Use of a Modified Tibial Plateau Levelling Osteotomy with Double Cut and Medial Crescentic Closing Wedge Osteotomy to Treat Dogs with Cranial Cruciate Ligament Rupture and Tibial Valgus Deformity

Abstract Objective The aim of this study was to report efficacy of a modified tibial plateau levelling osteotomy (TPLO) with double cut and medial crescentic closing wedge osteotomy (TPLO/MCCWO) to treat dogs with cranial cruciate ligament rupture and concurrent tibial valgus. Study Design This study was a cases series. Materials and Methods Medical records of dogs that had TPLO with medial crescentic closing wedge osteotomy were reviewed. Data collected included signalment, body weight, pre- and postoperative tibial valgus angle, tibial plateau angle (TPA), surgical planning, corrective osteotomy technique, method of fixation, complications, and length of time to radiographic healing. Results Fifty-two surgical procedures performed in 45 dogs (7 bilateral) were included in the study. Mean age at surgery was 54 months, and body weight ranged from 5 to 63 kg (mean: 36.5 kg). Mean pre- and postoperative mechanical medial proximal tibial angle were 101° (98°–107°) and 92.80° (88°–97°) respectively. The mean pre- and postoperative TPA were 27.80° (16–35°) and 6.50° (3–11°) respectively. Intraoperative complications occurred in two stifles: in one stifle over-rotation of the proximal tibial segment resulted in a TPA of –8°, with immediate revision to a 5° TPA; in the second stifle a fissure of the lateral tibial cortex developed during insertion of a screw and required adjunctive fixation. No postoperative complications were recorded and all osteotomies healed uneventfully. Conclusions Tibial plateau levelling osteotomy/medial crescentic closing wedge osteotomy is an effective treatment for dogs with cranial cruciate ligament rupture and tibial valgus allowing accurate correction of the tibial deformity with a low complication rate.

[1]  R. Todhunter,et al.  Long Term Functional Outcome of Tibial Tuberosity Advancement vs. Tibial Plateau Leveling Osteotomy and Extracapsular Repair in a Heterogeneous Population of Dogs. , 2016, Veterinary surgery : VS.

[2]  C. Frost,et al.  Repeatability and reproducibility of measurements of femoral and tibial alignment using computed tomography multiplanar reconstructions. , 2014, Veterinary surgery : VS.

[3]  S. Koskinen,et al.  Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures: mid-term clinical and radiographic outcomes of 73 operatively treated patients , 2014, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[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]  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.

[7]  N. Fitzpatrick,et al.  Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. , 2010, Veterinary surgery : VS.

[8]  Kei Hayashi,et al.  Tibial plateau leveling and medial opening crescentic osteotomy for treatment of cranial cruciate ligament rupture in dogs with tibia vara. , 2010, Veterinary surgery : VS.

[9]  K. Wendelburg,et al.  Determination of the mechanical medial proximal tibial angle using a tangential radiographic technique. , 2010, Veterinary surgery : VS.

[10]  J. Cook,et al.  Radiographic measurement of canine tibial angles in the sagittal plane. , 2008, Veterinary surgery : VS.

[11]  A. Mullaji,et al.  Tibial articular cartilage wear in varus osteoarthritic knees: correlation with anterior cruciate ligament integrity and severity of deformity. , 2008, The Journal of arthroplasty.

[12]  J. Cook,et al.  Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. , 2007, Veterinary surgery : VS.

[13]  D. A. A. S. K. Dvm,et al.  Comparison of Computed Tomographic and Standard Radiographic Determination of Tibial Torsion in the Dog , 2005 .

[14]  J. Dyce,et al.  Comparison of computed tomographic and standard radiographic determination of tibial torsion in the dog. , 2005, Veterinary surgery : VS.

[15]  C. Decamp,et al.  Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. , 2004, Veterinary surgery : VS.

[16]  J. Hauptman,et al.  Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. , 2002, Veterinary surgery : VS.

[17]  S. Arnoczky,et al.  Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. , 2001, Veterinary surgery : VS.

[18]  R. Moore,et al.  Intra- and interobserver measurement variability of tibial plateau slope from lateral radiographs in dogs. , 2001, Journal of the American Animal Hospital Association.

[19]  I. Kiviranta,et al.  Slowly progressive osteoarthritis after tibial valgus osteotomy in young beagle dogs. , 1997, Clinical orthopaedics and related research.

[20]  B. Slocum,et al.  Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. , 1993, The Veterinary clinics of North America. Small animal practice.

[21]  M. B. Coventry.  Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. , 1987, The Journal of bone and joint surgery. American volume.