Читать книгу Complications in Canine Cranial Cruciate Ligament Surgery - Ron Ben-Amotz - Страница 4

1 Chapter 1Figure 1.1 An immediate postoperative radiograph of stifle stabilization via...Figure 1.2 Radiograph of a 12‐week‐old dog that suffered a traumatic CCL inj...Figure 1.3 Representation of offloading the left pelvic limb at a stance. Th...Figure 1.4 A patient with instability of the left pelvic limb secondary to a...Figure 1.5 An example of a positive sit test in a patient with a right CCL t...Figure 1.6 An example of a square sit in a patient with no CCL pathology. No...Figure 1.7 Demonstration of the cranial drawer test. One hand is placed on t...Figure 1.8 Demonstration of the tibial compression test. One hand is placed ...Figure 1.9 A lateral radiograph documenting appropriate positioning of the s...Figure 1.10 A cranial‐caudal radiograph documenting appropriate position of ...Figure 1.11 Evidence of joint effusion in the stifle of a patient with CCL p...Figure 1.12 Evidence of degenerative changes in the stifle of a patient with...

2 Chapter 2Figure 2.1 (a) Mild bacterial dermatitis with pustules and plaques. (b) Mild ...Figure 2.2 Hanging leg technique for limb suspension. (a) A piece of 2 in. t...Figure 2.3 Skin preparation steps. Note the assistant is wearing nonsterile ...Figure 2.4 (a) Chlorhexidine gluconate 4% soap solution. (b) Povidone‐iodine...Figure 2.5 (a) Avagard™ chlorhexidine gluconate 1% + ethyl alcohol 61%. (b) ...Figure 2.6 Example of a surgical safety checklist, based on the World Health...Figure 2.7 Following final skin preparation in the OR with the limb suspende...

3 Chapter 3Figure 3.1 For the Levine technique, the swab is contacting the wound bed on...Figure 3.2 (a) A craniocaudal (CC) view of a TPLO with periosteal reaction e...Figure 3.3 A dehisced lateral stifle incision with local erythema and purule...Figure 3.4 Scanning electron microscopy image of a biofilm.Figure 3.5 In this craniocaudal view of the antebrachium, two discontinuous ...Figure 3.6 (a) Exposed TPLO plate. (b) Screw removed. When removing screws t...

4 Chapter 4Figure 4.1 Radiograph of a stifle joint with a DDFT allograft secured by use...Figure 4.2 Intraoperative photograph of a DDFT allograft repair using the Tr...Figure 4.3 Harvesting a DDFT allograft for use in an IA repair. Damaging ten...Figure 4.4 A DDFT allograft after harvest. Due to the inconsistent circumfer...Figure 4.5 Placement of bone tunnels can be aided by use of an aiming guide....Figure 4.6 Bone tunnels are often difficult to visualize on postoperative ra...Figure 4.7 A challenge of IA repair can be passing the graft through the bon...Figure 4.8 (a–c) A 6.8‐year‐old male neutered Labrador Retriever (33 k...Figure 4.9 A 4.5‐year‐old male neutered Boxer (35 kg) presented for second‐l...Figure 4.10 This radiograph was taken while the patient was weight bearing. ...Figure 4.11 (a) A 4.5‐year‐old female spayed Labrador Retriever (33 kg) pres...Figure 4.12 (a) A 2.5‐year‐old male neutered mixed‐breed dog (23 kg) present...Figure 4.13 The arthroscopy image shows the remnants of the graft (white arr...Figure 4.14 (a) Preoperative and (b) 12‐month follow‐up radiographs from a d...Figure 4.15 A 6.5‐year‐old female spayed Labrador presented with an acute no...

