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Objectives: This study was designed to prospectively evaluate the feasibility of an opioid-free anesthesia protocol and describe the quality of recovery and management of postoperative analgesia in dogs after a tibial plateau leveling osteotomy (TPLO). Methods: In total, 20 dogs presented for TPLO were included. After premedication with intravenous (IV) medetomidine (0.005-0.007 mg/kg) and midazolam (0.2 mg/kg), the dogs were anesthetized using ketamine (2 mg/kg) and propofol and maintained with isoflurane and ketamine CRI (0.6 mg/kg/h). Sciatic and femoral nerve blocks were performed with bupivacaine 0.5% (0.087 +/- 0.01 and 0.09 +/- 0.02 mL/kg, respectively). Meloxicam (0.2 mg/kg IV) was administered intraoperatively, after osteotomy. Fentanyl (0.002 mg/kg IV) was administered intraoperatively, as rescue analgesia in the case of sustained increase in cardiorespiratory variables. Two pain scores (French 4A-VET and Glasgow short form) were performed at conscious sternal recumbency and 2, 4, 6, 8, 12, and 20 h after extubation and compared to baseline using a Friedman test followed by a Nemenyi post-hoc test. The time taken for the first food intake and urination was reported. Results: Intraoperative opioid-free anesthesia was feasible in 11 dogs, whereas 9 dogs received fentanyl once during arthrotomy. No opioid postoperative rescue analgesia was required. Food intake occurred within 6 h, and all dogs were discharged after 24 h without any complication. Conclusion: Total opioid-free postoperative analgesia was achieved in all dogs, with adequate recoveries. Although opioid-free anesthesia was feasible in 55% of the population, a single dose of fentanyl was necessary in 45% of the dogs during arthrotomy.

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OBJECTIVE: To determine if photobiomodulation causes a premature release of liposomal bupivacaine (LB) suspensions. ANIMALS: A 25-kg mixed breed dog cadaver euthanized for reasons unrelated to this study. METHODS: In September 2022, a proximomedial tibial incision was made in a dog cadaver, and a tibial plateau leveling osteotomy plate was implanted. A stab incision was made one-half inch distal to the incision, and a tunnel to the plate was created prior to closure of the primary wound. A 3-cc anal sac catheter was advanced through the distal incision until the bulb rested against the face of the plate. Seven treatment groups of treatment power (watts) and total energy (joules/cm2) were defined as: A, 0.5 W, 2.0 J/cm2; B, 0.5 W, 4.0 J/cm2; C, 0.5 W, 6.0 J/cm2; D, 1.0 W, 2.0 J/cm2; E, 1.0 W, 4.0 J/cm2; F, 1.0 W, 6.0 J/cm2; and sham, 0.0 W, 0.0 J/cm2. Ten samples per group of 2 mL of LB were infused into a new catheter and treated percutaneously with a class 3b laser. All samples remained in the catheter for 12 seconds to reflect the longest treatment time. Post-treatment free bupivacaine concentrations were identified with high-performance liquid chromatography. RESULTS: The median free bupivacaine concentration was reported as: sham, 1.89 mg/mL; A, 1.93 mg/mL; B, 2.01 mg/mL; C, 2.05 mg/mL; D, 1.92 mg/mL; E, 2.03 mg/mL; and F, 2.00 mg/mL. There were no differences in median free bupivacaine concentrations between groups (P = .988). CLINICAL RELEVANCE: Concurrent LB and photobiomodulation are recommended during the postoperative period. The results of this proof-of-concept study suggest that concurrent use of LB and photobiomodulation may be safe, but in vivo studies at similar and stronger photobiomodulation settings are warranted.

