Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints

2008 ◽  
Vol 21 (03) ◽  
pp. 250-255 ◽  
Author(s):  
C. Burns ◽  
R. Boudrieau
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Osteotomy Site ◽  
Bone Block ◽  
Common Tangent ◽  
Cranial Cruciate Ligament ◽  
Limb Position ◽  
Technical Errors ◽  
Similar Triangles

Summary Objective: To describe a modification of the tibial tuberosity advancement (TTA) procedure that required tuberosity advancement in excess of 12 mm for the stabilization of cranial cruciate ligament (CrCL) deficient stifle joints. Methods: Four large breed dogs with CrCL deficient stifle joints (one bilateral) underwent a modified TTA of 15 or 16 mm in order to obtain a patellar tendon angle of 90° to the tibial plateau slope or common tangent between femur and tibia in the extended limb position. The desired TTA was achieved by displacing a 12-mm cage distally; this displacement distance was calculated from two similar triangles formed within the planned osteotomy site. An allogenous cancellous bone block placed proximal to the cage provided buttress support; a corticocancellous allograft filled the remainder of the gap. Tibial tuberosity fixation was performed as previously described. Results: Healing of the osteotomy defects with incorporation of the cancellous block was observed at a mean of 8.6 weeks postoperatively. Normal return of limb function was reported in all of the dogs except for one dog that underwent revision surgery four months postoperatively for a continued lameness. Technical errors at the time of the original surgical procedure in this dog resulted in insufficient tuberosity advancement; additional advancement was performed, which resolved the lameness. Clinical significance: Results in this series suggest that our modification of the TTA, in order to advance the tuberosity in excess of 12 mm, could be successfully obtained using the currently available implants.

Conformation of the proximal tibia and cranial cruciate ligament disease in small breed dogs

2017 ◽  
Vol 30 (03) ◽  
pp. 178-183 ◽  
Author(s):  
Michal Kyllar ◽  
Duncan Midgley ◽  
Martin Owen ◽  
Jan Janovec
Keyword(s):  
Body Weight ◽  
Clinical Significance ◽  
Tibial Plateau ◽  
Proximal Tibia ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Relative Body Weight ◽  
Cranial Cruciate Ligament Disease ◽  
Small Breed

SummaryObjectives: To investigate the conformation of the proximal tibia in small breed dogs with and without cranial cruciate ligament disease (CCLD) and to identify morphologic abnormalities that may predispose to development of CCLD.Methods: Mediolateral radiographs of the entire tibia of dogs <15 kg with surgically confirmed CCLD were retrospectively evaluated. Proximal tibial width (PTW), tibial plateau length (TPL), tibial plateau angle as described by Slocum and Slocum (sTPA), proximal tibial tuberosity angle (PTTA), tibial plateau angle as described by Inauen and colleagues (nTPA), and diaphyseal tibial width (DTW) were measured. The same variables were obtained from mediolateral radiographs of the entire tibia of dogs <15 kg without CCLD. In addition, a quotient nTPA/ PTW, relative tibial tuberosity width (rTTW), and relative body weight (rBW) were calculated for each dog. Independent two-sample t-test (p = 0.05) was used to compare mean ± SD of all measured variables between the two groups.Results: Gender, age, and weight mean ± SD were not significantly different between the two groups of dogs (p <0.05). Dogs with CCLD had significantly greater sTPA (p = 0.015) and rBW (p = 0.016).Clinical significance: In dogs of small breeds, a combination of an excessively steep tibial plateau and an increased relative body weight may predispose to early CCLD development. The slope of the tibial plateau was found to be caused by an abnormal caudal angulation of the proximal tibia, a phenomenon previously associated with CCLD development in small breed dogs in individual cases.

scholarly journals Use of castor bean polymer in developing a new technique for tibial tuberosity advancement for cranial cruciate ligament rupture correction in dogs

