Laurie's Blogs.

I have stacks of JAVMA’s laying around.  Periodically, they are sorted through and all of the small animal ortho or neuro articles are ripped out and set aside to read at a later date.  Well, this is one of those later dates!  There are some good insights in the four cruciate surgery articles that I want to share with you today.  So, here they are as short, brief, knowledge nuggets for your brain growing pleasure!



Verpaalen VD, Baltzer WI, Smith-Ostrin S, Warnock JJ, Stang B, Ruaux CG. Assessment of the effects of diet and physical rehabilitation on radiographic findings and markers of synovial inflammation in dogs following tibial plateau leveling osteotomy. J Am Vet Med Assoc. 2018 Mar 15;252(6):701-709. 

What did they do?   TPLO & then dogs were either fed dry omega-3 fatty acid and protein-enriched dog food (formulated for joint health), or control food).  They were then further randomized to receive rehabilitation or not.   


Every dog was to follow a walking regimen and passive ROM exercises.  The ‘rehab’ dogs were additionally prescribed sit to stand exercises from 2 weeks – 3 months, and underwater treadmill therapy.

Findings?


1. The therapeutic diet resulted in lower synovial inflammation markers (regardless of rehab).

2. Six months after surgery the dogs that were on the therapeutic diet has less signs of osteoarthritis, as did those dogs that completed the rehabilitation program.

3. However, the dogs that received the therapeutic diet has slower osteotomy healing (at 8- & 24-weeks post-op), regardless of rehab status.  The ‘why’ on that is unclear.

Knight RC, Thomson DG, Danielski A. Surgical management of pivot-shift phenomenon in a dog. J Am Vet Med Assoc. 2017 Mar 15;250(6):676-680. 

This article is a report of a case study.  A 6-year-old male labradoodle with a CCL tear and subsequent TPLO.  He continued to have issues 1 year post-op despite the prescription of 6 months of meloxicam, tramadol, and exercise restriction. (!)


The reevaluation revealed a jerking lateral movement of the left stifle joint during walking and a ‘pivot-shift phenomenon’ was revealed on orthopaedic exam.

(Just to note, the veterinary world is using the term ‘pivot shift’ entirely contrary to its original definition in human sports medicine.  So, when the author note that this phenomenon is poorly described in the veterinary literature… it’s of little wonder!)

The pivot-shift phenomenon is being described (in dogs) as “a cranial subluxation of the tibia associated with internal tibial rotation, resulting in a sudden lateral change in direction of the stifle joint during weight bearing.”


Treatment consisted of an extracapsular implant with a synthetic braided ligament-like biomaterial (i.e. Tightrope technique).

The dog was then prescribed hydrotherapy and leash-only walks for 6 weeks, and there you go… all good!



von Pfeil DJF, Kowaleski MP, Glassman M, Dejardin LM. Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds). J Am Vet Med Assoc. 2018 Sep 1;253(5):586-597. 

And the winner was…


1. TPLO by 78.6%

Followed by…


2. TTA by 13.9%

3. Lateral Suture by 5.9%

4. Tight Rope by 1.6%.  This technique was also reported to be associated with the highest incidence of major complications.

Selmic LE, Ryan SD, Ruple A, Pass WE, Withrow SJ. Association of tibial plateau leveling osteotomy with proximal tibial osteosarcoma in dogs. J Am Vet Med Assoc. 2018 Sep 15;253(6):752-756.

This retrospective study looked back over an 8-year span and found 34 dogs diagnosed with osteosarcoma in the proximal tibia.  They then matched and compared those dogs with 79 similar dogs without osteosarcoma (as a way to compare ‘apples to apples’).



What they found?


1. After adjusting for body weight, dogs with a history of TPLO were 40X as likely to develop proximal tibial osteosarcoma as were the dogs with no history of TPLO.

2. Additionally, each 1kg (2.2lbs) increase in body weight was associated with an 11% increase in the odds of proximal tibial osteosarcoma.

Conclusion: “It is important for proximal tibial osteosarcoma to be included among the different diagnoses for new or worsening hind limb lameness in dogs that underwent TPLO greater than 1 year previously”


There you have it! 

These are you quick, easily digestible, snippets of wisdom and nuggets of knowledge to get you through the week!

Have a good one!


Cheers,


Laurie