Оглавление
Ron Ben-Amotz. Complications in Canine Cranial Cruciate Ligament Surgery
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Complications in Canine Cranial Cruciate Ligament Surgery
Preface
List of Contributors
Foreword
Acknowledgments
Disclosures
1 Pathology, Diagnosis, and Treatment Goals of Cranial Cruciate Ligament Rupture and Defining Complications
1.1 Introduction
1.2 Diagnosis
1.3 Treatment
1.4 Defining a Complication
1.4.1 Assessment of Success and Complications
References
2 Surgeon and Patient Preparation to Minimize Surgical Site Complications and Infection Surveillance Programs
2.1 Introduction
2.2 Host Factors. 2.2.1 Breed, Sex, and Body Weight
2.2.2 ASA Status and Endocrinopathies
2.2.3 MRSP Carrier Status
2.2.4 Dermatitis, Clipping, and Skin Preparation
2.3 Environmental Factors. 2.3.1 Sources of Contamination
2.3.2 Personnel
2.4 Surgical Procedure. 2.4.1 Surgeon Factors – Hand Hygiene, Glove Perforation, Surgical Technique
2.4.2 Anesthesia and Surgery Time
2.4.3 Draping
2.4.4 Implant Choices
2.4.5 Wound Closure and Protection
2.5 Antimicrobial Use
2.5.1 Preoperative
2.5.2 Perioperative
2.5.3 Postoperative
2.6 Surveillance
2.7 Conclusion
References
3 Identification, Addressing, and Following Up on Surgical Site Infection After Cranial Cruciate Ligament Stabilization
3.1 Introduction
3.2 Identification of Surgical Site Infections
3.3 Addressing Surgical Site Infections
3.4 Follow‐Up
References
4 Complications Associated with Intraarticular Repair Techniques
4.1 An Introduction to Intraarticular Repair in Veterinary Medicine
4.2 Intraarticular Repair Complications in Humans
4.3 Intraarticular Repair Complications in Canines
4.4 Graft Selection
4.5 Tunnel Creation
4.6 Graft Fixation
4.7 Intraarticular Repair Assessment and Revision
4.8 Conclusion
4.9 Clinical Examples
Clinical Example 4.1 Allograft or Autograft Harvesting
Clinical Example 4.2 Tunnel Creation
Clinical Example 4.3 Graft Placement
Clinical Example 4.4 Graft Fixation
Clinical Example 4.5 Graft Failure
Clinical Example 4.6 Infection
Clinical Example 4.7 Progressive Osteoarthritis
Clinical Example 4.8 Fracture of the Femur or Tibia
References
5 Complications Associated with Proximal Tibial Epiphysiodesis
5.1 Introduction
5.2 Identification of Potential Complications
5.3 Preoperative Planning Strategies
5.4 Surgical Technique
5.5 Identification and Correction of Intraoperative Complications
5.6 Evaluation and Identification of Postoperative Complications
5.7 Decision Making for Postoperative Complications
5.8 Revision Strategies for Postoperative Complications
5.9 Key Points
References
6 Extracapsular Stabilization Using Synthetic Material
6.1 Introduction
6.2 Preoperative Patient Classification and Suitability for Extracapsular Suture Procedure
6.3 Preoperative Planning Strategies to Minimize Complications both Intra‐operatively and Post‐operatively
6.4 Operative Features of Extracapsular Suture
6.5 Placement of Implant: Femoral and Tibial Insertion Sites and Options
6.6 Choice of Synthetic Material (Monofilament, Multifilament)
6.7 Prefatigue and Tensioning of Material
6.8 Method of Securing the Material
6.9 Intraoperative Contamination and Avoidance Strategies
6.10 Soft Tissue Plane(s) Closure and Material Used
6.11 Identification of Intraoperative Complications
6.11.1 Decision Making with Identification of Intraoperative Complications
6.11.2 Revision Strategies for Intraoperative Complications
6.12 Evaluation and Identification of Immediate Post‐operative Complications
6.12.1 Excessive Patient Discomfort
6.12.2 Failure to Commence Limb Use
6.12.3 Infection
6.13 Evaluation and Identification of Delayed, Midterm Post‐operative Complications
6.14 Evaluation and Identification of Long‐Term Post‐operative Complications
6.15 Conclusion
Contributors
References
7 Complications Associated with Extracapsular Stabilization Using Monofilament Material
7.1 Introduction