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During tibial plateau leveling osteotomy (TPLO), the laceration of the cranial tibial artery (LCTA) may occur, and the ligation of the cranial tibial artery might lead to impaired blood supply to the osteotomy site. The present case-control study aimed to evaluate the effect of LCTA on TPLO healing and the occurrence of perioperative complications. The incidence and predisposing factors to LCTA were also investigated. Fourteen cases experiencing LCTA were retrospectively enrolled from medical records of two veterinary teaching hospitals (LCTA group), whereas 28 randomly selected TPLOs that did not experience LCTA were included in the control group. Signalment data, proximal tibial epiphysis conformation, osteotomy features, perioperative complications, and bone healing were compared between the two groups. Bone healing was evaluated using the modified radiographic union scale for tibial fracture and the visual analog scale. The mean incidence was 9.6%. Bodyweight was significantly higher in the LCTA group compared to the control group (P = 0.009). Dogs belonging to the LCTA groups were significantly younger (P = 0.01). Intraoperative hypotension was significantly overreported in the LCTA group (P = 0.0001). None of the other variables differed significantly between the two groups. Dogs' size seems to be a predisposing factor, with dogs weighing >15 kg having 22 times more chance of experiencing LCTA. Due to the well-developed collateral blood supply of the canine hindlimb, LCTA and the closure of the cranial tibial artery did not appear to delay the radiographic bone healing or affect the incidence of perioperative complications.

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Case summary: An 11-year-old female neutered domestic shorthair cat was referred for surgical management of a traumatic right stifle luxation. Orthopaedic examination of the affected stifle under general anaesthesia revealed joint effusion and craniocaudal and rotational instability. Cranial displacement of the tibia with respect to the femur and infrapatellar pad sign were identified on radiography. Intraoperatively, complete rupture of both cruciate ligaments and marked disruption of the mid and caudal poles of the medial and lateral menisci were observed. Both collateral ligaments appeared intact. The remnants of the injured cruciate ligaments were removed, and medial and lateral caudal hemimeniscectomies were performed. A tibial plateau levelling osteotomy (TPLO) was performed to address the craniocaudal stifle instability. Intraoperative assessment of the stifle revealed persistent instability with cranial tibial translation, internal and external rotation, and a positive caudal draw test. A lateral augmentation suture was employed to address the persistent cranial tibial translation and internal rotation. To successfully neutralise caudocranial and external rotational instability secondary to the caudal cruciate ligament deficiency, a medial augmentation suture was placed with the aid of three interference screws. Stifle stability was achieved. A modified Robert-Jones bandage was kept on for 24 h postoperatively. An excellent outcome was achieved, with successful limb function restoration. Relevance and novel information: This case report represents the first documented instance of feline traumatic stifle luxation repair by combining a corrective tibial osteotomy and extra-articular augmentation. Notably, it introduces the novel technique of implementing a TPLO with medial and lateral augmentation sutures to address multidirectional stifle instability.

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OBJECTIVE: To evaluate the incidence of surgical site infections (SSIs) in dogs undergoing a tibial plateau leveling osteotomy (TPLO) with silver-coated (SC) and noncoated (NC) TPLO plates. ANIMALS: 65 dogs (73 surgical procedures). METHODS: Client-owned dogs undergoing a TPLO procedure between November 2021 and May 2023 were prospectively enrolled. Dogs were randomly assigned either an SC or NC TPLO plate at the time of surgery. Follow-up was performed at 2 weeks and 8 weeks postoperatively by in-person examination, client questionnaire, or telephone interview. Dogs were followed up 100 days postoperatively for any incisional or implant complications. RESULTS: Among 73 stifles that underwent a TPLO, the overall SSI rate was 8.2% (6/73), with an infection rate of 14.3% (5/35) in the NC group and 2.6% (1/38) in the SC group; this difference was not significant (P = .17). Five of these infections were superficial, and only 1 deep SSI was recorded within the 100-day study period (NC group). CLINICAL RELEVANCE: Although no significant difference was noted between the SC and NC groups, likely due to a small sample size and overall low infection rate, there was a trend showing a higher infection rate in the NC group. No conclusions can be drawn on the impact of silver coating on deep or organ/space incisional infections due to the low incidence reported in this study (n = 1). Further investigation of SC TPLO implants in a larger and more long-term clinical study is warranted.

