Tibial tuberosity advancement in 65 canine stifles

2006 ◽  
Vol 19 (04) ◽  
pp. 219-227 ◽  
Author(s):  
J. M. Miller ◽  
C. P. Ober ◽  
O. I. Lanz ◽  
R. A. Martin ◽  
P. K. Shires ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Degenerative Joint Disease ◽  
Activity Level ◽  
Tibial Tuberosity ◽  
Joint Disease ◽  
Patellar Ligament ◽  
Cranial Cruciate Ligament ◽  
The Mean ◽  
Owner Satisfaction

SummaryThe tibial tuberosity advancement (TTA) procedure was developed to treat dogs with cranial cruciate ligament deficient stifles. A retrospective, descriptive study was performed on 57 dogs that underwent unilateral or bilateral TTA. Medical records were reviewed and pre-, postoperative and follow-up radiographs were evaluated for patellar ligament-tibial plateau angle (α), distance of the tibial tuberosity advancement and progression of degenerative joint disease. A questionnaire was sent to all owners to obtain their assessment of the procedural outcome. Sixty-five stifles in 57 dogs received a TTA. Mean age was 5.2 ± 2.5 years while mean weight was 39.7 ± 11.9 kg. Eighteen breeds were represented with Labrador retrievers and mixed breeds predominating. The mean duration of lameness prior to surgery was 6.2 ± 6.7 months, with a median lameness score of 3/4. Fifty-nine percent of cases encountered complications, the majority of which were minor. 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. TTA subjectively appears to be a useful alternative in the management of cranial cruciate ligament disease. Few severe complications were encountered. Good clinical outcome and owner satisfaction was reported with the procedure in this set of cases.

scholarly journals Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation

2016 ◽  
Vol 29 (06) ◽  
pp. 536-540 ◽  
Author(s):  
Katherine Leonard ◽  
Michael Kowaleski ◽  
William Saunders ◽  
Robert McCarthy ◽  
Randy Boudrieau
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Frontal Plane ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Fixation Method ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Additional Surgery

SummaryObjectives: To describe the surgical technique and report short-term outcome for combined tibial plateau levelling osteotomy and tibial tuberosity transposition (TPLO-TTT) as an option in the treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation.Methods: Medical records were reviewed (2011–2013) of dogs that underwent a standard tibial plateau levelling osteotomy followed by a tibial tuberosity transposition in the frontal plane and stabilized with pin and tension-band wire fixation as a component of surgical treatment for combined cranial cruciate ligament insufficiency and medial patellar luxation. Signalment, fixation method together with any ancillary procedures, function at the in-hospital follow-up examinations, and any complications were recorded. Healing was assessed retrospectively based on the grading criteria of the International Society Of Limb Salvage.Results: Fifteen stifle joints in 11 dogs were identified; 13 stifles were available for in hospital follow-up. All 13 achieved union (3 with grade III/IV and 10 with grade IV/IV radiographic healing scores); mean time to healing was 10.6 (± 2.9) weeks. Patellar ligament thickening was also identified radio-graphically in seven of the 13 of stifle joints. All dogs were reported to have mild or no lameness at their last follow-up examination. No catastrophic or major postoperative complications occurred that required additional surgery. Patellar re-luxation did not occur in any of the 13 stifles available for in-hospital follow-up.Clinical significance: The TPLO-TTT was found to be a reliable and effective technique when used as a part of the treatment of combined cranial cruciate ligament insufficiency with concomitant medial patellar luxation in this series of dogs.Supplementary Material to this article is available online at http://dx.doi.org/10.3415/VCOT-15-12-0195.