5 Chapter 5Figure 5.1 Original case published on the Slocum Enterprises website in Augu...Figure 5.2 Variation of the slope after partial epiphysiodesis in dogs from ...Figure 5.3 Decreasing of the TPA of all dogs after partial epiphysiodesis 30...Figure 5.4 Mediolateral radiographic view of the tibia. Both the tibial and ...Figure 5.5 Partial CCL rupture in the left stifle of a 5.5‐month‐old Maremma...Figure 5.6 Caudocranial radiographic view of the tibia. Mechanical medial pr...Figure 5.7 Femoral avulsion of the origin of the CCL in a 6‐month‐old Labrad...Figure 5.8 Tibial avulsion of the insertion of the CCL in (a) a 5‐month‐old ...Figure 5.9 Complete rupture of the CCL in the right stifle of a 4.5‐month‐ol...Figure 5.10 Femoral avulsion of the caudal cruciate ligament in the left sti...Figure 5.11 A medial femoral condylar osteochondrosis lesion in a 7‐month‐ol...Figure 5.12 Seven‐month‐old Great Dane with avulsion of the origin of the lo...Figure 5.13 (a–d) Intraoperative pictures of an acute femoral avulsion...Figure 5.14 Radiographic views of the case shown in Figure 5.13. (a) Preoper...Figure 5.15 Tibial avulsion of the insertion of the CCL in a 5.5‐month‐old A...Figure 5.16 Insertion of guide wire: a stab incision is made medial or later...Figure 5.17 Correct screw position at the most proximal part of the tibial p...Figure 5.18 The position of the K‐wire is confirmed with fluoroscopy, in bot...Figure 5.19 (a–e) A cancellous screw of a planned length is then inser...Figure 5.20 Cannulated screw used over a guide wire. Predrilling and tapping...Figure 5.21 Insertion of a cannulated screw over a guide wire is performed o...Figure 5.22 (a) Postoperative radiographs (medio‐lateral and caudo‐cranial) ...Figure 5.23 (a) Intraoperative image of a 5‐month‐old Golden Retriever with ...Figure 5.24 (a) Immediate postoperative screw position for PTE. Note the lat...Figure 5.25 Lateral radiographic projection of a 5‐month‐old Golden Retrieve...Figure 5.26 Cranio‐caudal radiographic views measuring the mMPTA of the same...Figure 5.27 A minimal medial offset of a screw (frontal plane) resulted in 8...Figure 5.28 A marked medial offset of a screw (frontal plane) resulted in 9°...Figure 5.29 Moderate lateral offset of a screw (frontal plane) resulted in 8...Figure 5.30 Centrally positioned screw (frontal plane) resulted in no change...Figure 5.31 Right stifle: a malpositioned screw head can result in an insuff...Figure 5.32 Immediate postoperative radiograph showing a screw placed too de...Figure 5.33 An insufficient reduction of a TPA at 3 months postoperatively i...Figure 5.34 PTE performed in a 6‐month‐old Weimaraner resulted in an insuffi...Figure 5.35 PTE performed in a 6‐month‐old Newfoundland. At 6 months postope...Figure 5.36 PTE performed in a 6‐month‐old Labrador Retriever. At 6 months p...Figure 5.37 PTE performed in a 4.5‐month‐old Border Collie. At day 70, the T...Figure 5.38 PTE performed in a 5.5‐month‐old Labrador Retriever with a Salte...Figure 5.39 Excessive TPA necessitated the removal of the screw. A small inc...

6 Chapter 6Figure 6.1 Tensioning device being utilized Intra‐operatively to set a FCBT ...Figure 6.2 Second pair of gloves prepared for overgloving process prior to i...Figure 6.3 Arthrocentesis of a right stifle joint to detect the presence of ...Figure 6.4 (a) Explanted multifilament polyblend polyethylene implant with c...Figure 6.5 Therapeutic right stifle joint lavage in suspected septic arthrit...

7 Chapter 7Figure 7.1 (a) Preoperative lateral radiograph of a 4.3 kg Yorkie with TPA =...Figure 7.2 Bone anchor 3 years post placement in a 4.9 kg patient. (a) Later...Figure 7.3 Isometric points on femur and tibia.Figure 7.4 Femoral bone anchor failure. (a) Lateral view. (b) Caudal‐cranial...Figure 7.5 Path of LES enclosing femoral and tibial isometric points.Figure 7.6 (a) Properly crimped oval crimp tube. (b) Improperly crimped oval...Figure 7.7 LES failure with crimp displacement.

8 Chapter 8Figure 8.1 90° “hockey stick” morphology of the distal femur of a toy‐breed ...Figure 8.2 Lateral stifle anatomy relevant to localization of implantation s...Figure 8.3 TightRope implant placed on the lateral aspect of the stifle in c...Figure 8.4 SwiveLock® implant placed on the lateral aspect of the stifle in ...Figure 8.5 Tensioner with tensiometer suture tensioning device (Arthrex® AR‐...Figure 8.6 SwiveLock® implant placed on the lateral aspect of the stifle in ...Figure 8.7 Rescuing a Knotless SwiveLock® by converting to a Knotted SwiveLo...Figure 8.8 Postsurgical caudo‐cranial radiographic image of a TightRope® con...Figure 8.9 Bone tunnel widening most prominently observed on the lateral asp...Figure 8.10 Note that the angle of the femoral bone tunnel is parallel to th...Figure 8.11 A joint tap should be performed in all patients failing to meet ...Figure 8.12 Bone tunnel widening caused by infection. Note the severe bone t...

