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.

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.

Clinical audit for the tibial tuberosity advancement procedure

2013 ◽  
Vol 26 (04) ◽  
pp. 280-284 ◽  
Author(s):  
S. A. Corr ◽  
J. L. J. Proot
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Clinical Audit ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Complication Rates ◽  
Cranial Cruciate Ligament ◽  
Major Complications ◽  
Cumulative Summation ◽  
Meniscal Pathology

SummaryObjective To quantitatively assess the learning curve for the tibial tuberosity advancement (TTA) procedure performed by a single surgeon using the cumulative summation (CUSUM) technique and to determine if surgeon performance remained under control (i.e. within specified quality boundaries) after the learning curve had been climbed. Study design: Retrospective study.Animals Dogs (n = 122) with cranial cruciate ligament deficient stifles (n = 167).Methods Records of all dogs that had a TTA procedure performed by the same surgeon were reviewed. Cases were included if the following information was available: weight, breed, date of surgery, presence of partial or full cruciate rupture, meniscal pathology, occurrence and description of postoperative complications and treatment with a minimum of 12 months follow-up. Patients were excluded if they had a concurrent illness. Major complications were defined as those requiring revision surgery. The CUSUM technique was used to determine the time taken for the surgeon to reach a pre-defined level of competency and to monitor ongoing performance.Results Major complications occurred in 15 out of 167 procedures (9%) within 12 months of TTA surgery. The complication rate decreased as surgical experience was gained with the technique, however the learning curve continued until the 22nd procedure. Thereafter, despite the target complication rate being re-set at a lower level, the surgeon's performance remained acceptable, i.e. within the revised quality boundary.Clinical significance The CUSUM technique was used for clinical audit, to determine the learning curve for the TTA procedure for a single surgeon, and to monitor ongoing performance. An experienced general practitioner had a learning curve of 22 procedures and complication rates were within the published ranges.

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 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.

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.

scholarly journals Risk factors for short-term postoperative complications in the 8 weeks after tibial plateau leveling osteotomy in dogs weighing less than 15 kilograms: A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247555
Author(s):  
Karen Marin ◽  
Marcos D. Unis ◽  
Jason E. Horgan ◽  
James K. Roush
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Complication Rate ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Short Term ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cranial Cruciate Ligament Rupture

The purpose of this retrospective study was to evaluate the risk factors for short-term postoperative complications in the 8 weeks after unilateral tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament rupture in small dogs weighing less than 15 kg. Medical records were retrospectively reviewed for 90 dogs weighing <15 kg that underwent medial parapatellar arthrotomy with inspection of the meniscus and TPLO performed by the same surgeon between January 2012 and December 2017. The overall complication rate was 4.44% (4/90 dogs). There were four cases of partial incisional dehiscence, none of which required surgical revision. Complications were significantly more likely in dogs that had undergone placement of a 2.4-mm TPLO plate. Overall, the complication rate was less than that in previous studies of dogs weighing > 15kg. In this study, patients in which 2.4-mm TPLO plates were used were more likely to develop postoperative complications. Dogs weighing <15 kg that underwent TPLO had good short-term outcomes with minimal complications. In our study, the overall complication rate after TPLO in dogs weighing <15 kg is less than that historically reported in heavier dogs. Our data suggests that TPLO is a safe treatment option in small dogs with cranial cruciate ligament rupture.

Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease

2017 ◽  
Vol 30 (03) ◽  
pp. 209-218
Author(s):  
Albane Fauron ◽  
Mieghan Bruce ◽  
Daniel James ◽  
Mark Owen ◽  
Karen Perry
Keyword(s):  
Logistic Regression ◽  
Postoperative Complications ◽  
Clinical Outcome ◽  
Surgical Procedure ◽  
Cruciate Ligament ◽  
Postoperative Outcome ◽  
Tibial Tuberosity ◽  
Complication Rates ◽  
Cranial Cruciate Ligament ◽  
Referral Hospitals

