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.

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.

Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog

2011 ◽  
Vol 24 (01) ◽  
pp. 18-26 ◽  
Author(s):  
N. Fitzpatrick ◽  
M. P. Kowaleski ◽  
R. Yeadon
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Tibial Tuberosity ◽  
Patella Baja ◽  
Cranial Cruciate Ligament ◽  
Cage Size ◽  
Design Case ◽  
Cranial Cruciate Ligament Disease ◽  
Lost To Follow Up

Summary Objective: To report surgical technique, morphometric effects and clinical outcomes for tibial tuberosity transposition-advancement (TTTA), sulcoplasty and para-patellar fascial imbrication for management of concomitant medial patellar luxation (MPL) and cranial cruciate ligament (CCL) disease in 32 dogs. Study design: Case series. Methods: A previous technique for tibial tuberosity advancement was modified to incorporate lateral and distal tibial tuberosity transposition. Preoperative, immediate, and six to eight week postoperative radiographs were reviewed with morphometry of a range of tibial and stifle anatomic parameters. Findings of sequential clinical examinations to six to 20 months postoperatively were recorded. Results: Thirty-nine stifles were treated by surgery. Medial patellar luxation grade ranged from II to IV/IV. The CCL rupture was complete in 17/39 stifles, and incomplete in 22/39. Complications occurred in 11/39 stifles including MPL recurrence (n = 4). Resolution of subjectively-assessed lameness occurred in 29/39 stifles at the six to eight week assessment. Resolution of lameness was eventually documented in 35/39 stifles (4/39 lost to follow-up), and was maintained at the six to 20 month reassessment where available. The TTTA induced relative patella baja in 31/39 stifles. Magnitude of actual tibial tuberosity advancement was lower than that predicted by cage size. Clinical significance: Tibial tuberosity transposition-advancement is a potential treatment modality for concomitant CCL disease and MPL in the dog, but refinement of planning is required, while biomechanical and kinematic effects remain unknown.

scholarly journals In dogs weighing under 15 Kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Tafara Mapuvire
Keyword(s):  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Research Question ◽  
Tibial Tuberosity ◽  
Clinical Expertise ◽  
Best Interest ◽  
Bottom Line ◽  
Cranial Cruciate Ligament ◽  
Cranial Cruciate Ligament Disease

PICO question In dogs weighing under 15 kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed There were no papers that answered the PICO question Strength of evidence Zero Outcomes reported Between TTA and LFS none of the techniques was shown to provide better long-term functional outcomes than the other in dogs weighing less than 15 kg Conclusion Given the absence of evidence answering the PICO question, choice and recommendation of procedure between TTA and LFS in dogs weighing under 15 kg should be guided by what the surgeon deems to be in the best interest of the patient   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.  

Incidence of complications associated with tibial tuberosity advancement in Boxer dogs

2016 ◽  
Vol 29 (01) ◽  
pp. 39-45 ◽  
Author(s):  
Rui Sul ◽  
Tim Parkin ◽  
Ignacio Calvo ◽  
Brigite de Lima Dantas
Keyword(s):  
Revision Surgery ◽  
Medical Records ◽  
Odds Ratio ◽  
Surgical Repair ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
P Value ◽  
Cranial Cruciate Ligament ◽  
Cranial Cruciate Ligament Disease ◽  
Boxer Dogs

SummaryObjective: To retrospectively review and describe the incidence of complications associated with tibial tuberosity advancement (TTA) surgical procedures in a group of Boxer dogs (n = 36 stifles) and compare the data with a non-Boxer control population (n = 271 stifles).Methods: Retrospective analysis of medical records to identify all dogs that underwent TTA surgery due to cranial cruciate ligament disease. These records were categorized into two groups: Boxer dogs and non-Boxer dogs (controls – all other breeds).Results: Of the 307 stifles included, 69 complications were reported in 58 joints. The complication rate differed significantly for Boxer dogs (16/36 stifles) and non-Boxer dogs (42/271 stifles), corresponding to an odds ratio of 5.8 (confidence interval: 1.96–17.02; p-value <0.001). Boxer dogs were more likely to undergo revision surgery and to develop multiple complications. The incidence of tibial tuberosity fractures requiring surgical repair (2/36 versus 1/271) and incisional infections requiring antibiotic treatment (three in each group) was significantly higher in the Boxer group.Clinical significance: Boxer dogs had more major and multiple complications after TTA surgery than the control non-Boxer group; these complications included higher rates of revision surgery, tibial tuberosity fractures requiring stabilization, and infection related complications. The pertinence and value of breed-specific recommendations for cranial cruciate ligament disease appears to be a subject worthy of further investigation.

