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

Summary Objectives: 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.

[1]  E. Comerford.  The stifle joint , 2016 .

[2]  M. Schembri,et al.  Accuracy of tibial osteotomy placement using 2 different tibial plateau leveling osteotomy jigs. , 2014, Veterinary surgery : VS.

[3]  S. Kerwin,et al.  32 – Common Orthopedic Conditions and Their Physical Rehabilitation , 2014 .

[4]  A. Piras,et al.  Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. , 2013, Veterinary surgery : VS.

[5]  R. Boudrieau,et al.  Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs. , 2011, Veterinary surgery : VS.

[6]  N. Fitzpatrick,et al.  Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog , 2010, Veterinary and Comparative Orthopaedics and Traumatology.

[7]  M. Conzemius,et al.  Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. , 2010, Veterinary surgery : VS.

[8]  C. Horstman,et al.  Severity of patellar luxation and frequency of concomitant cranial cruciate ligament rupture in dogs: 162 cases (2004-2007). , 2010, Journal of the American Veterinary Medical Association.

[9]  D. Marcellin-Little,et al.  Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling. , 2010, The Journal of small animal practice.

[10]  R. Boudrieau,et al.  Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. , 2009, Veterinary surgery : VS.

[11]  R. Boudrieau.  Tibial plateau leveling osteotomy or tibial tuberosity advancement? , 2009, Veterinary surgery : VS.

[12]  Kenneth A Johnson,et al.  Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. , 2008, Veterinary surgery : VS.

[13]  R. Boudrieau,et al.  Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. , 2006, Veterinary surgery : VS.

[14]  A. D. Elkins,et al.  Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). , 2006, Journal of the American Animal Hospital Association.

[15]  S. Monette,et al.  Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy , 2005, Veterinary and Comparative Orthopaedics and Traumatology.

[16]  J. Mattoon,et al.  The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study. , 2005, Veterinary surgery : VS.

[17]  Ann L. Johnson,et al.  Pre- and postoperative radiographic and computed tomographic evaluation of dogs with medial patellar luxation. , 2005, Veterinary surgery : VS.

[18]  R. McCarthy,et al.  Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope , 2004, Veterinary and Comparative Orthopaedics and Traumatology.

[19]  D. Millis,et al.  Chapter 21 – Common Orthopedic Conditions and Their Physical Rehabilitation , 2004 .

[20]  J. Dodam,et al.  Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). , 2003, Journal of the American Veterinary Medical Association.

[21]  C. Jessen,et al.  Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). , 2003, Journal of the American Veterinary Medical Association.

[22]  G. Bacci,et al.  The effect of chemoterapy on uncemented prostheic replacement , 1991 .