SummaryObjectives: To compare complication rates and outcomes between cases of concomitant cranial cruciate ligament (CrCL) disease and medial patellar luxation (MPL) treated using extracapsular stabilization and tibial tuberosity transposition (ECS+TTT) and tibial tuberosity transposition and advancement (TTTA).Methods: In a multicentre retrospective study, records from four referral hospitals were reviewed for dogs with concomitant CrCL pathology and MPL treated using ECS+TTT or TTTA. Data retrieved included signalment, partial/complete CrCL tear, MPL grade, treatment performed, occurrence of postoperative complications, and postoperative outcome grade. Associations between surgical procedure and risk of complication and surgical procedure and outcome were investigated using univariable logistic regression and proportional odds logistic regression respectively. Multiple logistic regression was used to explore confounding factors.Results: A total of 72 stifles were evaluated in 66 dogs; 32 stifles were stabilized using ECS+TTT and 40 using TTTA. Overall complications were 2.7 times more frequent in the ECS+TTT group and major complications occurred only in this group. The TTTA group was less likely to suffer complications (17.5%) compared to the ECS+TTT group (46.9%) (p = 0.009) and TTTA cases had lower odds of a poorer clinical outcome (p = 0.047).Clinical significance: Stifles stabilized using ECS+TTT are more likely to suffer from postoperative complications and a poorer clinical outcome when compared to TTTA.Supplementary Material to this article is available online at https://doi.org/10.3415/VCOT-16-10-0148

Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs

2012 ◽  
Vol 25 (05) ◽  
pp. 402-409 ◽  
Author(s):  
M. S. Hirshenson ◽  
M. S. Thompson ◽  
H. M. Knapp-Hoch ◽  
A. R. Jay-Silva ◽  
M. McConkey ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Single Session ◽  
Short Term ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Significant Difference ◽  
Cranial Cruciate Ligament Rupture

SummaryObjective: To compare the resulting complications, short-term results, and client satisfaction for treatment of cranial cruciate ligament rupture using either unilateral or bilateral single-session tibial tuberosity advancement (TTA) in dogs.Methods: Medical records of 68 dogs (101 stifles) undergoing unilateral or bilateral single-session TTA were evaluated. Data gathered included signalment, history, physical examination findings, anaesthesia and surgical time, type of cranial cruciate ligament rupture and meniscal injury, implants, and intra-operative and postoperative complications. A mixed effect logistic regression analysis was performed to determine if complications were grouped by surgical procedure. Linear regression was performed to determine the influence of the variables on the occurrence of complications. Values of p <0.05 were considered significant.Results: No major intra-operative complications occurred. Twenty stifles (20%) developed a complication after surgery (11 minor, 9 major). There was no significant difference in occurrence of complications between dogs undergoing unilateral (n = 8) or bilateral single-session (n = 12) TTA (p = 0.69). The only risk factor found to be associated with complication occurrence was age.Clinical significance: This is the first report evaluating the use of bilateral simultaneous TTA. There was no significant difference in complication rates between unilateral and bilateral single-session TTA. Additional evaluation is needed to fully determine the extent of complications and long-term outcome of bilateral single-session TTA.

Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review

2018 ◽  
Vol 46 (04) ◽  
pp. 223-235 ◽  
Author(s):  
Patricia Beer ◽  
Barbara Bockstahler ◽  
Eva Schnabl-Feichter
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Complication Rates ◽  
Cranial Cruciate Ligament ◽  
Evidence Level ◽  
Lower Complication ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Rupture

Summary Objective: The optimal surgical technique for treatment of cranial cruciate ligament rupture in canine has been scientifically discussed for decades. Despite the continuous debate, proximal tibial osteotomies such as tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) are increasingly common. The objective of this review was to systematically evaluate the literature reporting outcome and complications associated with TPLO and TTA. Materials and methods: A systematic search of literature databases identified articles published from August 2004 to February 2016 describing evaluations of short- or longterm outcomes as well as complications following TPLO or TTA. Results: Ninety-one studies were included in this review and assigned to one out of four evidence levels. Of those, 89 studies provided the lowest evidence level and only two were assigned to the third-best evidence level. A comparison of subjective gait analyses could not detect differences in the decrease of lameness between TPLO and TTA, while objective gait analysis supports the superiority of TPLO. Fewer patients treated with TPLO were diagnosed with postoperative joint instability and TPLO had a lower percent increase of osteoarthritis (OA) after surgery. Owner satisfaction was high for both techniques. For TPLO and TTA the average total, minor, major and catastrophic complication rates were 15.9 % and 20.8 %, 7.9 % and 11.6 %, 5.2 % and 13.2 % as well as 0.8 % and 5.6 %, respectively. Conclusion and clinical significance: The assessed literature supports the hypothesis that TPLO is associated with lower complication rates, an improved clinical-functional outcome and less increase of OA compared to TTA. The results are indicative for a long-term restoration of normal limb function after TPLO. However, the strength of available evidence and the comparability of each study’s results were poor and more comparative studies are needed to draw strong conclusions towards the superiority of the TPLO over the TTA.

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