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This randomized, prospective clinical trial investigates the impact of a novel undenatured collagen type 2 (T2NDC)-based nutraceutical, ARTHROSHINE® HA² (AS), on postoperative rehabilitation following Tibial Plateau Leveling Osteotomy (TPLO) in 50 dogs with unilateral cranial cruciate ligament rupture (CCLR). The patients were randomly allocated to either group A, receiving AS once daily for 24 weeks post-TPLO surgery, or group B, without any supplementation. Frequency matching was applied to enhance group comparability. Assessment of outcomes included computerized gait analysis and a validated owner questionnaire. AS supplementation was well received, without any reported side effect. Consistently, patients in group A exhibited significantly higher peak vertical force values during all follow-up assessments. By the 12-week mark, gait analysis indicated a return to a physiological gait pattern in group A, while group B achieved this normalization only by the 24-week point. The administration of AS post-TPLO surgery demonstrates promise in enhancing limb function, leading to faster restoration of a physiological gait pattern. The inclusion of AS, a T2NDC-based nutraceutical, in the post-TPLO rehabilitation protocol may contribute to improved limb function and an expedited recovery, potentially facilitating a quicker return to normalcy. It is noteworthy that subjective owner perceptions did not differ between the two groups.

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OBJECTIVE: Effect of photobiomodulation therapy (PBMT) in patients with CCLR after TPLO surgery by measuring C-reactive protein (CRP), percentage weight bearing, lameness using a short form of a composite measure pain scale, evaluated by the clinician and owners, and surgical site infection. SAMPLE: 54 client-owned dogs with CCLR undergoing unilateral TPLO surgery were enrolled in this study between April 5, 2021, through April 10, 2022. METHODS: The study population was randomly assigned to either a treatment group receiving PMBT (24 dogs) or a control group (30 dogs). PMBT was performed on the treatment group immediately after induction, and 6 hours, 24 hours, 48 hours, and 8 weeks postoperatively. The control group received sham PMBT (device turned off) at the same time. Evaluation of CRP, CMPS-SF, evidence of SSI, and %WB were evaluated for all dogs 24 hours preoperatively, and then 24 hours, 48 hours, and 8 weeks postoperatively. Owners completed CMPS-SF and subjective evaluations weekly for 8 weeks postoperatively. RESULTS: No statistically significant differences were found between treatment groups when evaluating CRP, %WB, and CMPS-SF by the clinician and weekly evaluation of the CMPS-SF by owners. Although no statistically significant differences were found in patients developing surgical site infections between treatment groups, SSI was only observed in patients in the control group (5/30, 16.6%). Most were minor/superficial infections (4/30 13.3%), and a single dog (1/30, 3.3%) had a major/deep surgical site infection. CLINICAL RELEVANCE: Although with promising but not statistically significant differences between groups, surgical site infections may be reduced after PBMT application.

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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.

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A 7-year-old neutered Maltese dog weighing 5.1 kg was presented, with a tibial plateau-leveling osteotomy (TPLO) on the right hindlimb 42 days prior. The patient's right hind limb showed lameness, intermittent limping, and atrophy, and the patient had not experienced rehabilitation since TPLO surgery. The patient showed a pain reaction at the end of the stifle extension, and an increased body temperature was identified on the medial side of the right hindlimb when compared with the left hindlimb using a digital thermal imaging device. In addition, a type of lameness, only partial weight bearing in the right hindlimb, was also identified during the gait analysis. The pain was relieved by applying a cold pack and transcutaneous electrical nerve stimulation, and the patient's weak muscles were strengthened through treadmill exercises. In this study, physical therapy and rehabilitation exercises controlled pain and induced rapid recovery, indicating that rehabilitative intervention is required after TPLO surgery.

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OBJECTIVE: To investigate the use of a locking 3.5/4.0-mm jumbo tibial plateau leveling osteotomy (TPLO) plate in maintaining the postoperative tibial plateau angle (TPA) in giant-breed dogs weighing > 50 kg and to report the associated complications. ANIMALS: Canine patients weighing > 50 kg that underwent TPLO stabilized with a locking 3.5/4.0-mm jumbo TPLO plate between January 2017 and May 2022. METHODS: Retrospective case series retrieving postoperative outcomes from the medical records. Healing scores and TPAs were calculated using postoperative and recheck radiographs. Owner-perceived outcomes were obtained via questionnaire. RESULTS: 24 stifles in 22 dogs were included. Postoperative complications were recorded in 11 of 24 cases (45.8%) inclusive of 1 minor, 1 catastrophic, and 9 major complications. A statistically significant increase in TPA over the convalescent period was found. Grade 4 healing was present in 18 of 24 (75%) stifles, while the remainder were scored as grade 3. CLINICAL RELEVANCE: The use of a locking 3.5/4.0-mm jumbo TPLO plate did not prevent a statistically significant increase in TPA through convalescence. This procedure displayed an unacceptably high complication rate when compared with contemporary literature of TPLO. Despite a high complication rate in this patient population, most complications were successfully managed with medical and/or surgical treatment, and high mean and median healing scores were achieved at the radiographic recheck. Additionally, owner-perceived long-term outcomes were excellent.

