Warzee CC, Dejardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286.
    CrossrefPubMedGoogle Scholar