{"id":19626,"date":"2026-11-01T18:20:10","date_gmt":"2026-11-01T10:20:10","guid":{"rendered":"https:\/\/fotonmedix.com\/?p=19626"},"modified":"2026-11-01T18:20:10","modified_gmt":"2026-11-01T10:20:10","slug":"overcoming-post-surgical-muscle-fibrosis-in-canines","status":"publish","type":"post","link":"https:\/\/fotonmedix.com\/fr\/overcoming-post-surgical-muscle-fibrosis-in-canines.html","title":{"rendered":"Surmonter la fibrose musculaire postop\u00e9ratoire chez les chiens"},"content":{"rendered":"<p class=\"wp-block-paragraph\">L'administration de classe IV \u00e0 quatre longueurs d'onde p\u00e9n\u00e8tre profond\u00e9ment dans les tissus cicatriciels chirurgicaux denses, stimule la recanalisation vasculaire p\u00e9riarticulaire et g\u00e8re l'accumulation thermique gr\u00e2ce \u00e0 un contr\u00f4le du cycle de service \u00e0 l'\u00e9chelle de la microseconde.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Une chienne Golden Retriever \u00e2g\u00e9e de 4 ans est admise dans le service de r\u00e9\u00e9ducation huit semaines apr\u00e8s avoir subi une ost\u00e9otomie de nivellement du plateau tibial (TPLO). Au lieu d\u2019une extension en charge fluide, le genou reste bloqu\u00e9 \u00e0 un angle d\u2019extension d\u2019\u00e0 peine cent dix degr\u00e9s. La palpation au niveau de l'incision chirurgicale m\u00e9diale r\u00e9v\u00e8le une masse dure, froide et rigide de tissu fibrotique dense ancrant le tendon rotulien directement au tibia proximal. La chienne pr\u00e9sente une boiterie de grade 3 ; le groupe musculaire des quadriceps pr\u00e9sente une atrophie circonf\u00e9rentielle de 25 % par rapport au membre controlat\u00e9ral ; et la kin\u00e9sith\u00e9rapie manuelle provoque une vocalisation intense. Les traitements conservateurs (compresses chaudes, massages et ultrasons th\u00e9rapeutiques) se sont av\u00e9r\u00e9s inefficaces, ce qui inqui\u00e8te le chirurgien traitant quant \u00e0 un risque de contracture articulaire permanente et frustre le propri\u00e9taire de l\u2019animal face \u00e0 l\u2019absence de progr\u00e8s.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Le traitement de la fibrose p\u00e9riarticulaire post-chirurgicale s\u00e9v\u00e8re met en \u00e9vidence les limites physiques des modalit\u00e9s \u00e0 faible \u00e9nergie. Les fibres de collag\u00e8ne de type III, denses et r\u00e9ticul\u00e9es, pr\u00e9sentes au sein du tissu cicatriciel chirurgical mature, constituent une barri\u00e8re de diffusion optique intense qui r\u00e9fl\u00e9chit les photons superficiels. Les appareils \u00e0 faible puissance mettent vingt minutes \u00e0 g\u00e9n\u00e9rer une chaleur superficielle sans fournir d\u2019\u00e9nergie significative \u00e0 la capsule articulaire fibros\u00e9e situ\u00e9e \u00e0 quatre centim\u00e8tres sous la peau. Pour surmonter l\u2019arthrofibrose postop\u00e9ratoire, il est n\u00e9cessaire de passer \u00e0 un laser th\u00e9rapeutique v\u00e9t\u00e9rinaire de classe 4 \u00e0 haute puissance, capable de transmettre une fluence suffisante \u00e0 travers les cicatrices chirurgicales denses jusqu\u2019aux structures articulaires sous-jacentes.