Tibial Plateau Leveling Osteotomy Plate Design Influences Interfragmentary Compression: An In Vitro Study

Abstract

Objectives

To compare immediate, static interfragmentary compression patterns of three tibial plateau leveling osteotomy (TPLO) plate designs.

Study Design

TPLO was performed on 15 synthetic canine tibiae (SYNBONE AG, Switzerland) using 3D-printed guides. Compression was evaluated using pressure-sensitive films (Prescale, Fujifilm, UK). Three 3.5-mm TPLO plates were tested according to the manufacturer guidelines for dynamic compression screws placement: Synthes, Arthrex, and Biocurve. Each plate was tested five times using a new bone model. The interfragmentary surface was divided into quadrants: Q1 (craniomedial), Q2 (craniolateral), Q3 (caudomedial), and Q4 (caudolateral). Compression was classified as low (<0.12 MPa), moderate (0.12–0.25 MPa), or high (>0.25 MPa).

Results

Significant differences in overall interfragmentary compression were found among the plates (p < 0.001). The Biocurve plate generated the highest and most uniform compression (Q1: 0.285 ± 0.023 MPa; Q2: 0.304 ± 0.010 MPa; Q3: 0.220 ± 0.014 MPa; Q4: 0.237 ± 0.010 MPa). The Arthrex plate produced high compression in Q2 (0.292 ± 0.012 MPa) and moderate in other quadrants (Q1: 0.177 ± 0.016 MPa; Q3: 0.141 ± 0.011 MPa; Q4: 0.189 ± 0.013 MPa). The Synthes plate showed the lowest compression throughout (Q1: 0.050 ± 0.008 MPa; Q2: 0.075 ± 0.009 MPa; Q3: 0.111 ± 0.008 MPa; Q4: 0.109 ± 0.008 MPa).

Conclusion

The Biocurve plate, with two angled dynamic compression screw holes, provided the highest, most uniform compression. Further studies are needed to assess clinical relevance.

Keywords

TPLO - interfragmentary compression - compression patterns - tibial plateau leveling osteotomy - cranial cruciate ligament disease

Authors' Contribution

D.M. developed the study design, designed the 3D-printed guides, contributed to data collection and analysis, manuscript drafting, and reviewing. R.A. contributed to study design, data collection and analysis, manuscript drafting, and reviewing. M.Z. contributed to data collection, manuscript drafting, and reviewing.

Publication History

Received: 05 December 2024

Accepted: 04 July 2025

Article published online:
01 August 2025

• References

• 1 Johnson JM, Johnson AL. Cranial cruciate ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Vet Clin North Am Small Anim Pract 1993; 23 (04) 717-733
• 2 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39 (04) 460-474
• 3 Coletti TJ, Anderson M, Gorse MJ, Madsen R. Complications associated with tibial plateau leveling osteotomy: a retrospective of 1519 procedures. Can Vet J 2014; 55 (03) 249-254
• 4 Baki ME, Aldemir C, Duygun F, Doğan A, Kerimoğlu G. Comparison of non-compression and compression interlocking intramedullary nailing in rabbit femoral shaft osteotomy model. Eklem Hastalik Cerrahisi 2017; 28 (01) 7-12
• 5 Solano MA, Danielski A, Kovach K, Fitzpatrick N, Farrell M. Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg. Vet Surg 2015; 44 (01) 59-64
• 6 McGregor RE, Buffa EA, Tan CJ, Schembri MA, Badcock CA, Lai A. A retrospective study using the string of pearls tibial plateau levelling osteotomy locking plate for the treatment of cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2019; 32 (06) 483-491
• 7 Alvarez R, Motta C, Miraldo D. In vitro assessment of compression patterns using different methods to achieve interfragmentary compression during tibial plateau levelling osteotomy. Vet Comp Orthop Traumatol 2024; 37 (03) 130-137
• 8 Johnson AL, Houlton JE, Vannini R. AO Principles of Fracture Management in the Dog and Cat. AO Publishing; 2005; available at: https://vetbooks.ir/ao-principles-of-fracture-management-in-the-dog-and-cat-pdf-dvd/
• 9 Aro HT, Chao EY. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res 1993; (293) 8-17
• 10 Kowaleski MP, Boudrieau RJ, Beale BS, Piras A, Hulse D, Johnson KA. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. Vet Surg 2013; 42 (07) 847-852
• 11 Kowaleski MP, McCarthy RJ. Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope. Vet Comp Orthop Traumatol 2004; 17 (01) 30-34
• 12 Wallace AL, Draper ER, Strachan RK, McCarthy ID, Hughes SP. The vascular response to fracture micromovement. Clin Orthop Relat Res 1994; (301) 281-290
• 13 Macrì F, Cicero L, Angileri V. et al. Locking compression plates versus locking plates for tibial plateau levelling osteotomy in dogs: progression of osteoarthritis, bone healing score and lameness degree. BMC Vet Res 2021; 17 (01) 193
• 14 Jermyn K, Roe SC. Influence of screw insertion order on compression generated by bone plates in a fracture model. Vet Comp Orthop Traumatol 2011; 24 (06) 403-407
• 15 Csiszer AB, Daly CM, Dyce J, Litsky AS, Olmstead ML. Comparison of the effects of two screw insertion patterns on bone fragment translocation in a 3.5 mm dynamic compression plate and a 3.5 mm limited-contact dynamic compression plate. Vet Surg 2012; 41 (02) 300-306
• 16 Assari S, Darvish K, Ilyas AM. Biomechanical analysis of second-generation headless compression screws. Injury 2012; 43 (07) 1159-1165
• 17 Acker ML, Torrance B, Kowaleski MP, Boudrieau RJ. Structural properties of synthetic bone models compared to native canine bone. In: Proceedings of the 19th Annual Scientific Meeting of the European College of Veterinary Surgeons; February 20--27, 2010; Colorado, United States: A15
• 18 Gardner MP, Chong AC, Pollock AG, Wooley PH. Mechanical evaluation of large-size fourth-generation composite femur and tibia models. Ann Biomed Eng 2010; 38 (03) 613-620
• 19 Marturello DM, Wei F, Déjardin LM. Characterization of the torsional structural properties of feline femurs and surrogate bone models for mechanical testing of orthopedic implants. Vet Surg 2019; 48 (02) 229-236