Tibial Plateau Leveling Osteotomy following Tibial Tuberosity Advancement Cage Removal: A Case Report.

The purpose of this case report is to describe the functional and clinical outcome of a tibial plateau leveling osteotomy (TPLO) in a dog with joint instability and persistent lameness following a Tibial Tuberosity Advancement surgery (TTA) Rapid. A six-year-old male Labrador retriever (38 kg) with a tibial plateau angle of 27° and a patella ligament to tibial plateau angle of 102° and persistent lameness lasting six months after TTA Rapid surgery has been examined. During orthopedic examination, the lameness was subjectively graded 3/5 and the positive drawer and tibial compression tests were performed. The TTA Rapid cage and all screws were completely removed from the tibia to have enough room to perform a TPLO radial cut. A lameness score evaluation, client satisfaction and radiographic follow-up were performed at 4 weeks, 8 weeks and 6 months postoperatively. Long-term follow-up showed radiologically excellent healing with fusion of the gap and disappearance of the osteotomy line. Six months postoperatively, no lameness was detected at a walk and trot. The owner was completely satisfied and reported the dog being free from lameness even after long walks. No complications related to the TPLO surgery occurred.

A quadrigeminal arachnoid cyst as a cause of neurological symptoms in an 11-month-old Brussels Griffon - A case study.

An intracranial arachnoid cyst (IAC) is a rare developmental disorder that is consistent with cerebrospinal fluid accumulation between the brain and the arachnoid membrane. A quadrigeminal cyst is a specific type of cyst that is identified based on its localization. To the best of our knowledge, this is the first study to report on this type of pathology in a Brussels Griffon. This case study describes an 11-month-old female Brussels Griffon with symptoms of reluctance to lower the head and eat from a bowl placed on the ground, combined with episodes of vocalization. The patient was subsequently diagnosed with a quadrigeminal cyst during a low-field magnetic resonance imaging (MRI) exam, and she tested positive for toxoplasmosis in the blood test. Arachnoid cysts are often described as incidental findings, but the characteristics of neurological symptoms in the presented patient suggest that the cyst was clinically significant. The currently known options of pharmacological and surgical treatment give some hope for symptomatic patients, although their definitive success rate is not yet fully known.

Mechanical Testing of the New Cage for Tibial Tuberosity Advancement with the Cranial Implant Fixation (TTA CF) Technique-Ex Vivo Study on Sheep Model.

Background: Modifications of tibial tuberosity advancement are well accepted for cranial cruciate rupture repair. We compared the loads that were needed to pull the TTA CF cage out in the two groups. The first group consisted of five sheep in which osteotomy and TTA CF cage fixation were performed as assumed preoperatively. The second group consisted of five sheep in which intraoperative or postoperative discrepancies from preoperative planning were found. This is also the first report describing biomechanical testing after tibial tuberosity advancement with cranial implant fixation (TTA CF) surgical procedures. Results: A total of 10 ovine proximal tibiae were tested biomechanically by tearing out TTA CF implants from the bone. The mean maximal loaded forces to pull out the cage in Group 1, in which fixation of the implant was performed as assumed preoperatively, was 878 ± 61 N, and in Group 2, in which discrepancies from preoperative planning were found, was 330 ± 55 N. The mean implant displacement under maximal load to failure was 2.6 mm and 2.2 mm in Groups 1 and 2, respectively. There was a significant difference between Group 1 and Group 2 in the maximal loads-to-failure; however, the difference in the displacement at maximal loaded forces to pull out the cage was not significant between the groups. Conclusions: The mean maximal loaded forces to pull out the cage was significantly lower in Group 2, where discrepancies from preoperative planning were found (878 ± 61 N vs. 330 ± 55 N). The lower forces that were needed to extract the TTA CF implant from the tibia can lead to the conclusion that biointegration of the implant is also weaker. Correct positioning of the osteotomy line and TTA CF implant is essential for good biointegrity and thus for limiting complications in the form of tibial tuberosity avulsion fracture or tibial shaft fracture.

Ultrasonographic Imaging Protocol and Sonoanatomy of the Lumbar Spine in Healthy Dogs.