Modified Triple Tibial Osteotomy for Combined Cranial Cruciate Ligament Rupture, Tibial Deformities, or Patellar Luxation

2019 ◽  
Vol 55 (6) ◽  
pp. 291-300
Author(s):  
Véronique Livet ◽  
Mathieu Taroni ◽  
François-Xavier Ferrand ◽  
Claude Carozzo ◽  
Eric Viguier ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Radiographic Evaluation ◽  
Tibial Osteotomy ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
The Mean ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Rupture

ABSTRACT Proximal tibial deformities or patellar luxation may occur concurrently with cranial cruciate ligament rupture. The objective of this study was to describe the management of those conditions with a modified triple tibial osteotomy (TTO) in nine dogs. Medical records of dogs who underwent a modified TTO were reviewed. The mean pre- and postoperative patellar tendon angles were 104.2° and 92.9°, respectively. The mean pre- and postoperative mechanical medial proximal tibial angles were 99.5° and 91.5°, respectively. Medial patellar luxation was present in five dogs (55.6%) and treated in all five dogs with a tibial crest transposition. Tibial torsion was grossly resolved in two dogs (22.2%). Perioperative distal tibial crest fracture was treated by pins and a figure-of-eight tension-band wire in five dogs (55.6%). One major (surgical site infection) and three minor postoperative complications were observed. At the last follow-up, seven dogs (77.8%) had no lameness, one dog (11.1%) had mild lameness, and one dog (11.1%) had moderate lameness. Radiographic evaluation showed good (2/9; 22.2%) to excellent (7/9; 77.8%) bone healing. The visual analog scale evaluation revealed good-to-excellent owner satisfaction. Cranial cruciate ligament rupture, tibial deformities, and medial patellar luxation are difficult to treat together. A modified TTO may be used to treat these conditions.

The Modified Maquet Procedure (MMP) in Dogs: Technical Development and Initial Clinical Experience

2016 ◽  
Vol 52 (4) ◽  
pp. 242-250 ◽  
Author(s):  
Malcolm Graham Ness
Keyword(s):  
Cruciate Ligament ◽  
Major Complication ◽  
Tibial Tuberosity ◽  
Radiographic Examination ◽  
Computer Assisted ◽  
Clinical Report ◽  
Modified Technique ◽  
Cranial Cruciate Ligament ◽  
Titanium Foam

ABSTRACT The literature about tibial tuberosity advancement surgery in dogs and humans informed the development of a version of the operation using a wedge-shaped implant of titanium foam. Computer-assisted drawing and stereolithography was used to create instruments and implants that were evaluated by cadaver surgery. A trial, involving 26 client-owned dogs with lameness due to cranial cruciate ligament failure, was started. Follow-up was done by clinical and radiographic examination after 4 wk and clinical examination again 6–11 mo after surgery. The titanium foam implant maintained tibial tuberosity advancement easily and effectively. The same major complication occurred in 2 of the first 6 cases before, a slightly modified technique was used to treat 20 dogs without complication. At mid-term follow-up (6–11 mo), 20/26 dogs (77%) had returned to full function, two dogs (7.7%) had acceptable function, two dogs (7.7%) could not be evaluated due to recent contra lateral modified Maquet procedure surgery, and two (7.7%) dogs had died for reasons unrelated to the study. This is the first clinical report of the use of titanium foam in veterinary orthopaedics. Modified Maquet procedure appears to be an effective treatment for lameness due to failure of the cranial cruciate ligament in dogs.

Measurement of the tibial plateau angle in cats with and without cranial cruciate ligament rupture

2009 ◽  
Vol 22 (02) ◽  
pp. 83-86 ◽  
Author(s):  
S. Reese ◽  
K. Lorinson ◽  
D. Lorinson ◽  
E. Schnabl
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Inter Observer Variability ◽  
Measurement Results ◽  
Cranial Cruciate Ligament Rupture

SummaryThe objective of the present study was to determine the tibial plateau angle (TPA) in cats without stifle pathology and to compare it with cats suffering from an isolated cranial cruciate ligament rupture. Mediolateral radiographs of the stifle were taken and the tibial plateau angle was measured based on the method previously described by Slocum and Devine (1983) for dogs. Three observers with different levels of experience evaluated the radiographs of all of the cats in this study. The mean tibial plateau angle measured by all three observers in the cats with a rupture of the cranial cruciate ligament (CCL) was 3.1° greater than in cats without stifle pathology. Neither gender, age, body weight nor degenerative joint disease had an influence on measurement results. The authors found an inter-observer variability of ± 5.3°. Hence it can be concluded that cats with cranial cruciate ligament rupture have a greater TPA, and this at least lends some credence to the possibility of higher TPA being a predis-posing factor for cruciate injury in this species.

