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Surgery Spotlight
Veterinary Surgery Publishes VSS/Western University Study on Postoperative Complications of 1,613 Tibial Tuberosity Advancements
Veterinary Surgical Specialists (VSS), a leader in surgery for the cruciate deficient stifle in dogs, in collaboration with Western University of Health Sciences, College of Veterinary Medicine, conducted a study on postoperative complications of tibial tuberosity advancement (TTA). This is the largest reported sequential case series of TTAs with the longest postoperative follow-up in the literature. The research was recently published in the May 2017 edition of Veterinary Surgery.[1]
About the study:
  • Design: Retrospective case series study (N = 1,613 dogs) evaluating TTA and related complications.
  • Methods: Medical records were reviewed for dogs that underwent TTA procedures performed at VSS from December 2007 through 2013 and included at least one year of postoperative follow-up.
  • Conclusions:
    • Major complications after TTA were uncommon, even in dogs with concurrent patellar luxation or bilateral simultaneous procedures.
    • Medial meniscal release may prevent postliminary meniscal tears. 
Discussion:  The study's time frame included the period when the three VSS surgeons favored TTA. This favoritism arose due to  complications from implant-related problems (implant failure, infection, neoplasms, etc.) with the tibial plateau leveling osteotomy (TPLO) procedure. The titanium implants used in the TTA procedure appeared to be much better tolerated, which was confirmed in the paper.

More recently the advancement in TPLO locking plate technology and newer materials  have  improved outcomes by reducing complication rates. At VSS, we now predominantly perform the TPLO procedure with state-of-the-art implants, including for smaller dogs (less than 40 pounds), where a lateral suture might have been used in the past. We plan to repeat a retrospective on TPLO surgeries with a similar follow-up period in these cases using the newer implants.

Immediate post-operative radiograph of a TTA repaired stifle from the study
Recent KYON titanium locking plate TPLO repaired stifle. Note the minimal plate to bone contact in order to limit periosteal damage.

[1] Costa M, Craig D, Cambridge, T, Sebestyen P, Su Y, Fahie MA. Major complications of tibial tuberosity advancement in 1613 dogs. Veterinary Surgery. 2017;46(4):494-500. https://doi.org/10.1111/vsu.12649

VSS Now Offers Small Animal Musculoskeletal Digital Ultrasound 

Diagnostic ultrasound of the musculoskeletal system has been an important part of sports medicine and orthopedics in human and equine medicine for many years. With the availability of advanced, high-resolution probes that provide clear and accurate images, small-animal diagnostic musculoskeletal ultrasound is now available to help diagnose sprains, strains, tears, and other soft tissue conditions.

It can be performed in the awake or slightly sedated patient, making it an appealing alternative to other diagnostics. The relatively low cost also allows for more affordable rechecks. While the best images are obtained with the area of interest clipped, sometimes this is disagreeable to the client.

At VSS, we use musculoskeletal ultrasound to evaluate:
  • Muscles
  • Tendons
  • Ligaments
  • Joints
  • Cartilage
  • Inflammation
  • Orthopedic disease
  • Aspirates and joint injections
The structures of the shoulder are particularly available to examination with ultrasound. Injuries causing medial shoulder instability with subscapularis tendon and medial glenohumeral ligament tears are of particular interest. We are also actively developing skills in evaluating meniscal anatomy in the stifle. Lastly, our new SonoSite SII unit includes software capable of enhancing biopsy and injection procedures, rendering them more accurate.

If you would like to consult about a case, or refer a patient, we welcome your call at 949.936.0055.

Veterinary Surgical Specialists - Operating with care.
2965 Edinger Avenue | Tustin, CA 92780 | 949.936.0055 | vssoc.com