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Profils d'att\u00e9nuation tissulaire et synergies multi-longueurs d'onde<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Les photons traversant des tissus post-chirurgicaux subissent une forte att\u00e9nuation. Les faisceaux denses de collag\u00e8ne cicatriciel, les d\u00e9p\u00f4ts localis\u00e9s d\u2019h\u00e9mosid\u00e9rine d\u2019origine chirurgicale et le tissu musculaire hypertonique compensatoire constituent un obstacle optique. Selon les mod\u00e8les standard de diffusion biologique, la lumi\u00e8re perd une partie significative de son intensit\u00e9 par millim\u00e8tre, \u00e0 moins que cette perte ne soit compens\u00e9e dans certaines bandes critiques du proche infrarouge.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pour d\u00e9livrer une densit\u00e9 de photons cibl\u00e9e au niveau des adh\u00e9rences myofasciales profondes, il est n\u00e9cessaire de comprendre les caract\u00e9ristiques d'absorption des chromophores tissulaires :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>R\u00e9sonance de l'h\u00e9moglobine \u00e0 980 nm :<\/strong> Les incisions chirurgicales sectionnent les microcapillaires locaux, laissant derri\u00e8re elles des marges fibrotiques hypoxiques o\u00f9 le sang stagne. La lumi\u00e8re \u00e0 980 nm cible l'h\u00e9moglobine oxyg\u00e9n\u00e9e et d\u00e9soxyg\u00e9n\u00e9e, g\u00e9n\u00e9rant des gradients thermiques contr\u00f4l\u00e9s et localis\u00e9s qui favorisent une perfusion microvasculaire active, soulagent les spasmes musculaires compensatoires et \u00e9liminent les exsudats inflammatoires.<\/li>\n\n\n\n<li><strong>P\u00e9n\u00e9tration profonde dans les tissus fibreux \u00e0 1 064 nm :<\/strong> Gr\u00e2ce \u00e0 une absorption n\u00e9gligeable par la m\u00e9lanine et l'eau, la longueur d'onde de 1 064 nm traverse directement les faisceaux cicatriciels denses. Elle d\u00e9pose l'\u00e9nergie photonique directement dans les tissus conjonctifs p\u00e9riarticulaires profonds afin de stimuler la synth\u00e8se cellulaire d'ad\u00e9nosine triphosphate (ATP) dans les t\u00e9nocytes et les fibroblastes \u00e9puis\u00e9s.<\/li>\n\n\n\n<li><strong>Modulation de l'eau \u00e0 haute affinit\u00e9 \u00e0 1 470 nm :<\/strong> Le tissu fibrotique retient souvent des poches de liquide interstitiel chronique, ce qui augmente la pression tissulaire. La forte absorption de la lumi\u00e8re \u00e0 1 470 nm par l'eau contribue \u00e0 mobiliser le liquide stagnant, \u00e0 assouplir les bandes de collag\u00e8ne rigides et \u00e0 am\u00e9liorer l'\u00e9lasticit\u00e9 des tissus.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">C'est pr\u00e9cis\u00e9ment pour obtenir rapidement ces effets physiologiques que les cliniques font appel aux meilleurs \u00e9quipements de th\u00e9rapie laser v\u00e9t\u00e9rinaire pour la r\u00e9\u00e9ducation. Au lieu de passer trente minutes \u00e0 maintenir une sonde fixe de faible puissance, qui n'apporte qu'un b\u00e9n\u00e9fice minime au patient, les cliniciens peuvent utiliser un syst\u00e8me \u00e0 haute puissance pour traiter le genou, le quadriceps et les ischio-jambiers en moins de dix minutes, brisant ainsi le cycle de la contracture articulaire postop\u00e9ratoire.