Association of mineralisations in the stifle joint of domestic cats with degenerative joint disease and cranial cruciate ligament pathology

2016 ◽  
Vol 19 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Katja Voss ◽  
Philemon Karli ◽  
Pierre M Montavon ◽  
Hans Geyer
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Degenerative Joint Disease ◽  
Joint Capsule ◽  
Degenerative Changes ◽  
Joint Disease ◽  
Fat Pad ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Periarticular Tissue

Objectives The aim of the study was to evaluate the prevalence, size, location and appearance of mineralisations in feline stifle joints, and to evaluate their relationship with osteoarthritis and cranial cruciate ligament (CrCL) status. Methods Presence or absence, and size of mineralisations were determined from lateral stifle radiographs of 25 cats with CrCL rupture, and 44 cat cadavers without CrCL rupture. Mineralisations were classified as small, medium or large. Prevalence was compared between the clinically affected cats and the cadavers; the cadaver group was subdivided into an age-matched and an older group. Ten stifles with varying sizes of mineralisations were prepared as whole-knee specimens for histopathology. Location and appearance of the mineralisations, and degenerative changes in the cruciate ligaments, menisci, articular cartilage and joint capsule are described. Results Prevalence of articular mineralisations was 0.76 in stifles of cats with CrCL rupture (mean ± SD age 8.6 ± 4.5 years), 0.64 in stifles of age-matched cat cadavers and 0.74 in older cat cadavers (mean ± SD age 17.0 ± 2.4 years). Cats with CrCL rupture had a higher percentage of medium and large mineralisations than cats without CrCL rupture. Microscopically, small mineralisations were calcifications usually located in the cranial horn of the medial meniscus. Larger mineralisations were found to be ossifications, commonly located in the joint capsule and fat pad. Cats with larger mineralisations showed more signs of osteoarthritis, including degenerative changes in the CrCL. Conclusions and relevance Mineralisations in feline stifle joints were found to differ in size, appearance and location. Small mineralisations were usually confined to the medial meniscus, as described previously; larger mineralisations tended to be located in the tissues cranial to the menisci and seemed to be associated with osteoarthritis and CrCL pathology. Large mineralisations in feline stifles are ossifications in periarticular tissue and are associated with degenerative joint disease.

scholarly journals Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease

2008 ◽  
Vol 21 (03) ◽  
pp. 243-249 ◽  
Author(s):  
D. Damur ◽  
T. Guerrero ◽  
M. Haessig ◽  
P. Montavon ◽  
K. Voss
Keyword(s):  
Functional Outcome ◽  
Cruciate Ligament ◽  
Force Plate ◽  
Tibial Tuberosity ◽  
Ground Reaction Forces ◽  
Cranial Cruciate Ligament ◽  
Reaction Forces ◽  
Vertical Ground ◽  
Vertical Ground Reaction Forces

