Page 592 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 592

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An Urban Experience
preoperatively and treated differently. A possible strategy to prevent postoperative instability is to combine dynamic (osteotomy) and static (extra-articular technique) stabilization techniques. The preliminary results of
a recent in vivo  uoroscopic study evaluating sti e kinematics in dogs before and after TPLO, demonstrated that dogs without instability may have a degree of external tibial rotation, in contrast to the dogs with tibial subluxation which had severe internal tibial rotation. It
is possible that dogs with mild tibial internal torsion or varus may This study would support the hypothesis
that rotational instability may have an important role
in postoperative subluxation after TPLO and that a
lateral anti-rotational suture may improve stability. The combination of the TPLO with an anti-rotational lateral suture in dogs at higher risk of rotational instability may improve outcome and decrease the incidence of post- surgical meniscal injuries. This hypothesis needs to be con rmed with future biomechanical and clinical studies.
A novel strategy to control cranio-caudal as well as rotational instability is the new TPLO Internal brace technique. This technique is possible using a locking plate that allows anchoring the extra-articular suture directly to the plate. This plate is designed with several new features, which allow the surgeon easier and more consistent plate placement and offer the option of a knotless anti-rotational lateral stabilization technique (Internal Brace) in dogs with severe sti e instability. Although TPLO is widely considered a successful surgery, several reports suggest that persistent instability can be found in about 30% of dogs. In addition the occurrence of meniscal injuries after TPLO suggests that some dogs may have continuous subluxation. A recent in vivo  uoroscopic study evaluating sti e kinematics in dogs before and after TPLO2, demonstrated that dogs without instability had about 5°-10° of external tibial rotation, in contrast to the dogs with tibial subluxation which had severe internal tibial rotation. This study would support the hypothesis that rotational instability may be the inciting cause of subluxation after TPLO and that a lateral anti-rotational suture may improve stability.
The combination of the TPLO with an anti-rotational lateral suture in dogs at higher risk of rotational instability may improve outcome and decrease the incidence of post-surgical meniscal injuries.
The TPLO is performed using standard technique. The anti-rotational lateral suture (Internal Brace) consists of Fibertape looped around the suture hole of the plate and secured with a knotless Swivelock anchor to the lateral femoral condyle. A bone tunnel is drilled from lateral-to-medial using an aiming device to exit at the level of the plate suture hole. The lateral anatomical landmark for the tibial tunnel has been described for Swivelock CrCL technique. A single strand of Fibertape is passed into the suture hole of the plate and shuttled
through the tunnel. The Fibertape is secured to the lateral femoral condyle using a 3.5mm or 4.7 mm Swivelock. The suture is tensioned to eliminate excessive internal rotation. Excessive tension should be avoided, because the Internal Brace is only acting as rotational stabilizer, while the TPLO is providing dynamic cranio-caudal stabilization.
42ND WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND FECAVA 23RD EUROCONGRESS


































































































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