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"395\" height=\"373\" src=\"https:\/\/fotonmedix.com\/wp-content\/uploads\/2026\/10\/pasted-image-20261012-031712-602.jpg\" alt=\"Th\u00e9rapie au laser pour chiens (5)\" class=\"wp-image-19630\" srcset=\"https:\/\/fotonmedix.com\/wp-content\/uploads\/2026\/10\/pasted-image-20261012-031712-602.jpg 395w, https:\/\/fotonmedix.com\/wp-content\/uploads\/2026\/10\/pasted-image-20261012-031712-602-300x283.jpg 300w, https:\/\/fotonmedix.com\/wp-content\/uploads\/2026\/10\/pasted-image-20261012-031712-602-13x12.jpg 13w\" sizes=\"auto, (max-width: 395px) 100vw, 395px\" \/><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9vention de la surchauffe \u00e9pidermique gr\u00e2ce au contr\u00f4le du cycle de service<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">L'application d'une puissance th\u00e9rapeutique \u00e9lev\u00e9e sur une peau cicatris\u00e9e ou ras\u00e9e comporte des risques cliniques si l'\u00e9nergie thermique n'est pas correctement g\u00e9r\u00e9e. Les cicatrices chirurgicales pr\u00e9sentent souvent une sensibilit\u00e9 r\u00e9duite en raison de la section des terminaisons nerveuses cutan\u00e9es, ce qui signifie que le patient ne peut pas signaler de mani\u00e8re fiable lorsque les temp\u00e9ratures de surface deviennent excessives. Une lumi\u00e8re \u00e0 haute puissance en onde continue dirig\u00e9e sur des plaques ou des vis chirurgicales peut \u00e9galement faire augmenter la temp\u00e9rature p\u00e9riost\u00e9e.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La modulation du rapport cyclique de l'impulsion permet de r\u00e9soudre ce probl\u00e8me technique :<\/p>\n\n\n\n<pre class=\"wp-block-code\"><code>Onde continue : [================ Accumulation thermique cumulative ================] -&gt; Risque de point chaud au niveau de l'\u00e9piderme\nImpulsions \u00e0 50 % de duty cycle : [== Impulsion activ\u00e9e ==] [Relaxation thermique] [== Impulsion activ\u00e9e ==] -&gt; Saturation de la cible profonde\n<\/code><\/pre>\n\n\n\n<p class=\"wp-block-paragraph\">Pendant la phase active de l'impulsion, une puissance de cr\u00eate \u00e9lev\u00e9e propulse les photons en profondeur dans la capsule articulaire et le tissu cicatriciel environnant. Pendant la phase sombre, la circulation sanguine capillaire dans la peau dissipe la chaleur en surface. Comme l'articulation fibros\u00e9e en profondeur dissipe la chaleur plus lentement que le derme vascularis\u00e9, l'\u00e9nergie th\u00e9rapeutique s'accumule au niveau de la zone cible sans provoquer de br\u00fblures cutan\u00e9es.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C'est gr\u00e2ce \u00e0 cette approche contr\u00f4l\u00e9e que ces plateformes comptent parmi les appareils de th\u00e9rapie laser v\u00e9t\u00e9rinaire les plus utilis\u00e9s dans les centres modernes de chirurgie et de r\u00e9\u00e9ducation. Les praticiens peuvent passer en toute s\u00e9curit\u00e9 des fr\u00e9quences de d\u00e9sensibilisation rapide \u00e0 des fr\u00e9quences plus basses destin\u00e9es au remodelage structurel, garantissant ainsi le confort du patient tout au long de la s\u00e9ance.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Protocole clinique et r\u00e9cup\u00e9ration de l'amplitude articulaire<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Selon les principes de remodelage du tissu conjonctif d\u00e9crits par Curcio et valid\u00e9s dans le cadre d\u2019\u00e9tudes v\u00e9t\u00e9rinaires sur la r\u00e9\u00e9ducation orthop\u00e9dique men\u00e9es par l\u2019American College of Veterinary Surgeons, la phototh\u00e9rapie au proche infrarouge favorise la d\u00e9gradation enzymatique du tissu cicatriciel d\u00e9sorganis\u00e9 tout en stimulant, parall\u00e8lement, la fibrillogen\u00e8se du collag\u00e8ne. La r\u00e9duction des cytokines pro-fibrotiques qui en r\u00e9sulte, telles que le facteur de croissance transformant b\u00eata 1, permet le r\u00e9tablissement d'une mobilit\u00e9 m\u00e9canique normale.