What's new in orthopedics--part II.

The first World Veterinary Orthopedic Congress was held September 5th to 8th, 2002, in Munich, Germany, as a joint meeting between the European Society of Veterinary Orthopedics and Traumatology and its North American sister organization, the Veterinary Orthopedic Society. The Congress attracted almost 400 delegates from 32 countries and featured over 150 lectures, papers, and laboratory sessions. Orthopedic surgeons can seemingly never gather without extensive discussion of cranial cruciate ligament (CCL) rupture in the dog, and this Congress was no exception. Data were presented indicating that more than 70% of CCL ruptures are nontraumatic (1). It has been recognized for some time that CCL rupture in some dogs occurs as the culmination of a long-term degenerative process in the stifle joint. This retrospective study suggests that 11% of these nontraumatic injuries are partial ligament tears, and that higher standing stifle angles (“straight-legged” conformation) and obesity are predisposing factors to CCL injury. The tibial plateau leveling osteotomy (TPLO), a technique developed more than 2 decades ago by Slocum as a treatment for CCL rupture (2), may finally be shedding its “controversial” label. Slocum's initial work with the procedure involved patenting the technique; thus restricting its teaching and the accumulation of clinical data. The data that might have taken only 5 y to generate are only now becoming available after 20 y. While there remains debate over how and why the technique is effective, there is little dispute that the TPLO does work, that it decreases long-term degenerative joint disease, and, consequently, that it may be the treatment of choice, especially in large breed dogs (3). The TPLO procedure is based on the leveling of the tibial plateau to eliminate the cranial tibial thrust produced by axial loading of the CCL-deficient stifle. A radial osteotomy of the proximal extremity of the tibia is made as one looks at the stifle in the mediolateral plane. The proximal fragment of the tibia is then rotated so as to level the cranial to caudal slope of the tibial plateau. The osteotomy is then fixed with a specialized bone plate and screws. The results of over 20 000 TPLO procedures at several institutions worldwide, which continue to provide positive results on the procedure's efficacy, were presented to Congress delegates. However, results do not suggest that other techniques should be abandoned. Data were presented showing that 6 mo postoperatively, weight-bearing in 68 Labrador retrievers, as measured by force plate analysis, was not significantly different between TPLO repairs and extracapsular repairs (5). Information was presented on the management of partial CCL tears that cast doubt on the wisdom of handling such cases with a conservative “wait and see” approach (6). Without surgical stabilization, complete rupture was found to be a virtual inevitability. The TPLO procedure was shown to prevent partial tears from becoming complete ruptures and to dramatically decrease degenerative joint disease, as compared with joints treated conservatively. The partial CCL tears were confirmed arthroscopically by the authors before they proceeded with TPLO. While hip replacement surgery in the dog has become commonplace at academic and referral institutions worldwide, the replacement of other troublesome joints, specifically the elbow and stifle, has been slower in progressing. Research in both these areas was presented at the Congress (7,8). A prosthetic elbow joint appears to be close to commercial production, but it will likely be some years yet before elbow and stifle replacements are commonly available.

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