Tibial tuberosity fracture as a complication of tibial tuberosity advancement

Summary

Objectives

To retrospectively compare two clinical subsets of dogs suffering tibial tuberosity (TT) fracture (incidental finding or sudden onset severe lameness) as a complication of tibial tuberosity advancement (TTA) and to report the surgical management and outcome of TT fracture as a complication of TTA.

Material and methods

The medical records of 10 dogs with eleven TT fractures or crest fractures after TTA were reviewed. The outcome and complications were determined from clinical and radiographic follow-up examinations. Limb function was evaluated between six and 12 weeks postoperatively. Owners were contacted by phone for long-term follow-up at least six months after the last examination.

Results

Four dogs required surgical stabilization and six dogs had conservative management. In the surgical group, every case experienced a sudden non-weight-bearing lameness after the initial TTA surgery. In three of the four cases an attempt was made to stabilize the TT and crest fracture while maintaining the TT advancement. Postoperative complications were encountered in three of the four surgically treated cases. Functional outcome was considered excellent in seven cases and good in the other three.

Clinical significance

Tibial tuberosity fracture is a complication of TTA that seems to have a favourable prognosis, although it can result in significant morbidity and in some cases revision surgery may be required.

Keywords

TTA - tibial tuberosity - fracture - dog - stifle

• References

• 1 Hoffmann DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
• 2 Lafaver S, Miller NA, Stubbs WP. et al. Tibial tuberosity advancement for stabilization of the cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
• 3 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. Proceedings of the 1st World Veterinary Orthopaedic Congress. 2002. September 5-8 Munich, Germany: pg. 89.
• 4 Tepic S, Montavon PM. Is cranial tibial advancement relevant in the cruciate deficient stifle?. Proceedings of the 12th ESVOT Congress. 2004. September 10-12 Munich, Germany: pg. 132-133.
• 5 Hulse D. Evidence based evidence information regarding TPLO and TTA. Proceedings of the 31st WSAVA/12th FECAVA/14th CSAVA Congress. 2006. October 11-14 Prague, Czech Republic: pg. 625.
• 6 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
• 7 Stein S, Schmoekel H. Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. J Small Anim Prac 2008; 49: 398-404.
• 8 Wolf RE, Scavelly TD, Hoelzler MG. et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007-2009). J Am Vet Med Assoc 2012; 240: 1481-1487.
• 9 Boudrieau RJ. Tibial tuberosity advancement (TTA): Beyond the learning curve. Kyon Symposium: Innovations in veterinary orthopaedics and trauma. 2008. April 19 Zurich, Switzerland:
• 10 Pacchianna PD, Morris E, Gillins SL. et al. Surgical and postoperative complications associated with tibial plateau levelling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-193.
• 11 Priddy II 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.
• 12 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.
• 13 Calvo I, Yeadon R, Bennett D. Tibial tuberosity fracture as a complication of tibial tuberosity advancement: Risk factors. Proceedings of the 2011 BSAVA Congress. 2011. March 31- April 3 Birmingham, UK: pg. 442.
• 14 Calvo I, Yeadon R, Chase D. et al. Tibial tuberosity fracture as a complication of tibial tuberosity advancement: Risk factors and management. Proceedings of the III World Veterinary Orthopaedic Congress. 2010. September 15-18 Bologna, Italy: pg. 89.
• 15 Piermattei DL, Johnson KA. Approach to the stifle joint through a medial incision. In: An Atlas of Approaches to the Bone and Joints of the Dog and Cat. Philadelphia: WB Saunders; 2004. pg. 2004-346.
• 16 Higgins B, Coughlan A, Pettitt R. et al. The use of transarticular external skeletal fixation in the management of failed tibial tuberosity transposition in five dogs. Vet Comp Orthop Traumatol 2010; 23: 109-111.
• 17 Proot LJL, Corr SA. Clinical audit for the tibial tuberosity advancement procedure: establishing the learning curve and monitoring ongoing performance for the tibial tuberosity advancement procedure using the cumulative summation technique. Vet Comp Orthop Traumatol 2013; 26: 280-284.