7.2 History of Lateral Extracapsular Suture
7.3 Patient Selection Considerations for Lateral Extracapsular Suture
7.4 Preoperative Planning Tips to Minimize Complications
7.5 Intraoperative Technical Considerations, Complications, and Revision Strategies
7.6 Tips to Prevent Intraoperative Complications
7.7 Identification and Management of Postoperative Complications
7.8 Tips to Prevent Postoperative Complications
7.9 Conclusion
References
8 Complications Associated with Extracapsular Stabilization using Multifilament Material
8.1 Introduction
8.1.1 Preoperative Goals of Extracapsular Stabilization
8.1.2 Intraoperative Goals of Extracapsular Stabilization
8.1.3 Postoperative Goals of Extracapsular Stabilization
8.2 Preoperative Planning. 8.2.1 Introduction
8.2.1.1 Can I Easily Perform the Procedure in This Patient?
8.2.1.2 Does the Patient Have Physical Features That Will Stress the Repair?
8.2.1.3 Does the Patient Have Predisposing Risk Factors for Infection?
8.2.1.4 Will This Patient and Client Be Compliant Postoperatively?
8.2.2 Preoperative Planning Summary
8.3 Intraoperative Procedure. 8.3.1 Intraoperative Objectives of Extracapsular Stifle Stabilization with Multifilament Material
8.3.2 Intraoperative Mechanical Objectives
8.3.2.1 Identifying and Correcting Intraoperative Mechanical Errors. 8.3.2.1.1 Impaired Tarsal Range of Motion:
8.3.2.1.2 Stifle Conflict Palpable During Range of Motion:
Evaluating Isometric Error
Evaluation of Isometry Using the Suture Tensioner
8.3.2.1.3 Excessive Cranial Drawer or Cranial Tibial Thrust:
Isometric Error
Insufficient Tensioning
Tensioning with the Stifle in Excessive Drawer
Implant and Tissue Creep
Managing Creep Using the Suture Tensioner
Rescuing a Knotless SwiveLock Stabilization
Presence of Soft Tissue Between Toggle/Suture Buttons and the Bone
8.3.2.1.4 Tibia Fixed in External Rotation
8.3.2.2 Meticulous Aseptic Technique
8.3.3 Intraoperative Summary
8.4 Postoperative Considerations
8.4.1 Maintain a Mechanically Sound Stifle
8.4.1.1 Periarticular Fibrosis Formation
8.4.1.2 Bone Tunnel Maturation
8.4.1.2.1 What is Necessary for Bone Tunnel Maturation to Occur?
8.4.1.2.2 Surgical Considerations for Bone Tunnel Maturation. Origins of Bone Tunnels at Optimal Locations to Maximize Joint Isometry
Bone Tunnel Angulation
Bone Tunnel Size and Implant Type
8.4.2 Infection
8.4.3 Postoperative Activity Restrictions
8.4.4 Postoperative Benchmarks of Expectation
8.4.4.1 Limb Use Expectation: 2 Weeks Postoperative
8.4.4.1.1 History Considerations. What Analgesics is the Client Administering?
Was the Patient Using the Leg at Any Point of the Recovery?
How Has the Patient Been Confined and How Much Activity Has the Patient Been Getting?
Has an E‐collar or Other Device Been Used?
8.4.4.1.2 Physical Examination and Orthopedic Examination. Evaluate the Entire Limb
Evaluate for Evidence of Infection
Limb Mechanics Assessment
8.4.4.1.3 Additional Diagnostics. Follow‐Up Radiographs
Arthrocentesis
Joint Irrigation
Empirical Antibiotic Therapy
8.4.4.2 Six Weeks Postoperative Follow‐Up
8.4.4.2.1 Limb Use Expectation: Six Weeks Postoperative
8.4.4.2.2 Poor Limb Use: Six Weeks Postoperative
8.4.4.2.2.1 History
8.4.4.2.2.2 Physical and Orthopedic Examination
8.4.4.2.2.3 Additional Diagnostics. Stifle Radiographs
Arthrocentesis
8.4.4.2.3 Managing Implant‐Associated Pain
8.4.4.2.4 Managing Restricted Stifle Range of Motion
8.4.4.2.5 Managing Excessive Stifle Instability
8.4.4.2.6 Acute Onset of Lameness in the Recovery Period
Differentiating a Joint Sprain from a Subsequent Meniscal Tear
8.4.4.3 Limb Use Expectation: 14 Weeks Postoperative
8.5 Conclusion
References
9 Complications Associated with Cranial Closing Wedge Osteotomy
9.1 Introduction
9.2 Preoperative Planning
9.2.1 Isosceles Modified Cranial Closing Wedge Osteotomy (mCCWO) Planning
9.3 Intraoperative Complications
9.3.1 The Surgical Approach