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Le cas clinique suivant illustre l'application de ce protocole \u00e0 longueurs d'onde multiples chez un chien ayant subi une intervention chirurgicale et souffrant d'une contracture grave du genou.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Dossier clinique : arthrofibrose et contracture du quadriceps post-TPLO<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>R\u00e9f\u00e9rence du dossier :<\/strong> REHAB-2026-CANINE-0914<\/li>\n\n\n\n<li><strong>Profil du patient :<\/strong> Golden retriever femelle st\u00e9rilis\u00e9e, \u00e2g\u00e9e de 4 ans<\/li>\n\n\n\n<li><strong>Masse corporelle :<\/strong> 31,2 kg<\/li>\n\n\n\n<li><strong>Diagnostic :<\/strong> Arthrofibrose post-chirurgicale et adh\u00e9rences p\u00e9ri-incisionnelles s\u00e9v\u00e8res au niveau du genou gauche \u00e0 la suite d\u2019une intervention de type TPLO ; extension articulaire limit\u00e9e \u00e0 110 degr\u00e9s (extension normale du c\u00f4t\u00e9 controlat\u00e9ral : 165 degr\u00e9s) ; boiterie de grade 3 ; atrophie du quadriceps gauche de 4,2 cm de circonf\u00e9rence par rapport au membre controlat\u00e9ral<\/li>\n\n\n\n<li><strong>Traitement conservateur ant\u00e9rieur :<\/strong> Meloxicam par voie orale \u00e0 raison de 0,1 mg\/kg une fois par jour pendant quatre semaines, compresses chaudes et exercices passifs de mobilisation articulaire ; progr\u00e8s minimes et douleur intense lors d'une flexion passive sup\u00e9rieure \u00e0 90 degr\u00e9s<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Param\u00e8tres du protocole de traitement complet<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Num\u00e9ro de session<\/strong><\/td><td><strong>Objectif de r\u00e9\u00e9ducation<\/strong><\/td><td><strong>Puissance de sortie (W)<\/strong><\/td><td><strong>Mode de fonctionnement et rapport cyclique<\/strong><\/td><td><strong>Distribution spectrale cibl\u00e9e<\/strong><\/td><td><strong>Fr\u00e9quence (Hz)<\/strong><\/td><td><strong>\u00c9nergie totale (Joules)<\/strong><\/td><td><strong>Fluence (J\/cm\u00b2)<\/strong><\/td><\/tr><\/thead><tbody><tr><td>01<\/td><td>D\u00e9sensibilisation des tissus cicatriciels<\/td><td>10,0 W<\/td><td>En mode puls\u00e9 (rapport cyclique 40%)<\/td><td>M\u00e9lange \u00e9quilibr\u00e9 980 nm \/ 1064 nm<\/td><td>3 000 Hz<\/td><td>3,000 J<\/td><td>7,5 J\/cm\u00b2<\/td><\/tr><tr><td>02<\/td><td>D\u00e9congestion capillaire<\/td><td>12,0 W<\/td><td>En mode puls\u00e9 (rapport cyclique 45%)<\/td><td>Haute r\u00e9solution \u00e0 980 nm \/ Focalisation par perfusion<\/td><td>1 500 Hz<\/td><td>4,200 J<\/td><td>10,5 J\/cm\u00b2<\/td><\/tr><tr><td>03<\/td><td>Mobilisation du liquide interstitiel<\/td><td>15,0 W<\/td><td>Impulsionnel (cycle de service 50%)<\/td><td>Haute fr\u00e9quence 1 470 nm \/ Focalisation sur l'eau<\/td><td>800 Hz<\/td><td>5,400 J<\/td><td>13,5 J\/cm\u00b2<\/td><\/tr><tr><td>04<\/td><td>Rupture profonde de l'adh\u00e9rence<\/td><td>18,0 W<\/td><td>Superpuls\u00e9 (cycle