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OBJECTIVE: To assess the effect of arthroscopic partial meniscectomy in dogs with bucket handle meniscal tears and tibial plateau leveling osteotomy (TPLO), compared with dogs with cranial cruciate ligament rupture and no meniscal tear treated by TPLO alone. ANIMALS: 30 client-owned dogs with cranial cruciate rupture treated by either TPLO and arthroscopy alone if the meniscus was normal (normal meniscus [NM] group, n = 14) or by TPLO and an arthroscopic partial meniscectomy if a bucket handle tear was diagnosed (meniscal tear [MT] group, n = 16). METHODS: Medical records, lameness score, and symmetry gait analysis parameters were retrospectively collected from patient records preoperatively (PreO), then at 1, 3, and 6 months postoperatively (M1, M3, and M6, respectively). Osteoarthritic (OA) radiographic score was performed and compared at PreO and M6. RESULTS: PreO gait analysis parameters were lower in the MT group (P < 0.005). In the MT group, the lameness score significantly improved between PreO and M1, and there were no significant differences between groups at M6. OA score was significantly higher in the MT group at PreO and M6. However, postoperative progression of OA did not differ between the 2 groups (P = 0.16). CLINICAL RELEVANCE: Treatment for meniscal tear results in a significant improvement in lameness, with postoperative outcomes at 6 months comparable with dogs with intact menisci. Despite having significant osteoarthritic lesions at all time points, the progression of osteoarthritis is similar between dogs with meniscal tears and those with intact menisci.

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Introduction: The objective of this study was to investigate the effect of a novel screw type on stiffness and failure characteristics of a tibial plateau leveling osteotomy (TPLO) construct under cyclic loading conditions. The authors hypothesized that bone-screw-fasteners (BSF) would result in superior biomechanical stability compared with locking buttress screws (LBS). Materials and Methods: Twelve pairs of canine cadaveric pelvic limbs were included in this ex vivo biomechanical study. A TPLO was performed using a 3.5mm locking TPLO plate and stabilized using either LBS or BSF. Cyclic loading was performed for 30,000 cycles at 4Hz with a peak-load of 1000N (50N valley). The cyclic test was then continued by stepwise incremental increase of peak-load at a rate of 75N per 500 cycles until failure. Results: Cycles to failure for LBS (44,260 ± 5,770) and BSF (41,540 ± 7,686) were not significantly different (p = 0.36). Maximum force for LBS (3,134 ± 797N) and BSF (2,940 ± 831N) was not significantly different either (p = 0.58). Dynamic stiffness for LBS (1,778 ± 932 N/mm) and BSF (1,574 ± 677 N/mm) was not significantly different (p = 0.58). Discussion: Stabilization of the TPLO with BSF provided similar biomechanical stability under cyclic axial loading conditions as the LBS. BSF may be an acceptable alternative to traditional locking screws for TPLO.

