TTA Komplikationen

Zu den erfassten Hauptkomplikationen gehören vor allem technische Probleme durch den Chirurgen. Die Position des Käfigs und der Osteomieschnittes sind die kritischen Punkte. Zudem haben wir gesehen, dass das korrekte Beurteilen des Meniskus zum Erfolg der Technik beitragen kann. Viele okkulte Meniskusverletzungen wurden übersehen und führten später zu Komplikationen, die eine 2. Chirurgie für die partielle Meniskektomie erforderten.

Weitere Probleme waren: Verletzung der Sehne des M. extensor digitalis longus, Implantatversagen, periartikuläre Infektion, Fraktur der Tuberositas tibiae, Fraktur der Tibia. Die Komplikationsrate liegt jetzt bei ca. 3%.

Quelle:

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TTA Studie von 101 Hunden ( 08.10.2007 ):

Komplikationen traten bei 31,5% auf, 12,3 % schwer und bei 19,3% leicht.

Schwere Komplikationen: Meniskus Riss, Tibia Fraktur, Implantatverlust, Infektion, Leck Granulom, Trauma der Schnittstelle und Kniescheibenluxation.

74,5% zeigten keine Lahmheit, 23,5% leichte Lahmheit, 2% mittelgradige und 1% schwere Lahmheit 13,5 Wochen Post Op.

Quelle

Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs.

Citation:

Vet Surg, United States; Vol 36, No 6 (8/10/2007): pp. 573-86

Affiliation:

Alameda East Veterinary Hospital, Denver, CO, USA.

Authors:

Sarah Lafaver, Nathan A Miller, W Preston Stubbs, Robert A Taylor, Randy J Boudrieau

Die gesamte Studie zur TTA liegt mir vor . Studien werden aber nur zum Spaß gemacht.

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Esvot Kongress in München 2006 Seite 21 und 22

There were 4 cases in which the orientation of the plate was not ideal after advancing (and rotating) the tibial tuberosity forward; this was attributed to a technical error, which after being recognized did not occur subsequently. In one of these cases, a non-displaced fracture line was generated at the distal screw-hole upon attempting to modify the plate and screw position; a Type I ESF was placed across the tibia for the first 6 weeks postoperatively. Short-term postoperative complications included: one case with failure of the fixation at 3 weeks postoperatively (attributed to a technical error of plate placement) that was successfully revised, one dog with a seroma that was drained one time, and one dog that created a lick granuloma over the plate; the plate subsequently was removed, although based upon a later experience with a non-related surgery in this dog it was believed that this was a suture reaction to Polysorb® (US Surgical; Norwalk, CT). Long-term postoperative complications included: subsequent meniscal tears, which required re-operation in 7 cases (24 of the first 40 cases had intact menisci – without meniscal release; subsequently all cases received a medial meniscal release of the caudal meniscal-tibial ligament), two cases with a poor mineralization of the graft site (DMB only) that were not treated further, one case that developed a medial patellar luxation and persistent craniocaudal joint laxity that was corrected with a lateral suture, and one case that has developed an apparent pivot shift that has yet to be addressed. In both of these latter two cases it was believed that insufficient tibial tuberosity advancement was obtained (original series of 40 cases).

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Major post-operative complications were uncommon but consisted of implant failure, tibial crest displacement and medial meniscal tears. The mean radiographic preoperative angle α was 100°, while the postoperative was 95.5°. Mean osteoarthrosis scores were significantly different between preoperative and follow-up radiographs with 67% of cases showing radiographic progression. Seventy percent of owners responded to the survey with overall outcome considered good to excellent in 90%. Activity level was improved in 90% of responses.

Tibial tuberosity advancement in 65 canine stifles

D. E. Hoffmann, J. M. Miller, C. P. Ober, O. I. Lanz, R. A. Martin, P. K. Shires

Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA