Treatment Outcome and Radiographic Appearance of Healed Tibial Tuberosity Avulsion Fractures in Skeletally Mature Dogs: 21 Cases (2016–2023)

Abstract

Objective

The aim of this study was to evaluate the function and radiographic appearance of healed tibial tuberosity avulsion fractures (TTAF) in dogs after they achieve skeletal maturity.

Study Design

This was a retrospective, single-centre cohort study. The medical records of skeletally mature dogs with previously treated TTAF were reviewed.

Bilateral mediolateral stifle radiographs were obtained. Radiographic measurements of tibial plateau angle, patellar position (PP) and axial and transverse tibial tuberosity position were statistically evaluated. Treatment outcome was assessed via direct examination and owner evaluation.

Results

Twenty-one dogs were included. Treatment groups were open reduction and internal fixation with pins only (n = 9), open reduction and internal fixation with pins and tension band (n = 6) and non-surgical management with a cast (n = 6). In surgically managed cases, the tibial plateau angle and transverse tibial tuberosity position of TTAF stifles decreased while PP and axial tibial tuberosity position increased. Changes were not observed in the non-surgically managed group. The outcome of surgically managed cases was excellent. The outcome of non-surgically managed cases was reported by owners as good to excellent, although medial patellar luxation was observed in two dogs.

Conclusion

Surgically managed TTAF result in altered tibial tuberosity and PP but lead to excellent outcomes despite morphologic changes at skeletal maturity. Non-surgically managed TTAF do not significantly alter tibial tuberosity and PP and result in good to excellent outcomes but may increase the risk of patellar luxation.

Keywords

tibial tuberosity avulsion fracture - radiographs - skeletal maturity - dog

Authors' Contribution

J.N.Z. contributed to study design, data collection, data analysis, interpretation of results, and manuscript writing. S.C.R. contributed to study conception, study design, interpretation of results, and manuscript revision. All authors approved the final manuscript.

