Advances in the Canine Cranial Cruciate Ligament, 2nd edition

(Wang) #1

222 Surgical Treatment


Figure 27.4 Lateral view radiograph of a dog 8 weeks
after tibial plateau leveling osteotomy, demonstrating
marked thickening of the patellar tendon (white arrows).


(A) (B)

Figure 27.5 Cranial-caudal (A)
and lateral (B) radiographic
views of a dog 10 weeks after
tibial plateau leveling osteotomy,
showing a short oblique proximal
fibular fracture (white arrows).

complication is unclear and is more commonly
identified in heavily muscled dogs with genu
varum conformation. Most cases improve with
aggressive physical therapy. However, a lateral
fabellar imbrication suture or a femoral correc-
tive osteotomy may be required in severe cases.
Fractures of the fibula or tibia are poten-
tially more serious complications that may be
encountered during or after the TPLO proce-
dure (Figure 27.5). Fibular fractures occurred in
5.4% of cases in a series of 168 TPLO procedures,
with identified risk factors including increased
body weight, greater preoperative TPA, greater
change in TPA, and TPLO performed without
the use of a jig (Tuttle & Manley 2009). A subse-
quent study by Tayloret al. (2011) of 355 TPLO
cases reported a 15% fibula fracture rate, with
increased body weight and an unfilled fibular
drill hole identified as risk factors. Risk factors
for tibial tuberosity fracture after TPLO include
simultaneous bilateral TPLO, a thinner postop-
erative mean thickness of the tibial tuberosity,
and an increase in TPA during convalescence
(Kergosienet al. 2004; Berghet al. 2008).
The use of a structured postoperative phys-
iotherapy program has been shown to result
in a greater stifle range of motion (ROM)
for dogs undergoing TPLO at 3 and 6 weeks
postoperatively, and greater likelihood of full
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