2016 ◽  
Vol 61 (No. 7) ◽  
pp. 382-388 ◽  
Author(s):  
RM Medeiros ◽  
MAM Silva ◽  
PPM Teixeira ◽  
LGGG Dias ◽  
DG Chung ◽  
...  
Keyword(s):  
Ricinus Communis ◽  
Cruciate Ligament ◽  
The Body ◽  
Tibial Tuberosity ◽  
Osteotomy Site ◽  
Cranial Cruciate Ligament ◽  
Time Points ◽  
Metallic Implants ◽  
A New Technique ◽  
Distal Fixation

The purpose of the current study was to develop a new tibial tuberosity advancement (TTA) technique, by replacing the original titanium cage with a Ricinus communis polyurethane resin-made wedge polymer. The implants were manufactured using the same size and angles of the original titanium cages, though larger distally. The modified TTA technique (TTAm) was performed in 42 knees of 35 dogs diagnosed with rupture of the cranial cruciate ligament (RCCL). Animals were submitted to radiographic and gait assessments preoperatively, early postoperatively and following 30, 60, 90 and 120 days. All animals exhibited good clinical outcome. There were no cases of impaired healing or bone resorption until 120 days postoperatively and there was no patient with patellar distress after TTAm. Scores of gait evaluation revealed differences between time points. There were also differences between the evaluations of control and pre- and post-operative times. However, there was no difference among the assessment of 30 days and the following time points. The use of the polyurethane polymer for TTAm was advantageous, not only due to biocompatibility and osseointegration, but also for providing easy handling; it can be moulded intra-operatively if necessary. Moreover, it allows precise adaptation to the osteotomy site, as opposed to the original TTA metallic implants, which cannot be moulded. It is suggested that incision lengths for TTAm are slightly shorter than those required for the conventional TTA as this requires the distal fixation of the plate at the beginning of the middle third of the body of the tibia. The TTAm does not require the use of fixation plates and it is performed only at the cranial aspect of the tibia. The method of attachment of the tibial tuberosity in the craniocaudal direction was effective. The setting associated with the use of the polyurethane polymer allowed simplification of the technique for easier implementation, and the amount of implant material required to perform TTAm was reduced in comparison to the conventional TTA. This technique can be used for treating the knees of dogs with RCCL, and provides for easy execution, less invasiveness to the tissues of the knee joint and more versatility in comparison to conventional TTA.

scholarly journals Radiographic assessment of the proximal tibial angles in dogs and cats with and without cranial cruciate ligament rupture

2018 ◽  
Vol 38 (6) ◽  
pp. 1190-1195 ◽  
Author(s):  
Ana Flávia D.P. Arruda ◽  
Leonardo A.L. Muzzi ◽  
Antonio C.C. Lacreta Junior ◽  
Ruthnéa A.L. Muzzi ◽  
Gabriela R. Sampaio ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Patellar Ligament ◽  
Common Tangent ◽  
Cranial Cruciate Ligament ◽  
Mean Values ◽  
Stifle Joint ◽  
Significant Difference ◽  
Tangent Method ◽  
Healthy Dogs

ABSTRACT: The influence of the proximal tibial angles in the cranial cruciate ligament (CCL) rupture in dogs is still controversial, and little is known regarding this topic in cats. The aim of this study was to evaluate and compare the angles of the proximal portion of the tibia in dogs and cats with and without CCL rupture. Retrospective and prospective radiographs of the stifle joints were obtained and divided into four groups. Group 1 was composed of 70 stifle joint images of dogs without orthopedic disorders (healthy dogs), group 2 had 70 stifle joint images of dogs with CCL rupture, group 3 had 50 stifle joint images of cats without orthopedic disorders (healthy cats) and group 4 had 25 stifle joint images of cats with CCL rupture. Radiographs were taken with the stifle joint in the mediolateral projection, positioned at the angle of hind limb support. Between the two groups of dogs evaluated, the dogs with CCL rupture had statistically greater tibial plateau angle (TPA) compared with healthy dogs. No difference was shown in relation to the TPA between healthy cats and cats with CCL rupture. In relation to the patellar ligament angle by tibial plateau method the values for the healthy dogs were significantly higher than those for the CCL ruptured dogs. Similarly, healthy cats had significantly higher mean values than cats with CCL rupture. In the patellar ligament angle by common tangent method there was no significantly difference between the two groups of dogs. Between the two groups of cats, animals with CCL rupture had statistically higher mean values than healthy cats. In general, the groups of dogs showed higher mean values than the groups of cats. For the patellar ligament insertion angle (PLIA) healthy dogs showed a significantly higher mean than dogs with CCL rupture. There was no significant difference between the groups of cats. In conclusion, the TPA and the PLIA possibly influence the etiology of CCL rupture in dogs but not in cats. The low patellar ligament angle measured by common tangent method may favorably influence the reduced incidence of CCL rupture in cats.

