Triple tibial osteotomy for treatment of the canine cranial cruciate ligament-deficient stifle joint

Summary

Objective: To report the surgical findings and early post-operative complications of triple tibial osteotomy (TTO) for the treatment of cranial cruciate ligament disruption in dogs.

Methods: Clinical records of 84 dogs (97 stifles) that had TTO procedures were reviewed. Surgical findings and postoperative complications were assessed. A complication was defined as any undesirable outcome resulting from TTO that required further diagnostic investigation or surgical treatment.

Results: Mean tibial wedge angle was 13.6 degrees (range 10–20). Incomplete tibial crest osteotomy was achieved in 79% of TTO procedures. Implants were placed in the tibial crest in 67% of stifles. Early postoperative complications occurred in 23% of joints, and included avulsion of the tibial crest (9.1%), fracture at the distal cortical attachment of the tibial crest (6.2%), fibula fracture (4.1%), patellar tendonitis (3.1%), late meniscal injury (3.1%), implant complications (3.1%) and patellar fracture (2.1%). Increased patient age (p = 0.023), increased wedge angle (p = 0.009) and intra-operative fracturing of the cranial tibial cortex (p = 0.017) were significantly associated with postoperative tibial crest avulsion. Implants did not prevent tibial crest avulsion. Increased patient age (p = 0.012) was significantly associated with tibial crest fracture.

Clinical relevance: Tibial crest avulsion and fracture are the most common postoperative complications for TTO. Late meniscal injury is uncommon after TTO.

Keywords

Triple tibial osteotomy - cranial cruciate ligament - stifle - canine - tibial plateau levelling

• References

• 1 Bruce WJ, Rose A, Tuke J. et al Evaluation of the triple tibial osteotomy. A new technique for the management of the canine cruciate-deficient stifle. Vet Comp Orthop Traumatol 2007; 20: 159-168.
• 2 Kim SE, Pozzi A, Kowaleski MP. et al Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125.
• 3 Bruce WJ.. Cranial Cruciate Ligament Injuries--Surgical Management. In Proceedings of the World Small Animal Veterinary Association World Congress, Sydney, Australia, August 2007
• 4 Bruce WJ.. TTO Workshop, Australian College of Veterinary Scientists, Surgery Chapter Conference, Gold Coast, Australia, July. 2008
• 5 Johnson KA, Francis DJ, Manley PA. et al Comparison of the effects of caudal pole hemi-meniscectomy and complete medial meniscectomy in the canine stifle joint. Am J Vet Res 2004; 65: 1053-1060.
• 6 Vasseur PB. Stifle Joint. In Textbook of Small Animal Surgery. 2^nd ed Slatter DH. (ed). Philadelphia: W.B.Saunders Co.; 1993: 1817-1865.
• 7 Priddy 2nd NH, Tomlinson JL, Dodam JR. 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). J Am Vet Med Assoc 2003; 222: 1726-1732.
• 8 Pacchiana PD, Morris E, Gillings SL. et al Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998–2001). J Am Vet Med Assoc 2003; 222: 184-193.
• 9 Stauffer KD, Tuttle TA, Elkins AD. et al Complications associated with 696 tibial plateau leveling osteotomies (2001–2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
• 10 Hoffmann DE, Miller JM, Ober CP. et al Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
• 11 Lafaver S, Miller NA, Stubbs WP. et al Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
• 12 Voss K, Damur DM, Guerrero T. et al Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2008; 21: 243-249.
• 13 Burns CG, Boudrieau RJ. Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints. Vet Comp Orthop Traumatol 2008; 21: 250-255.
• 14 Tepic S, Damur D, Montavon PM.. (2002) Biomechanics of the stifle. In ESVOT-VOS: 1st World Orthopaedic Veterinary Conference, Munich, Germany, 5^th-8^th September 2002
• 15 Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
• 16 Bergh MS, Rajala-Schultz P, Johnson KA. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37: 374-382.
• 17 Metelman L, Schwarz PD. et al An evaluation of three different cranial cruciate ligament surgical stabilization procedures as they relate to postoperative meniscal injuries. Vet Comp Orthop Traumatol 1995; 8: 118-123.
• 18 Fraser A.. Tibial tuberosity advancement in 59 dogs. In Proceedings of the Australian College of Veterinary Scientists, Surgery Chapter Conference, Gold Coast, Australia, July 2008
• 19 Thieman KM, Tomlinson JL, Fox DB. et al Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35: 705-710.
• 20 Case JB, Hulse D, Kerwin SC. et al Meniscal injury following initial cranial cruciate ligament stabilization surgery in 26 dogs (29 stifles). Vet Comp Orthop Traumatol 2008; 21: 365-367.
• 21 Corr SA, Brown C. A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures. Vet Comp Orthop Traumatol 2007; 20: 312-319.
• 22 Piermattei DL, Flo GL.. The stifle joint. In Brinker, Piermattei, and Flo’s Handbook of small animal orthopaedics and fracture repair 3^rd ed Philadelphia: W.B.Saunders Co.; 1997: 516-579.
• 23 Caylor KB, Zumpano CA, Evans LM. et al Intraand interobserver measurement variability of tibial plateau slope from lateral radiographs in dogs. J Am Anim Hosp Assoc 2001; 37: 263-268.