9 Chapter 9Figure 9.1 Various CCWO wedge geometries. In all cases, the wedge angle is 3...Figure 9.2 Preoperative planning. An isosceles triangle wedge is templated w...Figure 9.3 The proximal and distal osteotomies meet at a point 1–2 mm crania...Figure 9.4 (a) The position of the proximal osteotomy on the cranial cortex ...Figure 9.5 (a) A 32° wedge is planned in a small dog. The length of the base...Figure 9.6 (a) The osteotomy positions have been scored with the oscillating...Figure 9.7 The optimal appearance of a CCWO wedge. Note the presence of the ...Figure 9.8 (a) The wedge and packing swabs have been removed. Note the intac...Figure 9.9 Postoperative (a) craniocaudal and (b) mediolateral projections s...Figure 9.10 Postoperative (a) craniocaudal and (b) mediolateral projections ...Figure 9.11 (a,b) Postoperative projections reveal a small lateral osteotomy...Figure 9.12 (a) A broad 3.5 mm locking TPLO plate is offered up to the corte...Figure 9.13 (a) Routine symmetrical wedge planning. The wedge is planned 10 ...Figure 9.14 (a) In the context of tibial plateau leveling, sagittal plane an...Figure 9.15 (a) “Rock‐back” following CCWO describes loss of reduction of th...Figure 9.16 Reduced radiopacity at the osteotomy site without loss of reduct...

10 Chapter 10Figure 10.1 (a) Appropriate limb positioning for a radiograph in the mediolat...Figure 10.2 (a) The saphenous neurovascular bundle (black arrow). (b) Identif...Figure 10.3 (a) To mark D1, the caliper is placed with one arm at the insert...Figure 10.4 In this cadaveric image, one can identify the popliteal artery l...Figure 10.5 (a) Identification of the insertion point for rotational pin pla...Figure 10.6 (a) Postoperative TPLO using a six‐hole Synthes locking plate. T...Figure 10.7 (a) Postoperative craniocaudal radiographs in which a screw is no...Figure 10.8 (a) Precontoured plate. Note the direction on the proximal three ...Figure 10.9 (a–c) Immediate postoperative TPLO using a 2.4 locking plat...Figure 10.10 (a) Immediate postoperative craniocaudal radiographs showing a m...Figure 10.11 (a) The skin has been retracted laterally and the fibula is expo...Figure 10.12 (a) Fourteen months post TPLO radiographs following a chronic dr...Figure 10.13 (a) Tibial tuberosity fracture in a small‐breed dog 2 weeks foll...Figure 10.14 Apical patella fracture (yellow arrow) and patellar tendon thic...Figure 10.15 (a,b) Four months post TPLO procedure in a German Shorthaired Po...Figure 10.16 (a,b) Immediate postoperative TPLO radiographs indicating target...Figure 10.17 Mediolateral projection is used for accurate measuring of the t...Figure 10.18 Two weeks postoperative TPLO patient that sustained a fall. A s...Figure 10.19 Mediolateral projection is used for accurate measuring of the t...Figure 10.20 (a,b) Ten‐day postoperative radiographs showing a catastrophic f...Figure 10.21 (a) Postoperative TPLO failure. There is marked caudal displacem...

11 Chapter 11Figure 11.1 A lateral radiograph of the left stifle. Notice how the proximal...Figure 11.2 The same lateral radiograph as in Figure 11.1; the angle formed ...Figure 11.3 A lateral radiograph of the left stifle revealing preoperative p...Figure 11.4 A lateral radiograph of the left stifle following complete osteo...Figure 11.5 The goal of the cranial exit of the osteotomy is that it is tang...Figure 11.6 Impingement of the cranial cortex of the proximal fragment resul...Figure 11.7 Immediate lateral postoperative radiograph following a right CBL...Figure 11.8 Ten‐day postoperative lateral radiograph of a 170 lb dog followi...Figure 11.9 (a) Medial aspect of the tibia of a bone model demonstrating the ...Figure 11.10 (a) Medial aspect of the tibia of a bone model demonstrating lac...Figure 11.11 Preoperative planning radiograph to ensure that plate placement...Figure 11.12 Immediate postoperative lateral radiograph of a 170 lb dog foll...Figure 11.13 Immediate cranio‐caudal postoperative view following revision s...