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OBJECTIVE: To determine the influence of two intraoperative pain management protocols on the need for additional opioids in patients receiving an epidural and periarticular liposomal bupivacaine (PLB) vs. PLB alone in the 12-24 h period after undergoing a TPLO. STUDY DESIGN: Retrospective study. ANIMALS: One hundred seventy-four dogs with cranial cruciate ligament tears presenting for TPLO. METHODS: Medical records of dogs presenting for a unilateral or bilateral cranial cruciate ligament tear who had a TPLO performed were reviewed for signalment, weight, body condition score, and peri-operative pain management protocol. Dogs were divided into two groups: those who received an epidural and PLB, and those who received only PLB. Post-operative opioid administration was recorded for each group. RESULTS: Patients who received an epidural and PLB received fewer postoperative opioids. There were 36% fewer opioid injections administered to dogs who received epidurals compared to dogs who did not receive epidurals (IRR) (95% CI) = 0.64 (0.45-0.92), P = 0.02). BCS was not a significant predictor of the post-operative opioid requirement (IRR (95% CI) = 1.3 (0.75-2.4), P = 0.38). When adjusting for BCS as a possible confounder, there were 39% fewer opioid injections in dogs who received epidurals than dogs without (IRR (95% CI) = 0.61 (0.42-0.88), P = 0.009). CONCLUSIONS: The incidence of postoperative opioid administration was significantly diminished in patients receiving both an epidural and PLB. CLINICAL SIGNIFICANCE: Administration of an epidural in addition to infiltration of PLB significantly decreased the incidence of postoperative opioid administration in dogs undergoing a TPLO.

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In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients' owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons' training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options.

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Objective: To report surgical site infections (SSI) after Tibial Plateau Leveling Osteotomy (TPLO), treatment course, associated risk factors, bacterial isolates and antimicrobial resistance. Study design: Retrospective clinical cohort study. Study population: Six hundred and twenty seven dogs and 769 TPLO procedures. Methods: Data from electronic medical records of dogs undergoing TPLO between 2005 and 2015 at a single institution have been retrospectively reviewed. A generalized mixed logistic regression was used to determine possible risk factors. The Chi-Square test of independence was used to examine the relationship between the isolation of multidrug-resistant (MDR) bacteria and the development of major infections undergoing additional surgical treatment. To assess the correlation between number of SSI and number MDR isolate per year, Pearson's correlation coefficient was calculated. Results: The overall complication rate was 19.3% (n = 149). SSI was most frequent with 8.5% (n = 65). Major SSI occurred in 6.8% (n = 52) TPLO (80.0% SSI). Staphylococcus (S.) pseudintermedius (n = 37) and S. aureus (n = 10) were most frequently isolated. Multidrug-resistant bacteria were identified in 2.7% (n = 21) TPLO (32.3% SSI) but were not associated with major SSI (p = 0.426). There was a strong positive correlation between number of MDR isolates per year and number of SSI per year [r (9) = 0.79, p = 0.004]. Factors associated with SSI were previous TPLO in the contralateral stifle (p = 0.02, OR = 2.01, 95% CI = 1.11-3.64) and German Shepherd dogs (p = 0.035, OR = 4.41, 95% CI = 1.11-17.54). The use of non-locking implants was found to be protective (p = 0.02, OR = 0.179, 95% CI = 0.18-0.77). Clinical significance: Infection with multidrug-resistant bacteria is an emerging problem in veterinary practice and treatment is challenging. The incidence of major SSI was found to be high but was not associated with the isolation of MDR bacteria.

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Introduction: Accurate radiographic assessment of bone healing is vital in determining both clinical treatment and for assessing interventions aimed at the promotion of bone healing. Several scoring systems have been used to evaluate osteotomy changes following tibial plateau leveling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing following TPLO over time (Aim I), and to evaluate the influence of limb positioning on TPLO osteotomy scoring (Aim II). Materials and methods: Phase I-A randomized, blinded, prospective study was conducted using similarly positioned postoperative TPLO radiographs from seven dogs taken immediately postoperatively, 6-weeks, and 8-weeks postoperatively. Ten reviewers assessed the radiographs, and five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week postoperative were compared to 8-week postoperative. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score). Phase II-An international group of 39 reviewers was asked to score radiographs from three dogs, taken in different positions, using the VAS grading system. Scores were averaged and comparisons were made for each set. Results: Phase I-The VAS system identified the greatest number of sets correctly (76%), with the least unchanged scores (15%), and 9% incorrect scores. Phase II-All three patients had an increase in the average difference between VAS-scores for differently positioned radiographs compared to similarly positioned radiographs. The magnitude of change between different positions far exceeded the magnitude of comparison of the similarly positioned radiographs from the 6- and 8-week time point. Discussion/Conclusion: The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. In addition, the positioning of postoperative TPLO radiographs makes a substantial difference in the healing score that is assigned. Care must be undertaken when performing postoperative radiographs in both the clinical and research setting to ensure accurate assessment of bone healing.

