DIAG IM3 - Page 198

15Joint 5 Dental Surgery Equipment & Instrumentation Tibial Plateau Levelling Osteotomy - Standard www.vetinst.com Tibial Plateau Levelling by Radial Osteotomy Slocum Tibial Plateau Levelling Osteotomy (TPLO) was originally developed by Barclay Slocum in the 1980s. Slocum realised that given the standing angle of the dog’s knee, the cranial cruciate ligament deficient stifle had a tendency to subluxate cranially because of the opposing forces generated between the tibial plateau and the femoral condyles. He speculated that making a corrective osteotomy and changing (flattening) the tibial plateau angle should neutralise cranial tibial thrust and therefore the instability resulting from cranial cruciate ligament rupture. The osteotomy was originally designed as a wedge ostectomy, which still exists as a separate procedure for cranial cruciate ligament rupture and has its own advantages and disadvantages; see other section on CWO-TPLO on page 178. The wedge ostectomy then evolved into the curved / cresenteric osteotomy that differs by separating the tibial plateau from both the tibial metaphysis and the tibial tuberosity. A radial saw blade with a TPLO specific oscillating saw is used that makes the crescentic osteotomy (see page 222 for saws and blades). Once the tibial osteotomy is made, it is rotated by a calculated amount by inserting a rotation pin (tables are available to determine the correct amount of rotation for each blade size, see page 221.The aim is to achieve a Tibial Plateau Angle (TPA) of 5 to 7 degrees. Once rotated, the tibial plateau segment is temporarily held in position by a single K-wire, or fracture reduction forceps. Then the plate and screws are applied for definitive stabilisation. Slocum Style Plates Slocum style TPLO plates. Not pre-contoured. Plate profiles on page 375. SLOCUM STYLE TPLO PLATES TPLOS35BL TPLO Plate Broad Slocum Style 3.5mm Left TPLOS35BR TPLO Plate Broad Slocum Style 3.5mm Right TPLOS35L TPLO Plate Slocum Style 3.5mm Left TPLOS35R TPLO Plate Slocum Style 3.5mm Right TPLOS27BL TPLO Plate Broad Slocum Style 2.7mm Left TPLOS27BR TPLO Plate Broad Slocum Style 2.7mm Right TPLOS27L TPLO Plate Slocum Style 2.7mm Left TPLOS27R TPLO Plate Slocum Style 2.7mm Right TPLOS24L TPLO Plate Slocum Style 2.4mm Left TPLOS24R TPLO Plate Slocum Style 2.4mm Right TPLOS20L TPLO Plate Slocum Style 2.0mm Left TPLOS20R TPLO Plate Slocum Style 2.0mm Right BRTPLO TPLO Radial Cut Step by Step Guide TPLO was originally developed with many claims, including complete return of function, re-gaining full muscle mass, and the halting of progression of degenerative joint disease. Nowadays it is accepted that whilst TPLO does not achieve all these goals as it does not restore completely normal stifle biomechanics, it is arguably the best surgical procedure available for addressing the cranial cruciate ligament deficient stifle. For this reason, it is very popular amongst specialist surgeons, and evidence is starting to emerge that it offers the best outcome compared to other surgical techniques, including other osteotomies, to address cranial cruciate ligament rupture such as TTA or extra-capsular stabilisation. £77.25 £77.25 £77.25 £77.25 £77.25 £77.25 £56.65 £56.65 £56.65 £56.65 £56.65 £56.65 £FOC Pre-Contoured Slocum Style TPLO plates Pre-contoured version of the standard 3.5mm Slocum Style plate. Prebent and polished to leave no stress riser. May need a final intra-operative tweak in some cases. The original TPLO surgical technique was very specific, and surgeons all followed a very similar protocol. With the passage of time, surgeons have evolved individual variations on the original technique. For example, use of a jig is no longer universal, many surgeons have adopted a minimal soft tissue elevation technique as compared to the original extensive soft tissue elevation and packing technique, and stabilisation of the rotated tibial plateau can be achieved using pointed fracture