12 Chapter 12Figure 12.1 Medio‐lateral postoperative radiographs of the (a) original TTA ...Figure 12.2 (a) Screw and (b) fork‐based TTA plates.Figure 12.3 A proximodistal view of the articular surface of the tibia. A cr...Figure 12.4 A distal tibial tuberosity avulsion fracture involving the fork ...Figure 12.5 (a) Mediolateral radiograph of an immediate postoperative stifle....Figure 12.6 Correct TTA implant application principles and osteotomy charact...Figure 12.7 Mediolateral radiograph of a stifle illustrating an ideal tibial...Figure 12.8 Multiple mediolateral stifle radiographs demonstrating the varia...Figure 12.9 Intraoperative view of the proximal medial tibia showing the thi...Figure 12.10 (a) Mediolateral radiograph of a stifle showing proper straight ...Figure 12.11 Mediolateral radiograph of a postoperative stifle revealing fis...Figure 12.12 Mediolateral radiograph of an immediate postoperative stifle il...Figure 12.13 (a) The distal placement of the cage (red arrow) has brought the...Figure 12.14 Mediolateral radiograph of an immediate postoperative stifle il...Figure 12.15 A mediolateral radiograph of a potentially catastrophic complic...Figure 12.16 (a) Mediolateral radiograph of a potentially catastrophic compli...Figure 12.17 (a) Mediolateral radiograph revealing a cranially displaced tibi...Figure 12.18 Mediolateral radiograph of the proximal tibia illustrating the ...Figure 12.19 A proximodistal view of the tibia. (a) The oblique tibial osteo...

13 Chapter 13Figure 13.1 Original design and rationale of the Maquet technique.Figure 13.2 (a) Radiograph of the stifle joint in an appropriate position to ...Figure 13.3 Major effect of stifle extension angle on measurement of desired...Figure 13.4 Illustration of the approximate 20° tilt of the oscillating saw ...Figure 13.5 Successive steps of the modified Maquet technique (MMT). (a) The...Figure 13.6 Illustration of an isthmus (within red ellipse) along the crania...Figure 13.7 (a) Appropriate osteotomy gap healing 8 weeks post surgery. Note...Figure 13.8 (a,b) Medio‐lateral and cranio‐caudal radiographs of a dog in whi...Figure 13.9 (a) Postoperative radiograph of a MMT; note that a fissure can be...Figure 13.10 (a) A fracture of the distal aspect of the osteotomy resulting i...Figure 13.11 Fractures of the tibial shaft following an MMT procedure. Case ...Figure 13.12 This drawing illustrates patella baja expected after applicatio...

14 Chapter 14Figure 14.1 Examples of a custom‐made and an off‐the‐shelf stifle orthosis f...Figure 14.2 Three‐dimensional orthosis motion during a trotting gait. Data w...Figure 14.3 Computer‐simulated relative tibial translation (RTT) (a) and rel...Figure 14.4 Stifle motion (flexion and extension) with and without an orthos...Figure 14.5 Three‐dimensional stifle motion with and without an orthosis at ...Figure 14.6 Pelvic limb joint motion (flexion and extension) with and withou...Figure 14.7 Image of skin lesion caused by an orthosis. Hair loss and skin i...

15 Chapter 15Figure 15.1 Screen capture of a goniometric measurement collected using a ph...Figure 15.2 Screen capture of a video of a dog walking on a pressure‐sensiti...Figure 15.3 The evaluation of stifle joint motion using a goniometer provide...Figure 15.4 The evaluation of muscle mass is usually performed using a tape ...

16 Chapter 16Figure 16.1 Intraoperative view of the stifle of a cat with a cranial crucia...Figure 16.2 (a) A radiograph of a normal feline stifle; arrows indicate the n...Figure 16.3 Lateral stifle radiograph from a MN 7 kg Bengal. The cat had an ...Figure 16.4 Intraarticular mineralization. (a) A small lesion is often a nor...Figure 16.5 Preoperative measurement of tibial plateau angle (TPA) before pe...Figure 16.6 A medial meniscal bucket handle tear in a cat with the torn port...Figure 16.7 (a,b) A 6‐year‐old British Blue cat presented with left cranial c...Figure 16.8 A combined technique of cranial closing wedge osteotomy and extr...Figure 16.9 Different 2.0 mm plates which have been used for TPLO procedure....Figure 16.10 (a) An osteotomy performed for the modified Maquet procedure too...Figure 16.11 (a) Mediolateral and (b) craniocaudal preoperative views of a ca...Figure 16.12 Osteomyelitis after transarticular pin placement. (a) A mediola...Figure 16.13 (a) A transarticular external skeletal fixator (TESF) placed to ...Figure 16.14 Subluxation following surgery for a multiligamentous injury in ...Figure 16.15 Pin tract infection and risk of fracture of the femur in a cat ...

17 Chapter 17Figure 17.1 Recommended positioning for stifle arthroscopy with the patient ...Figure 17.2 A final adhesive antimicrobial incise drape is applied to the su...Figure 17.3 Extravasation is the accumulation of arthroscopic fluid in the l...Figure 17.4 At the start of arthroscopy, the joint capsule is distended, enh...Figure 17.5 The scope and instrument portals can shift in position and may c...Figure 17.6 An egress cannula is the preferred method of egress due to the m...Figure 17.7 Intraoperative hemorrhage obscures the image, making diagnosis a...Figure 17.8 (a) Appropriate placement of the arthroscope, and egress cannula....Figure 17.9 The scope should be positioned to view the top of the intercondy...Figure 17.10 Shaving of the fat pad from proximal to distal is performed unt...Figure 17.11 Cautery of bleeding vessels in the joint can be performed using...Figure 17.12 The egress cannula should be inserted with the stifle positione...Figure 17.13 A flexible fenestrated egress cannula is preferred by some surg...Figure 17.14 (a) Arthroscopic view of the caudal aspect of the medial stifle ...Figure 17.15 A blunt conical obturator is recommended when inserting scope, ...Figure 17.16 Iatrogenic damage to the articular cartilage of the patella (a)Figure 17.17 Iatrogenic cartilage damage occurred in these two patients (a,b...Figure 17.18 Cartilage damage can occur due to instrument manipulation durin...Figure 17.19 Meticulous handling of the arthroscopic instruments combined wi...Figure 17.20 A second lateral instrument portal proximal to the scope portal...Figure 17.21 Leipzig stifle distractor. A negatively threaded pin (3 mm diam...Figure 17.22 A common arthroscopic complication is the inability to identify...Figure 17.23 A partial meniscectomy was performed in this patient with a buc...Figure 17.24 An uncommon but important intraoperative complication is accide...Figure 17.25 The long digital extensor tendon (white arrow) must be avoided ...Figure 17.26 Care should be taken when using the grasper to remove a large m...Figure 17.27 The jaw of this grasper broke during the arthroscopic procedure...Figure 17.28 Diagnosis of early partial tears is greatly enhanced by the mag...Figure 17.29 Arthroscopy allows the surgeon to assess the integrity of the c...Figure 17.30 The remaining intact fibers of the CCL should be probed to dete...Figure 17.31 A partial tear of the craniomedial band of the cranial cruciate...Figure 17.32 Arthroscopy provides an enhanced view of the condition of the a...Figure 17.33 Chronic low‐grade synovitis has been shown to occur commonly fo...

18 Chapter 18Figure 18.1 Caudal view of a dog's stifle joint. The caudal pole of the late...Figure 18.2 The structures associated with the proximal tibia have been expo...Figure 18.3 Illustration of the different medial meniscal tears that can be ...Figure 18.4 A typical meniscal probe. The right‐angled tip helps the surgeon...Figure 18.5 Performance of a craniomedial arthrotomy in a left stifle joint....Figure 18.6 Performance of a craniomedial arthrotomy in a left stifle joint....Figure 18.7 Full craniomedial arthrotomy with the patella luxated laterally....Figure 18.8 Illustration of the caudal aspect of the stifle joint. Note that...Figure 18.9 Cartilage damage (black arrow) created by a Ventura stifle distr...Figure 18.10 When the tip of the stifle distractor is not positioned suffici...Figure 18.11 If the tip of the stifle lever distractor is placed on the tibi...Figure 18.12 The tip of the stifle distractor is placed medial to the caudal...Figure 18.13 A Gelpi retractor has been placed intraarticularly to help dist...Figure 18.14 (a) In this illustration of arthroscopy of a right stifle, the ...Figure 18.15 Leipzig stifle distractor. A negatively threaded pin (3 mm diam...Figure 18.16 Probing the meniscus (via arthrotomy or arthroscopy). Both the ...Figure 18.17 Performance of a caudal meniscotibial desmotomy of the medial m...Figure 18.18 (a) Correct blade position for performance of a midbody meniscal...Figure 18.19 (a) An incomplete midbody medial meniscal release has been perfo...Figure 18.20 Illustration of the proximal aspect of the tibia. Meniscal bloo...Figure 18.21 Simulated partial meniscectomy of a bucket handle tear of the c...Figure 18.22 Arthroscopic view of the medial compartment of the stifle joint...