Complications of tibial plateau levelling osteotomy in dogs

2012 ◽  
Vol 25 (05) ◽  
pp. 349-358 ◽  
Author(s):  
B. Peirone ◽  
M. S. Bergh
Keyword(s):  
Risk Factors ◽  
Surgical Procedures ◽  
Tibial Plateau ◽  
Postoperative Morbidity ◽  
Cruciate Ligament ◽  
Cranial Cruciate Ligament ◽  
Technical Errors ◽  
Surgeon Experience ◽  
Incidence Risk ◽  
Cranial Cruciate Ligament Disease

SummaryThe tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intraoperative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.

Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture

2011 ◽  
Vol 24 (01) ◽  
pp. 27-31 ◽  
Author(s):  
J. Mills ◽  
V. Busoni ◽  
L. Brunel ◽  
M. Balligand ◽  
S. Etchepareborde
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Direction Parallel ◽  
Cage Size ◽  
Osteotomy Plane ◽  
The Difference ◽  
Clinically Significant ◽  
Cranial Cruciate Ligament Rupture

Summary Objectives: To calculate the difference between the desired tibial tuberosity advancement (TTA) along the tibial plateau axis and the advancement truly achieved in that direction when cage size has been determined using the method of Montavon and colleagues. To measure the effect of this difference on the final patellar tendon-tibial plateau angle (PTA) in relation to the ideal 90°. Methods: Trigonometry was used to calculate the theoretical actual advancement of the tibial tuberosity in a direction parallel to the tibial plateau that would be achieved by the placement of a cage at the level of the tibial tuberosity in the osteotomy plane of the tibial crest. The same principle was used to calculate the size of the cage that would have been required to achieve the desired advancement. The effect of the difference between the desired advancement and the actual advancement achieved on the final PTA was calculated. Results: For a given desired advancement, the greater the tibial plateau angle (TPA), the greater the difference between the desired advancement and the actual advancement achieved. The maximum discrepancy calculated was 5.8 mm for a 12 mm advancement in a case of extreme TPA (59°). When the TPA was less than 31°, the PTA was in the range of 90° to 95°. Clinical significance: A discrepancy does exist between the desired tibial tuberosity advancement and the actual advancement in a direction parallel to the TPA, when the tibial tuberosity is not translated proximally. Although this has an influence on the final PTA, further studies are warranted to evaluate whether this is clinically significant.

scholarly journals Radiographic changes of the patellar ligament in dogs after tibial tuberosity advancement

2013 ◽  
Vol 82 (2) ◽  
pp. 215-218
Author(s):  
Ladislav Stehlík ◽  
Pavel Proks ◽  
Petra Fedorová ◽  
Alois Nečas
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Radiographic Examination ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Significant Difference ◽  
Cranial Cruciate Ligament Rupture

Patellar desmopathy in dogs after tibial plateau levelling osteotomy has been described in many studies. Tibial tuberosity advancement is a biomechanically different technique. It is assumed that the patellar ligament is loaded with little force similarly as after tibial plateau levelling osteotomy. Various aspects related to secondary patellar desmopathy are not completely understood. This study deals with computed radiography measurement of patellar ligament thickness after tibial tuberosity advancement in dogs with cranial cruciate ligament rupture. The thickness of the patellar ligament in exactly predetermined locations was measured from mediolateral radiographs of stifle joints. A total of 18 dogs (20 knee joints) with cranial cruciate ligament (ligamentum cruciatum craniale) rupture underwent three radiographic examinations of the knee (preoperative examination and control examination 7 and 15 weeks after the surgery). Significant difference was found between the thickness of the patellar ligament in the first and second examinations. Some of the demographic factors possibly related to patellar ligament thickness (age, sex, body weight, type of cranial cruciate ligament rupture, arthrotomy, cage size, meniscal injury, time between surgery and radiographic examination) were analyzed. However, statistical analyses did not show any effect of these factors on the thickness of the patellar ligament, except for the time between surgery and radiographic examination. These findings can extend the surgeons’ knowledge of biomechanical aspects of tibial tuberosity advancement.

Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog

2009 ◽  
Vol 22 (01) ◽  
pp. 16-20 ◽  
Author(s):  
D. Koch ◽  
M. Bass ◽  
M. Haessig ◽  
R. Inauen
Keyword(s):  
Body Weight ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Relative Body Weight ◽  
Breeding Selection ◽  
Healthy Dogs ◽  
Cranial Cruciate Ligament Rupture

SummaryThe influence of the tibial tuberosity conformation on cranial cruciate ligament (CrCl) rupture was evaluated and the size of the tibial tuberosity of healthy dogs (group H) was compared with dogs with CrCl rupture (group R) and dogs treated by tibial tuberosity advancement (TTA) (group T). The medio-lateral radio-graphs of 219 stifle joints were evaluated. Relative tibial tuberosity width (rTTW), proximal tibial tuberosity angle (PTTA), tibial plateau angle (TPA), tibial width (TW) and tibial plateau length (TPL) were measured on each radiograph. Body weight (BW) was measured and relative body weight (rBW) was calculated. The data from group H was compared with that of group R and group T. Group H had significantly larger rTTW, lower BW, lower rBW and smaller PTTA than group R. A comparison of groups H and T showed that dogs from group H were significantly younger, had a lower BW, a lower rBW, a greater PTTA and a smaller rTTW. In each of the comparisons, the TPA and the TW/TPL were not significantly different. The conformation of the canine tibial tuberosity has a significant influence on CrCl rupture. We hypothesized that the smaller the tibial tuberosity width, the larger the cranial tibial thrust, which results in more rapid CrCL degeneration, thus leading to rupture in a younger population of dogs. The rTTW could be a helpful measurement for breeding selection. Only dogs with a rTTW of more than 0.90 should be used for breeding.

Comparison of Intra- and Postoperative Complications between Bilateral Simultaneous and Staged Tibial Plateau Levelling Osteotomy with Arthroscopy in 176 Cases

2020 ◽  
Author(s):  
Raz Peress ◽  
Sebastian Mejia ◽  
Marcos Unis ◽  
Giovanni Sotgiu ◽  
Simone Dore ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Complication Rate ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Statistical Error ◽  
Major Complication ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Significant Difference ◽  
Client Factors

Abstract Objective The aim of this study was to compare the resulting short-term complications after simultaneous (SIM) or staged (ST) tibial plateau levelling osteotomy (TPLO) in patients that presented with bilaterally torn cranial cruciate ligaments. Study Design This was a retrospective study. Materials and Methods Medical records of dogs diagnosed with bilateral cranial cruciate ligament disease that underwent bilateral SIM or ST TPLO surgery with arthroscopy (2005–2015) were reviewed to evaluate the intra- and postoperative complications. Data were analysed and major and minor complications were compared between the two groups. Results A total of 176 client-owned dogs (352 stifles) that had TPLO performed bilaterally with SIM or ST procedures were included for analysis. The overall complication rate was 47.5% for the SIM group and 19.5% for the ST group. The incidence of major complications was 10.1 and 3.8% in the SIM and ST groups respectively. Minor complications were 38.4 and 15.6% in the SIM and ST groups respectively. Tibial tuberosity fractures requiring revision were noted in 2% of the SIM group and none of the ST group. Clinical Significance Although no significant difference was noted in major complication rate or tibial tuberosity fractures in our cohort of patients, a Type II statistical error was found. The complication rate in the SIM group is numerically greater by a factor of 2–3× or more for nearly all categories. Surgeons should consider the risks and benefits of SIM versus ST procedures as well as relevant individual patient and client factors before electing either alternative.

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