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OBJECTIVE: The aim of this study was to assess the potential consequences of tibial plateau levelling osteotomy (TPLO) for the medial collateral ligament (MCL) tibial insertion (TI) with a particular focus on the effects of the TPLO planning technique and of the size of saw blade. STUDY DESIGN: Eighty-six stifle joints were collected from 43 canine cadavers and dissected free of soft tissue to expose the MCL. The MCL insertion sites were first identified with Chinese ink on intact stifle joints, and then marked with radio-opaque barium sulfate after removal of the MCL. Mediolateral radiographs were made of each marked stifle joint and used for TPLO digital planning. For each stifle, planning the TPLO was performed by centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia in group 1, and at the top of the intercondylar tubercles in group 2. Whenever possible, two saw blade sizes were tested in each group. Measurements were taken after TPLO simulation to assess how the procedure would alter the MCL TI. RESULTS: In group 1, the integrity of the MCL TI was affected by the TPLO planning in 87.2% of the cases with the small saw blade and in 59.3% of the cases with the large blade, and in group 2, in 94.2% of the cases with the small and 77.9% with the large saw blade. In group 1, the osteotomy line was located above the TI, completely severing the MCL in four cases versus in 11 cases in group 2, while severing occurred in 14/15 cases with the small saw blade. CONCLUSION: During TPLO, the osteotomy line transected the MCL TI in the majority of dogs. Centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia and using the largest saw size that preserves tibial tuberosity and patellar tendon insertion seems to be the best way to preserve the MCL TI as much as possible. Further research is needed to evaluate the clinical impact of MCL TI transection.

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Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.

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Five canine cadaveric pelvic limbs with intact cranial cruciate ligaments were used to quantify the effect of variation in limb positioning on the radiographic measurement of the tibial plateau angle (TPA) with reference to the degree of femoral condyle superimposition. Intra-osseous pin placement and a custom jig design allowed the controlled three-dimensional manipulation of limbs. Medio-lateral digital radiographic projections were taken with perfect femoral hemicondylar superimposition to establish a "reference" TPA (difference in position = 0 mm), and subsequently in varying degrees of supination/pronation and abduction/adduction. The lack of femoral hemicondylar superimposition for each radiograph was quantified using a tangential line technique with reference to the long tibial axis. A total of 176 radiographs were each assessed by three observers. "True" TPA was measured and it ranged within 17-25° across all limbs assessed. Variation in femoral condylar positioning ranged from -13 mm to +13 mm proximo-distally, and -11 mm to +11 mm cranio-caudally. Moreover, 3 mm non-superimposition of the femoral condyles produced 90.6% of measurements with 1° difference between measured and "true" TPA, and a sensitivity of 97.9% for a 2° difference. Further reduction in femoral condylar superimposition to 4 mm reduced the frequency of 1° difference between measured and "true" TPA to 84.9%, and to 94.8% for a 2° difference. In conclusion, measurement of TPA in large breed dogs from radiographs with greater than 3 mm variation in femoral condylar superimposition should be interpreted with caution.

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The objective of this study was to assess the functional outcomes of dogs wearing nail grips in the first 2 weeks following tibial plateau leveling osteotomy (TPLO). Thirty dogs were included (n = 13 nail grips and n = 17 sham grips). Visual lameness scores (VLS), total pressure index (TPI), and client-specific outcome measures (CSOMs) were obtained by blinded observers on day 1 and day 14 +/- 3 post TPLO. CSOMs were also obtained on day 7. There were no differences in VLS and TPI between the treatment and sham group on day 14 (p = 0.44 and p = 0.59, respectively) or at any time point. CSOMs assessing walking on slippery flooring, ability to rise, and consistent use of surgical limb on a 5 min walk were also not different between groups (p = 0.78, p = 0.80, and p = 0.63) at any time point. Nail grips were well tolerated in dogs after orthopedic surgery. This study did not demonstrate a benefit for dogs wearing nail grips during the first two weeks after TPLO; however, further studies are warranted.