Summary Objective: To assess functional outcome in dogs with cranial cruciate ligament (CrCL) disease after tibial tuberosity advancement (TTA) using force plate gait analysis, and to evaluate parameters potentially influencing outcome. Study design: Prospective clinical study. Animals: Consecutive clinical patients (n=37) with CrCL-deficient stifles (n=40). Methods: The stifle joints were examined arthroscopically prior to TTA. Meniscal release was not performed if the medial meniscus was intact. Open medial arthrotomy and partial meniscectomy were performed in the presence of meniscal tears. Vertical ground reaction forces were measured preoperatively and at follow-up examinations four to 16 months postoperatively (mean: 5.9 months). The ground reaction forces of a group of 65 healthy dogs were used for the comparison. The potential effects of clinical parameters on functional outcome were evaluated statistically. Results: Complete CrCL rupture was identified in 28 joints, and partial CrCL rupture in 12 joints. The medial meniscus was damaged in 21 stifles. Vertical ground reaction forces were significantly higher at follow-up (P<0.01), but remained significantly lower than those of control dogs (P<0.01). Complications were identified in 25% of joints, and the dogs with complications had significantly lower peak vertical forces at follow-up than the dogs without complications (P=0.04). Other clinical parameters did not influence outcome. Conclusions: Tibial tuberosity advancement significantly improved limb function in dogs with CrCL disease, but did not result in complete return to function. Complications adversely affected functional outcome. Clinical significance: A return to a function of approximately 90% of normal can be expected in dogs with CrCL disease undergoing TTA.

Clinical Evaluation and Long-Term Follow-Up of Dogs Having Coronoidectomy for Elbow Incongruity

2003 ◽  
Vol 39 (5) ◽  
pp. 473-478 ◽  
Author(s):  
Margaret Puccio ◽  
Dominic J. Marino ◽  
Joseph D. Stefanacci ◽  
Brian McKenna
Keyword(s):  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Disease Entity ◽  
Radiographic Findings ◽  
Clinical Presentations ◽  
Long Term Follow Up ◽  
The Mean ◽  
Joint Incongruity

A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.

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 Advancement for Treatment of CrCL Injury: Complications and Owner Satisfaction

2011 ◽  
Vol 47 (4) ◽  
pp. 250-257 ◽  
Author(s):  
Ezra J. Steinberg ◽  
Raymond G. Prata ◽  
Karen Palazzini ◽  
Dorothy C. Brown
Keyword(s):  
Body Weight ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Tibial Tuberosity ◽  
Common Complication ◽  
Cranial Cruciate Ligament ◽  
Postsurgical Complications ◽  
Cage Size ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Disease

The purpose of this retrospective study of 171 dogs that underwent 193 tibial tuberosity advancement (TTA) surgeries was to describe complications and owner satisfaction associated with the procedure. Complications occurred in 21 cases (11%). Subsequent meniscal tear was the most common complication (10/193, 5.2%). Increasing body weight (P=0.02–0.04) and small cage size (P=0.06) were significantly associated with postsurgical complications. Ninety-two percent of owners were satisfied with the outcome of the TTA procedure, but only 84% stated that they would be willing to have the procedure performed again. The authors concluded that TTA had a complication rate and owner satisfaction similar to other tibial osteotomies for the surgical correction of cranial cruciate ligament disease.

Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: a retrospective study

1996 ◽  
Vol 32 (3) ◽  
pp. 247-255 ◽  
Author(s):  
AE Chauvet ◽  
AL Johnson ◽  
GJ Pijanowski ◽  
L Homco ◽  
RD Smith
Keyword(s):  
Cruciate Ligament ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Fibular Head ◽  
Radiographic Evidence ◽  
Cranial Cruciate Ligament ◽  
Treatment Groups ◽  
Ligament Rupture ◽  
Evaluation Scores ◽  
Cranial Cruciate Ligament Rupture

Sixty-one large dogs (weighing 22.7 kg or more) with cranial cruciate ligament ruptures (CCLRs) were treated with either fibular head transpositions (FHTs; n = 22 stifles), lateral fabellar sutures (LFSs; n = 39 stifles), or conservatively (CT; n = 11 stifles) with rest and aspirin. Based on owner evaluation, dogs treated with FHTs or CT did not perform as well as dogs treated with LFSs (p less than 0.05). There was no difference in owner evaluation scores for the dogs treated with FHTs or CT. Thirty dogs were reevaluated by investigators. No differences between treatment groups regarding age, sex, or time until diagnosis were noted. No differences in scores for lameness, stifle instability, or forceplate analysis among the treatment groups were observed. Degenerative joint disease progressed or remained severe regardless of treatment, based upon radiographic evidence.

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