CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO •...
Transcript of CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO •...
![Page 1: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/1.jpg)
CBLO:anotherosteotomyprocedureinthetreatmentofCCL
ruptureJarmoRintasalo,DVM
![Page 2: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/2.jpg)
CORAprinciple
• CoraBasedLevelingOsteotomy• CenterofRotationofAngulation• Methodtoanalyzeanddiagnosemalalignmentinlongbonesandplanfortheircorrectionbyosteotomy
![Page 3: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/3.jpg)
![Page 4: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/4.jpg)
Whyanotherosteotomy?
• Manygoodtechniques– TPLO– TTA– TightRope– Lateralsuture– Intra-articulargraft+augmentation
• Notechniqueisperfect
![Page 5: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/5.jpg)
Problemsw.currenttechniques
• Continuedlaxity– 30%ofTPLO– 70%ofTTA
• Latemeniscaltears• Arthrosis• Implantproblems• Infections• Tumors
![Page 6: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/6.jpg)
RationaleforCBLO
• AlterationoftibialaxiswithanosteotomyshouldoccurattheCORAtominimizeharmfuleffectsonjointmechanics
• Tibiahasnormallyproximalprocurvatum,whichcausesTPAtobe23-25degrees
• CBLOstraightensproximaltibialeaving8-12°ofpostoperativeTPA
![Page 7: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/7.jpg)
RationaleforCBLO
• TPLOcorrectsTPAto5-6degrees,whichmaybetoomuch– cartilagewear– upto14°isok
• TTAeffect(advancement)– tibialplateauat90°topatellatendon
![Page 8: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/8.jpg)
AdvantagesofCBLO
• Morebonestockproximally,helpfulespeciallyinsmallbreeddogs
• Mechanicalaxiswillbeinsidethebone,notcaudaltoit,nobalconyeffect
• Extra-articularosteotomy• Auxiliaryfixationpossible(derangedstifle)• Patellaluxationcorrectionwithtibialtuberositytranspositionpossible
![Page 9: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/9.jpg)
![Page 10: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/10.jpg)
AdvantagesofCBLO
• Facilitateslevelinginadolescentpatientsavoidingopengrowthplates
• FacilitatesprocedureindogswithTPA>34°• DoublecutinextremeTPAslopes• Facilitatescorrectionincaseswithcompromisedtibialcrest
![Page 11: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/11.jpg)
PlanningStartbymeasuringTPA
![Page 12: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/12.jpg)
PlanningJointorientationline
![Page 13: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/13.jpg)
PlanningJointorientationlineProximalmetaphyseallineCranialslopeofintercondylareminencedistallyat0,35xTPA,normally8-12° 81°
![Page 14: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/14.jpg)
PlanningJointorientationlineProximalmetaphyseallineProximaldiaphyseallineCenterofmedullarycavityatdistalendofcristatibaetotuberofGerdy
CORAlocationandmagnitude
CORA
MagnitudeofCORA
![Page 15: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/15.jpg)
PlanningJointorientationlineProximalmetaphyseallineProximaldiaphyseallineBisectingline
AllpointsonthislinerepresenttheCORA
![Page 16: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/16.jpg)
PlanningJointorientationlineProximalmetaphyseallineProximaldiaphyseallineBisectinglineSawbladesizeandorientation
perpendiculartocaudalcortexmeetscranialcortexcenteredonbisectingline
![Page 17: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/17.jpg)
PlanningJointorientationlineProximalmetaphyseallineProximaldiaphyseallineBisectinglineSawbladesizeandorientationAmountoftransferfromchartorcalculation
2πr=360
D1D2
![Page 18: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/18.jpg)
Stabilization
• CBLOplate,lockingscrews– VOI,Fixin
• TPLOplate• T-plate• Additionalfixationtocounteractquadriceps– Compressionscrew– Pin&wire
![Page 19: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/19.jpg)
![Page 20: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/20.jpg)
Pitfalls
• Rotationtendstocreatevalgusdeformity– Directionofsawcutimportant
• Fibulamayinterferewithrotation– Fibularbending
• Needforfixationagainstquadricepspull– Headlesscompressionscrew– Pin+wire
![Page 21: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/21.jpg)
![Page 22: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/22.jpg)
![Page 23: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/23.jpg)
![Page 24: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/24.jpg)
![Page 25: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/25.jpg)
Wiiwi,lab6months
![Page 26: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/26.jpg)
Wiiwi13months
![Page 27: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/27.jpg)
Sulo,whippet
• Avulsionofaclfromfemur• DistalcutaroundCORA
avoidingproximalgrowthplate
• FixationwithVIprototypelockingplate
![Page 28: CBLO: another osteotomy procedure in the treatment of CCL ... Jarmo.pdf · Advantages of CBLO • More bone stock proximally, helpful especially in small breed dogs • Mechanical](https://reader034.fdocuments.us/reader034/viewer/2022042102/5e7f4c81d579e670ed7d68b0/html5/thumbnails/28.jpg)
Sulo6/10weekspostop