Ultrasound is an imaging technique commonly used in veterinary medicine. Ultrasound devices are widely available, their means of examination are relatively short and cheap, and they do not generate ionizing radiation. In addition, ultrasound generally does not need to be performed under general anesthesia. This study was performed on 23 canine cadavers with full clinical histories and with no confirmed pathological changes in the spine region. The imaging modalities were established in dogs in lateral recumbency, with the selected side being the uppermost angle, in a neutral position. All dogs were examined in the transverse and longitudinal planes. Sacral crest, intertransverse ligament, vertebral canal floor, vertebral body, and intervertebral discs were only visible in the longitudinal plane. Vertebral arch, supraspinal ligament, dorsal wall of the vertebral canal and muscles were visualized only in the transverse plane. This article provides a brief and relatively easy-to-perform protocol for ultrasound imaging of the lumbar spine of dogs. In addition, it presents a detailed description of the sonoanatomy of the area under investigation.

Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial.

BACKGROUND: Quadratus lumborum block (QLB) provides a reduction in pain scores and opioid consumption after cesarean section (CS). Intrathecal morphine (ITM) is still considered as the gold standard of acute postoperative pain therapy, but it does have some significant side effects. The aim of this clinical study was to evaluate whether performing the quadratus lumborum block type I in patients undergoing CS would be associated with an increased satisfaction of pain therapy and a decreased incidence of chronic postsurgical pain (CPSP). METHODS: Sixty patients scheduled for elective CS were enrolled. All patients received spinal anesthesia and were randomly allocated to either the QLB group (received bilateral quadratus lumborum block type I with the use of 24 m mL 0.375% ropivacaine) or the control group (received no block). The level of satisfaction was evaluated using a three-step scale and the answers provided in a questionnaire regarding the patients' satisfaction with the method of postoperative pain treatment in the first 48 h. After a 6-month period, all patients were interviewed to evaluate the incidence and possible severity of CPSP. RESULTS: Satisfaction scores were significantly lower in the QLB group than in the control group (p = 0.0000). There were no significant differences between the QLB and control groups regarding the occurrence of chronic postsurgical pain after 6 months following CS (p = 0.102). No statistical differences between the groups were recorded when we compared the results of the questionnaire after a period of 48 h from CS (the number of participants were limited in number). CONCLUSIONS: QLB type I is an analgetic option that increased the satisfaction of parturients with pain therapy after CS compared to patients who did not receive the block, and there is a tendency for a lower incidence of CPSP.

Usefulness of Imaging Techniques in the Diagnosis of Selected Injuries and Lesions of the Canine Tarsus. A Review.

Tarsus lesions are not common in dogs, but they can cause serious health problem. They can lead to permanent changes in the joint and, in dogs involved in canine sports, to exclusion from training. The most common diseases and injuries involving the tarsal joint are osteochondrosis, fractures and ruptures of the Achilles tendon. These conditions can be diagnosed primarily through accurate orthopedic examination, but even this may be insufficient for performing a proper diagnosis. Imaging modalities such as radiography, ultrasonography, magnetic resonance imaging or computed tomography can facilitate the detection and assessment of lesions in the canine tarsal joint. This review paper briefly presents some characteristics of the above-mentioned imaging techniques, offering a comparison of their utility in the diagnosis of lesions and injuries involving the canine tarsus.

Tibial Diaphyseal Fracture as a Major Complication of Tibial Tuberosity Advancement With Cranial Fixation (TTA CF)-A Case Report.

This article reports a major complication of tibial tuberosity advancement with cranial fixation for the treatment of cranial cruciate ligament rupture in a Boxer. Twelve days postoperatively the dog underwent revision surgery for fracture of the tibia and tibial tuberosity. The tibial tuberosity fracture was secured to the tibial diaphysis using the 2 K-wires and a medial 3.5 dynamic compression plate was used to stabilize the tibial diaphysis fracture. The fracture was reduced and the plate applied using minimally invasive plate osteosynthesis to preserve the blood supply to the bone. Two weeks after revision surgery, the dog was using the operated limb without apparent lameness at a walk and trot. No complications were observed after revision surgery. Tibial tuberosity fracture and tibial diaphysis fracture as complications after tibial tuberosity advancement with cranial fixation healed with satisfactory clinical outcomes but revision surgery was required.

Single-stage Bilateral Tibial Tuberosity Advancement With Cranial Fixation in an English Bulldog - A Case Report.

This article presents a report of single-stage bilateral tibial tuberosity advancement for the treatment of cranial cruciate ligament rupture in an English bulldog. The reconstruction was performed by a new surgical technique involving tibial tuberosity advancement and fixation with two cranially placed lag screws. The patient was able to ambulate normally at a walk without lameness four days postoperatively. Except for bruising of the surgical site, no complications were observed during a six-month follow-up period.

Evaluation, Description of the Technique, and Clinical Outcomes After Tibial Tuberosity Advancement With Cranial Fixation (TTA CF) for Cranial Cruciate Ligament Rupture in 22 Dogs.