9.3.2 Ostectomy Position
9.3.3 The Osteotomies
9.3.4 Limb Alignment and Osteotomy Gaps
9.3.5 Plate Application
9.3.6 Wound Closure
9.4 Postoperative Complications
9.4.1 Acute Nonspecific Arthritis
9.4.2 Late Meniscal Injury
9.4.3 Infection
9.4.4 Fractures
9.4.5 Implant Failure
9.4.6 Patellar Instability/Luxation
9.4.7 Pivot Shift
References
10 Complications Associated with Tibial Plateau Leveling Osteotomy
10.1 Introduction
10.2 Literature Review of Complications
10.3 Complications Specific to Tibial Plateau Leveling Osteotomy: Tips to Minimize Complications
10.3.1 Preoperative: Radiographic Positioning
10.3.2 Intraoperative
10.3.2.1 Surgical Approach (Recognition and Avoidance of Important Anatomical Structures)
10.3.2.2 Osteotomy Planning
10.3.2.3 Thermal Necrosis
10.3.2.4 Hemorrhage (Laceration of the Cranial Tibial Artery)
10.3.2.5 Patellar Tendon Laceration
10.3.2.6 Rotational and Antirotational Pin Placement
10.3.2.7 Broken Drill Bits
10.3.2.8 Complications of Implant Positioning
10.3.2.8.1 Inadequate Number of Cortices Engaged/Fissuring of the Trans Cortex During Screw Placement
10.3.2.8.2 Screws That Penetrate the Osteotomy Line Might Interfere with Osteotomy Healing
10.3.2.8.3 Screws That Penetrate the Joint
10.3.2.8.4 Jig Pin Placement into the Joint
10.3.2.9 The Osteotomy Gap
10.3.2.10 Medial Patellar Luxation
10.3.2.11 Pivot Shift
10.3.2.12 Inability to Rotate to the Planned Rotation
10.3.2.13 Malalignment
10.3.3 Postoperative Complications. 10.3.3.1 Immediate Postoperative Complications (<14 days) 10.3.3.1.1 Identification of a Surgical Sponge at the Surgical Site
10.3.3.1.2 Incisional Seroma/Infection
10.3.3.1.3 Screws in the Joint/Osteotomy
10.3.3.1.4 Medial or Lateral Patellar Luxation
10.3.4 Delayed Postoperative Complications (>14 days) 10.3.4.1 Fibular Fracture
10.3.4.2 Incisional and Implant‐Related Infection
10.3.4.3 Medial or Lateral Patellar Luxation
10.3.4.4 Latent or Postliminary Meniscal Tear
10.3.5 Tibial Tuberosity Fracture
10.3.6 Patellar Fracture
10.3.7 Patellar Tendon Thickening
10.3.8 Loss of Reduction/Alignment (Rock‐Back)/Catastrophic Tibial Fracture with Implant Failure
10.3.9 Implant‐Associated Sarcoma
10.3.10 Long Digital Extensor Tendon Luxation
10.4 Return to Function
References
11 Complications Associated with CORA‐Based Leveling Osteotomy
11.1 Introduction
11.2 Literature Review of Complications
11.3 Complications Specific to CORA‐Based Leveling Osteotomy
11.4 Tips to Minimize Complications
References
12 Complications Associated with Tibial Tuberosity Advancement
12.1 Introduction
12.2 Intraoperative Complications
12.3 Postoperative Complications – Overall Frequency
12.4 Postoperative Complications – Minor
12.5 Postoperative Complications – Major
12.5.1 Meniscal Injury
12.5.2 Tibial Fractures
12.5.3 Surgical Site Infections
12.5.4 Patella Luxation
12.6 Risk Factors for Postoperative Complications
12.7 Conclusion
12.7.1 Disclosure Statement
References
13 Complications Associated with the Modified Maquet Technique
13.1 History
13.2 Guidelines to Perform a Modified Maquet Technique. 13.2.1 Preoperative
13.2.2 Intraoperative
13.2.3 Postoperative
13.3 Specific Complications. 13.3.1 Postliminary Medial Meniscal Tear. 13.3.1.1 Definition
13.3.1.2 Risk Factors
13.3.1.3 Diagnosis
13.3.1.4 Treatment
13.3.1.5 Outcome
13.3.2 Underestimation of Required Tibial Tuberosity Advancement. 13.3.2.1 Definition
13.3.2.2 Risk Factors
13.3.3 Inadequate Choice (Width) of Cage. 13.3.3.1 Definition
13.3.3.2 Risk Factors
13.3.3.3 Diagnosis
13.3.3.4 Treatment
13.3.3.5 Outcome
13.3.3.6 Prevention
13.3.4 Incorrect Cage Placement. 13.3.4.1 Definition
13.3.4.2 Diagnosis
13.3.5 Fissure/Fracture of the Tibia at the Bone Hinge; Fracture of the Tibial Shaft. 13.3.5.1 Risk Factors
13.3.5.2 Diagnosis
13.3.5.3 Treatment
13.3.5.4 Outcome
13.3.5.5 Prevention
13.3.6 Patella Baja. 13.3.6.1 Definition
13.3.6.2 Risk Factors
13.3.6.3 Diagnosis