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.

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.

Short-Term Radiographic Complications and Healing Assessment of Single-Session Bilateral Tibial Tuberosity Advancements

2016 ◽  
Vol 52 (2) ◽  
pp. 109-114 ◽  
Author(s):  
Briana Danielson ◽  
Matthew Barnhart ◽  
Adam Watson ◽  
Shawn Kennedy ◽  
Steve Naber
Keyword(s):  
Body Weight ◽  
Complication Rate ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Single Session ◽  
Short Term ◽  
Cranial Cruciate Ligament ◽  
Increased Risk ◽  
System Variables ◽  
Healing Assessment

The objective of this study is to report on the short-term radiographic complications and bone healing associated with single-session bilateral tibial tuberosity advancements (TTAs). This retrospective study consists of 74 client-owned dogs with bilateral cranial cruciate ligament rupture that underwent consecutive single-session bilateral TTAs. Radiographs from 74 dogs (148 stifles) were evaluated for evidence of postoperative complications. One hundred forty-three of 148 stifles were scored for radiographic healing using a previously described scoring system. Variables evaluated for a relationship with radiographic complications and healing scores were: breed, age, body weight, sex, and TTA plate type. The overall radiographic complication rate was 17.6% (13/74). Twelve of the 13 radiographic complications were considered to be minor and one was major. Increasing body weight and use of a fork implant were statistically significant factors associated with an increased risk of complication. One hundred forty-three stifle radiographs met the inclusion criteria to be assessed for healing. The mean score was 2.96 out of 4.0. The overall radiographic complication rate and healing scores associated with single-session bilateral TTAs were found to be similar to those described for unilateral TTA.

Short-Term Prospective Clinical Evaluation of a Polyglycolic Acid Tibial Tuberosity Advancement Cage Implant

2018 ◽  
Vol 54 (2) ◽  
pp. 85-94 ◽  
Author(s):  
Noah B. Bander ◽  
Matthew D. Barnhart ◽  
Adam T. Watson ◽  
Steven J. Naber
Keyword(s):  
Complication Rate ◽  
Cruciate Ligament ◽  
Polyglycolic Acid ◽  
Tibial Tuberosity ◽  
Implant Design ◽  
Complication Rates ◽  
High Complication Rate ◽  
Short Term ◽  
Cranial Cruciate Ligament ◽  
Cage Size

ABSTRACT This study investigated the short-term radiographic healing of the osteotomy following tibial tuberosity advancement (TTA), maintenance of patellar tendon angle (PTA), and complications in dogs receiving a polyglycolic acid (PGA) TTA cage. Patients diagnosed with unilateral cranial cruciate ligament disease requiring a 9- or 12-mm TTA cage were included. Twenty-six consecutive client-owned dogs were prospectively selected for this clinical study. Age, weight, sex, breed, cage size, surgery date, and follow-up time were recorded. Radiographs were scored for healing and measured for PTA immediately, at 6 wk, and at 10 wk postoperatively. All stifles were assessed for complications throughout the study period. Stifles with PGA cages had similar overall healing scores compared to previously reported values for metallic cages, and the PTA was well maintained at 6 and 10 wk postoperatively. Polyglycolic acid cages were associated with a higher complication rate (10/26, 38%; 95% confidence interval, 0.19–0.61) compared with previously reported complication rates for metallic cages. Despite favorable healing scores and overall PTA maintenance, PGA cage use resulted in a high complication rate. Proposed advantages offered by this particular implant over currently used metallic cages are offset by this high complication rate. Additional investigation of bioabsorbable materials and implant design should be considered.

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.

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