The objective of this study is to describe a modified surgical technique for tibial tuberosity advancement with cranial fixation (TTA CF) in dogs with cranial cruciate insufficiency and to report long term clinical outcomes and complications. TTA CF was performed with a novel titanium implant. A description of the specific implant with guide, drill and saw guide, instrumentation, and template are provided, along with clinical outcomes, complications, owners' evaluation, and a 1-year postoperation follow-up. Twenty two mixed breed dogs, with a median body weight of 23 kg (range, 11-45 kg) were included. The median age at surgery was 4 years (range, 1-8 years). Clinical bone healing was seen at a mean 10 weeks (range 6-14 weeks). The minor complication rate was 27% (n = 6). No major complication occurred, and no revision surgery was required. Twenty-one (95%) dogs had a good to excellent outcome 1 year after surgery. Currently there is no accepted best treatment of the canine cranial cruciate ligament deficient stifle. Most of TTA techniques are based on fixing the implant from the medial side of tibia. We report a modified TTA technique with cranial fixation of a titanium implant and suggest that the TTA CF surgical technique may be a feasible alternative to existing surgical procedures.

A novel tibial tuberosity advancement technique with cranial implant fixation (TTA CF): a pilot study in sheep.

BACKGROUND: Cranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals. An array of surgical techniques have been described to stabilize the stifle joint in dogs, including intraarticular stabilization, extraarticular stabilization, and tibial osteotomy techniques. Tibial plateau leveling osteotomy and tibial tuberosity advancement with a lot of modifications are the most common. In this study we report the possibility of fixing the novel titanium implant for tibial tuberosity advancement with two screws in a craniocaudal direction. The aim of our study was to improve the clinical benefit of the tibial tuberosity advancement surgical technique where an attempt was made to reduce the number of screws and obtain a strong implant fixation with minimal bone traumatization. This way of attachment allows to distribute the forces evenly on medial and lateral side of osteotomy gap. RESULTS: Tibial tuberosity advancement with cranial implant fixation was performed in four sheep. Complete radiographic and clinical follow up was recorded. All four sheep had a complete osteotomy line healing at a mean of 10 weeks postoperative (range 8-12 weeks). None of the animals had osteotomy gap healing grades of poor. Minor complication included the minimally cracked Maquet hole on the postoperative radiographs, without displacement of the tibial crest which occurred in 2 sheep. Major complication grade 1, major complication grade 2 and catastrophic were not found. CONCLUSIONS: The novel surgical technique for tibial tuberosity advancement with cranial implant fixation is technically comparable to the recent trend in tuberosity advancement techniques, where partial osteotomy of the cranial tibial tuberosity crest is performed. A cranial implant fixation allows to distribute the forces evenly on medial and lateral side of osteotomy gap, which may result in less number of major complications in dogs. A novel titanium implant decreases the tibial traumatisation by reducing the number of screws.

Quantification of cerebral lateral ventricular volume in cats by low- and high-field MRI.

Objectives The aim of this study was to evaluate variations in lateral ventricles in the examined feline population with the use of quantitative analysis methods to determine whether sex or body weight influenced the size of the ventricles, and to identify any significant differences in the results of low- and high-field MRI. Methods Twenty healthy European Shorthair cats, aged 1-3 years, with body weights ranging from 2.85-4.35 kg, were studied. MRI of brain structures was performed in a low- and a high-field MRI system. The height of the brain and lateral ventricles at the level of the interthalamic adhesion, and volume of the lateral ventricles were determined in T2-weighted images in the transverse plane. The degree of symmetry of lateral ventricles was analysed based on the ratio of right to left ventricular volume. The measured parameters were processed statistically to determine whether sex and body weight were significantly correlated with variations in ventricular anatomy. The results of low- and high-field MRI were analysed to evaluate for any significant differences. Results The average brain height was determined to be 27.79 mm, and the average height of the left and right ventricles were 2.98 mm and 2.89 mm, respectively. The average ventricle/brain height ratio was 10.61%. The average volume of the left ventricle was 134.12 mm3 and the right ventricle was 130.49 mm3. Moderately enlarged ventricles were observed in two cats. Moderate ventricular asymmetry was described in four cats. Sex and body weight had no significant effect on the evaluated parameters. The differences in the results of low- and high-field MRI were not statistically significant. Conclusions and relevance This study has determined reference intervals for ventricular volume in a population of European Shorthair cats without brain disease, which will facilitate the interpretation of MRI images and the characterisation of brain abnormalities in cats with neurological disease. Further research involving larger animal populations, including other breeds, is required to compare the measured parameters between breeds and to determine reference values for other breeds.