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  • Title: Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent 'pivot shift', meniscal tear and other complications.
    Author: Gatineau M, Dupuis J, Planté J, Moreau M.
    Journal: Vet Comp Orthop Traumatol; 2011; 24(5):333-41. PubMed ID: 21792470.
    Abstract:
    OBJECTIVE: To determine the rate of subsequent 'pivot shift', meniscal tear and risk factors associated with complications of tibial plateau levelling osteotomy (TPLO) and to assess clinical and owner perception outcome. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Three hundred and forty-eight dogs that had undergone TPLO surgical procedures (n = 476 stifles). METHODS: Medical records were reviewed for the retrieval of information on breed, sex, age, body weight, clinical history, radiograph findings, pre- and postoperative tibial plateau angle, limb alignment, unilateral versus bilateral disease, condition of cranial cruciate ligament (CCL) and menisci, implant material, healing time and complications. Clinical and owner-assessed questionnaire outcomes were also recorded. RESULTS: Forty-six (9.7%) postoperative complications were reported. Twenty (4.2%) were classified as major complications requiring an additional surgical intervention, and 26 (5.5%) as minor complications. No risk factors associated with postoperative complications were identified. Ten (2.1%) subsequent meniscal injuries in the stifles with normal un- altered menisci at time of TPLO were reported with a median postoperative time of 9.5 months. Signs of postoperative 'pivot shift' were reported in 15 (3.1%) stifles. All stifles with a 'pivot shift' had a complete CCL rupture or a debrided partial CCL rupture; a medial menisectomy was identified as a risk factor for a 'pivot shift' (p = 0.02). Dogs with intact medial meniscus had a significantly higher activity level (p <0.0001) and a shorter time to peak function (p = 0.02) than dogs that underwent menisectomy according to an owner questionnaire. CONCLUSIONS: Dogs with TPLO and intact meniscus seemed to have a better and faster recovery than dogs with TPLO and menisectomy based on owner questionnaires. 'Pivot shift' was infrequent after TPLO surgery. All dogs with a 'pivot shift' had a complete CCL rupture or a debrided partial CCL rupture and menisectomy was identified as a risk factor for its occurrence. CLINICAL RELEVANCE: Considering the relatively low rate of subsequent meniscal injury after TPLO, systematic medial meniscal release with TPLO may be unnecessary. The 'pivot shift' deserved further investigation to completely understand its mechanism, to identify its anatomic components and potential consequences on the stifle joint.
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