Publication History

Received: 06 October 2024

Accepted: 07 April 2025

Article published online:
03 May 2025

• References

• 1 von Pfeil DJF, Megliolia S, Malek S, Rochat M, Glassman M. Tibial apophyseal percutaneous pinning in skeletally immature dogs: 25 cases (2016–2019). Vet Comp Orthop Traumatol 2021; 34 (02) 144-152
• 2 Gower JA, Bound NJ, Moores AP. Tibial tuberosity avulsion fracture in dogs: a review of 59 dogs. J Small Anim Pract 2008; 49 (07) 340-343
• 3 von Pfeil DJF, Decamp CE, Diegel KL, Gholve PA, Probst CW, Dejardin LM. Does Osgood-Schlatter disease exist in the dog?. Vet Comp Orthop Traumatol 2009; 22 (04) 257-263
• 4 Clements DN, Gemmill T, Corr SA, Bennett D, Carmichael S. Fracture of the proximal tibial epiphysis and tuberosity in 10 dogs. J Small Anim Pract 2003; 44 (08) 355-358
• 5 Goldsmid S, Johnson KA. Complications of canine tibial tuberosity avulsion fractures. Vet Comp Orthop Traumatol 1991; 4 (02) 54-58
• 6 von Pfeil DJF, Decamp CE, Ritter M. et al. Minimally displaced tibial tuberosity s fracture in nine skeletally immature large breed dogs. Vet Comp Orthop Traumatol 2012; 25 (06) 524-531
• 7 von Pfeil DJF, Glassman M, Ropski M. Percutaneous tibial physeal fracture repair in small animals: technique and 17 cases. Vet Comp Orthop Traumatol 2017; 30 (04) 279-287
• 8 Moyer AL, Hudson CC, Beale BS. Outcome of tibial tuberosity avulsion repaired by pin (Kirschner wire) fixation with or without a tension band. Vet Comp Orthop Traumatol 2019; 32 (S4): A13-A24
• 9 Miller ZA, Cabrera SY, Mason D, Kass PH. Good clinical outcomes achieved in young dogs with tibial tuberosity avulsion fracture repairs when implants were left in situ past skeletal maturity. J Am Vet Med Assoc 2022; 260 (15) 1941-1946
• 10 Verpaalen VD, Lewis DD, Billings GA. Biomechanical comparison of three stabilization methods for tibial tuberosity fractures in dogs: A cadaveric study. Vet Comp Orthop Traumatol 2021; 34 (04) 279-286
• 11 Verpaalen VD, Lewis DD. Use of a hybrid external skeletal fixator construct for managing tibial tuberosity avulsion fractures in three dogs. J Am Vet Med Assoc 2021; 258 (10) 1098-1108
• 12 Pratt JNJ. Avulsion of the tibial tuberosity with separation of the proximal tibial physis in seven dogs. Vet Rec 2001; 149 (12) 352-356
• 13 Maffulli N, Longo UG, Spiezia F, Denaro V. Sports injuries in young athletes: long-term outcome and prevention strategies. Phys Sportsmed 2010; 38 (02) 29-34
• 14 Aertsens A, Rincon Alvarez J, Poncet CM, Beaufrère H, Ragetly GR. Comparison of the tibia plateau angle between small and large dogs with cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2015; 28 (06) 385-390
• 15 Johnson AL, Broaddus KD, Hauptman JG, Marsh S, Monsere J, Sepulveda G. Vertical patellar position in large-breed dogs with clinically normal stifles and large-breed dogs with medial patellar luxation. Vet Surg 2006; 35 (01) 78-81
• 16 Fujita Y, Hara Y, Ochi H. et al. The possible role of the tibial plateau angle for the severity of osteoarthritis in dogs with cranial cruciate ligament rupture. J Vet Med Sci 2006; 68 (07) 675-679
• 17 Seo BS, Jeong IS, Piao Z. et al. Measurement of the tibial plateau angle of normal small-breed dogs and the application of the tibial plateau angle in cranial cruciate ligament rupture. J Adv Vet Anim Res 2020; 7 (02) 220-228
• 18 Warzee CC, Dejardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286
• 19 Duerr FM, Duncan CG, Savicky RS, Park RD, Egger EL, Palmer RH. Risk factors for excessive tibial plateau angle in large-breed dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2007; 231 (11) 1688-1691
• 20 Brown NP, Bertocci GE, Marcellin-Little DJ. Canine stifle joint biomechanics associated with tibial plateau leveling osteotomy predicted by use of a computer model. Am J Vet Res 2014; 75 (07) 626-632
• 21 Hayashi K, Manley PA, Muir P. Cranial cruciate ligament pathophysiology in dogs with cruciate disease: a review. J Am Anim Hosp Assoc 2004; 40 (05) 385-390
• 22 Vedrine B, Guillemot A, Fontaine D, Ragetly GR, Etchepareborde S. Comparative anatomy of the proximal tibia in healthy Labrador Retrievers and Yorkshire Terriers. Vet Comp Orthop Traumatol 2013; 26 (04) 266-270
• 23 Su L, Townsend KL, Au J, Wittum TE. Comparison of tibial plateau angles in small and large breed dogs. Can Vet J 2015; 56 (06) 610-614
• 24 Morris E, Lipowitz AJ. Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries. J Am Vet Med Assoc 2001; 218 (03) 363-366
• 25 Reif U, Probst CW. Comparison of tibial plateau angles in normal and cranial cruciate deficient stifles of Labrador retrievers. Vet Surg 2003; 32 (04) 385-389
• 26 Venzin C, Howard J, Rytz U. et al. Tibial plateau angles with and without cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2004; 17 (04) 232-236
• 27 Vincenti S, Knell S, Pozzi A. Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja. Schweiz Arch Tierheilkd 2017; 159 (04) 237-242
• 28 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23 (04) 777-795
• 29 Tepic S, Damur DM, Montavon PM. Biomechanics of the stifle joint (Abstract). Paper presented at: 1st World Orthopaedic Veterinary Congress. ; September 5–8, 2002 ; Munich, Germany.
• 30 Kowaleski MJ, Boundrieau RJ, Pozzi A. Stifle joint. In: Tobias KM, Johnston SA. eds. 2nd ed. Veterinary Surgery Small Animal. Saint Louis, MO: Elsevier Saunders; 2017: 1079-1141
• 31 Drew JO. The Effect of Tibial Tuberosity Distalization, Femoral Shortening, and Tibial Plateau Leveling Osteotomy on the Canine Stifle Extensor Mechanism [RMT dissertation]. Perth, Australia: Murdoch University; 2017
• 32 Murakami S, Nagahiro Y, Shimada M. et al. Effect of limb position on measurements of the quadriceps muscle length/femoral length ratio in normal Beagle dogs. Vet Comp Orthop Traumatol 2020; 33 (04) 279-286
• 33 Feldmane L, Theyse LFH. Proximodistal and caudocranial position of the insertion of the patellar ligament on the tibial tuberosity and patellar ligament length of normal stifles and stifles with grade II medial patellar luxation in small-breed dogs. Vet Surg 2021; 50 (05) 1017-1022
• 34 Murakami S, Shimada M, Hara Y. Examination of proximodistal patellar position in dogs with the stifle at full extension. Vet Comp Orthop Traumatol 2023; 36 (04) 199-206
• 35 Giansetto TE, Pierrot E, Picavet PP. et al. Patellar proximo-distal displacement following Modified Maquet Technique is not predictive of patellar luxation. Vet Comp Orthop Traumatol 2023; 36 (02) 63-67