13.3.6.4 Treatment
13.3.7 Patella Luxation. 13.3.7.1 Definition
13.3.7.2 Risk Factors
13.3.7.3 Diagnosis
13.3.7.4 Treatment
13.3.7.5 Outcome
13.3.7.6 Prevention
13.3.8 Incomplete Bone Healing (Filling) of the Osteotomy Gap. 13.3.8.1 Definition
13.3.8.2 Risk Factors
13.3.8.3 Diagnosis
13.3.8.4 Treatment
13.3.8.5 Outcome
13.3.8.6 Prevention
13.4 Relevant Literature
References
14 Complications Associated with Stifle Orthotics
14.1 Introduction
14.2 Stifle Orthoses Construction
14.2.1 Stifle Orthosis Frame
14.2.2 Moveable Joint Options with Stifle Orthoses
14.3 Stifle Orthoses and Owner Perception
14.4 Stifle Orthoses and Weight Bearing
14.5 Stifle Orthoses and Cranial‐Caudal Translation
14.6 Stifle Orthoses and Joint Rotation
14.7 Stifle Orthoses and the Impact on Adjacent Joints
14.8 Clinical Complications during Orthotic Usage
14.8.1 Skin Irritation
14.8.2 Compression Phenomenon
14.8.3 Localized Pressure Necrosis
14.9 Conclusion
References
15 Complications from Cranial Cruciate Ligament Surgery: Rehabilitation Considerations
15.1 Introduction
15.2 Gait Evaluation
15.3 Surgical Limb Evaluation
15.4 Range of Motion Evaluation
15.5 Meniscal Evaluation
15.6 Muscle Strength Evaluation
15.7 Choice of Modalities
15.7.1 Thermal Medicine
15.7.2 Therapeutic Exercise
15.7.3 Electrical Stimulation
15.8 Communication to Minimize Complications
References
16 Complications Associated with Feline Cranial Cruciate Ligament Techniques
16.1 Introduction
16.2 Anatomy
16.3 Cranial Cruciate Ligament Rupture. 16.3.1 Etiopathogenesis
16.3.2 Clinical Signs
16.3.3 Diagnosis
Algorithm 16.1 Diagnosing CCL rupture in the cat
16.4 Meniscal Injury
16.4.1 Intraarticular and Meniscal Mineralization
16.5 Tibial Plateau Angle Measurement
16.6 Management Considerations
16.6.1 Conservative Management
Algorithm 16.2 Decision making when presented with a lame cat following conservative management of CCL rupture
16.6.2 Surgical Stabilization
Algorithm 16.3 Decision making for the cat with isolated CCL rupture
16.7 Extracapsular Stabilization
16.7.1 Complications with Extracapsular Stabilization
Algorithm 16.4 Decision making when presented with a lame cat post surgical management of CCL rupture
Algorithm 16.5 Treatment algorithm for multiligamentous injury of the feline stifle
16.8 Osteotomy for Cranial Cruciate Ligament Rupture in the Cat: Considerations
16.9 Tibial Plateau Leveling Osteotomy
16.9.1 Complications Following TPLO in Cats
16.9.2 Outcomes Following TPLO in Cats
16.10 Tibial Tuberosity Advancement
16.10.1 Complications Following TTA in Cats
16.11 Multiligamentous Stifle Injuries/Stifle Disruption
16.11.1 Complications and Outcomes Following Multiligamentous Injuries in Cats
Algorithm 16.6 Complications following surgery for multiligamentous stifle injury in the cat
References
17 Complications Associated with Arthroscopic Evaluation of the Stifle and Decision Making
17.1 Introduction
17.2 Preoperative Considerations and Complications
17.3 Intraoperative Considerations and Complications
17.3.1 Extravasation of Fluid
17.3.2 Intraarticular Hemorrhage
17.3.3 Iatrogenic Cartilage Damage
17.3.4 Meniscal Identification
17.3.5 Surgical Trauma
17.3.6 Instrument Failure
17.4 Postoperative Considerations and Complications
17.5 Decision Making with Arthroscopy: Short‐Term Implications
17.6 Decision Making with Arthroscopy: Long‐Term Implications
References
18 Complications Associated with the Meniscus and Decision Making
18.1 Introduction
18.2 Preoperative Meniscal Evaluation
18.3 Exposure of the Meniscus and Diagnosis of Meniscal Tears
18.3.1 Meniscal Evaluation with an Arthrotomy
18.3.2 Meniscal Evaluation with Arthroscopy
18.3.3 Detection of Meniscal Pathology
18.4 Meniscal Treatment. 18.4.1 Meniscal Release
18.4.2 Meniscal Repair or Debridement
18.5 Lateral Meniscal Tears
18.6 Postoperative Meniscal Complications
References
Index
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