de service 50%)<\/td><td>P\u00e9n\u00e9tration dominante (1 064 nm)<\/td><td>400 Hz<\/td><td>6,500 J<\/td><td>16,2 J\/cm\u00b2<\/td><\/tr><tr><td>05<\/td><td>Ramollissement de la matrice extracellulaire<\/td><td>20,0 W<\/td><td>Impulsionnel (cycle de service 50%)<\/td><td>R\u00e9seau \u00e9quilibr\u00e9 \u00e0 quatre longueurs d'onde<\/td><td>200 Hz<\/td><td>7,200 J<\/td><td>18,0 J\/cm\u00b2<\/td><\/tr><tr><td>06<\/td><td>R\u00e9organisation des fibrilles de collag\u00e8ne<\/td><td>22,0 W<\/td><td>Impulsionnel (cycle de service 50%)<\/td><td>M\u00e9lange pour remodelage structurel en profondeur<\/td><td>100 Hz<\/td><td>7 800 J<\/td><td>19,5 J\/cm\u00b2<\/td><\/tr><tr><td>07<\/td><td>Mobilisation fonctionnelle des articulations<\/td><td>20,0 W<\/td><td>Balayage dynamique continu<\/td><td>M\u00e9lange r\u00e9g\u00e9n\u00e9rant multispectral<\/td><td>CW \/ Dynamique<\/td><td>6,000 J<\/td><td>15,0 J\/cm\u00b2<\/td><\/tr><tr><td>08<\/td><td>Consolidation cin\u00e9tique active<\/td><td>16,0 W<\/td><td>Impulsionnel (cycle de service 50%)<\/td><td>Profil d'entretien mixte<\/td><td>30 Hz<\/td><td>4 800 J<\/td><td>12,0 J\/cm\u00b2<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Freiner l'extension de l'articulation et la r\u00e9cup\u00e9ration de la masse musculaire<\/h3>\n\n\n\n<pre class=\"wp-block-code\"><code>Extension passive du genou (degr\u00e9s) :\nAvant le traitement : [============================] 110\u00b0\nS\u00e9ance 03 :    [=================================] 130\u00b0\nS\u00e9ance 06 :    [======================================] 152\u00b0\nS\u00e9ance 08 :    [=========================================] 163\u00b0 (r\u00e9f\u00e9rence controlat\u00e9rale : 165\u00b0)\n\nDiff\u00e9rence de circonf\u00e9rence de la cuisse (d\u00e9ficit en cm par rapport au membre droit sain) :\nAvant traitement : [================] -4,2 cm\nS\u00e9ance 03 :    [============] -3,1 cm\nS\u00e9ance 06 :    [=====] -1,4 cm\nS\u00e9ance 08 :    [] -0,3 cm\n<\/code><\/pre>\n\n\n\n<p class=\"wp-block-paragraph\">D\u00e8s la troisi\u00e8me s\u00e9ance, la cicatrice chirurgicale s'\u00e9tait adoucie et le patient tol\u00e9rait une l\u00e9g\u00e8re flexion passive sans g\u00e9mir. \u00c0 la sixi\u00e8me s\u00e9ance, l'extension du genou atteignait cent cinquante-deux degr\u00e9s, ce qui a permis au chien de participer \u00e0 des s\u00e9ances actives sur tapis roulant sous l'eau. \u00c0 l\u2019issue des huit s\u00e9ances, le membre a atteint une extension de cent soixante-trois degr\u00e9s, la circonf\u00e9rence musculaire s\u2019est normalis\u00e9e et le traitement au m\u00e9loxicam a \u00e9t\u00e9 arr\u00eat\u00e9.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Avantages par rapport aux m\u00e9thodes de r\u00e9\u00e9ducation traditionnelles<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Les complications postop\u00e9ratoires, telles que les contractures articulaires, sont souvent source de tensions entre les propri\u00e9taires d'animaux, les v\u00e9t\u00e9rinaires g\u00e9n\u00e9ralistes et les chirurgiens orthop\u00e9distes. Une intervention de r\u00e9vision visant \u00e0 r\u00e9s\u00e9quer le tissu cicatriciel entra\u00eene un traumatisme suppl\u00e9mentaire, comporte un risque de contamination de l'implant et conduit fr\u00e9quemment \u00e0 une fibrose plus agressive. Se fier uniquement \u00e0 la th\u00e9rapie manuelle peut \u00eatre douloureux pour l'animal, fatigant pour le personnel et lent \u00e0 produire des r\u00e9sultats.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La phototh\u00e9rapie \u00e0 haute puissance offre des avantages cliniques ind\u00e9niables :<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">1. Ramollissement rapide des tissus avant le travail manuel<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">La th\u00e9rapie manuelle appliqu\u00e9e sur des tissus froids et fibrotiques peut d\u00e9chirer des fibres de collag\u00e8ne microscopiques, provoquant une inflammation aigu\u00eb et une contraction d\u00e9fensive des muscles. L'application d'une \u00e9nergie photonique \u00e0 haute intensit\u00e9 assouplit imm\u00e9diatement les adh\u00e9rences denses, d\u00e9tend les groupes musculaires environnants et permet aux th\u00e9rapeutes d'effectuer des exercices passifs d'amplitude articulaire sans rencontrer de r\u00e9sistance.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2. Des s\u00e9ances de traitement plus courtes et un nombre plus \u00e9lev\u00e9 de patients<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Les appareils \u00e0 faible puissance n\u00e9cessitent des dur\u00e9es d'application prolong\u00e9es, ce qui est source de stress pour les animaux en convalescence et mobilise le personnel de r\u00e9\u00e9ducation. Les syst\u00e8mes \u00e0 haute puissance administrent les doses th\u00e9rapeutiques en six \u00e0 huit minutes d'application continue et confortable par balayage, ce qui permet de maintenir l'efficacit\u00e9 des flux de travail au sein de la clinique et de r\u00e9duire le stress des patients canins.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">3. Des \u00e9tapes fonctionnelles claires qui renforcent la confiance des clients<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Les clients suivent des indicateurs concrets de r\u00e9tablissement : leur chien parvient-il \u00e0 se tenir debout sans difficult\u00e9, \u00e0 monter des marches ou \u00e0 jouer sans boiter ? Le fait d'observer des progr\u00e8s notables en mati\u00e8re de mobilit\u00e9 d\u00e8s les trois premi\u00e8res s\u00e9ances apporte aux propri\u00e9taires d'animaux une preuve imm\u00e9diate de r\u00e9tablissement, ce qui renforce leur engagement envers l'ensemble du programme de r\u00e9\u00e9ducation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La technologie de classe IV \u00e0 haute puissance constitue un outil indispensable pour les \u00e9quipes de r\u00e9\u00e9ducation v\u00e9t\u00e9rinaire. En projetant une densit\u00e9 de photons th\u00e9rapeutique au-del\u00e0 des cicatrices chirurgicales denses et directement dans les capsules articulaires raides, les praticiens peuvent r\u00e9soudre les complications postop\u00e9ratoires tenaces et aider les patients canins \u00e0 retrouver une vie active et sans douleur.<\/p>","protected":false},"excerpt":{"rendered":"<p>Quad-wavelength Class IV delivery penetrates deep dense surgical scar tissue, stimulates peri-articular vascular recanalization, and manages thermal accumulation via microsecond duty cycle control. A 4-year-old female Golden Retriever enters the rehabilitation ward eight weeks following a tibial plateau leveling osteotomy (TPLO). 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