Modified Tibial Plateau Leveling Osteotomy Combined with Cranial Closing Wedge in a Pomeranian Dog: A Case Report

Cranial cruciate ligament disease (CCLD) with medial patellar luxation occurs in up to 25% of cases with pelvic limb lameness and is influenced by misalignment of the stifle’s extensor mechanism. The tibial plateau levelling osteotomy (TPLO) is the preferred technique for treating CCLD but is limited to cases where the tibial plateau angle (TPA) is below 35 degrees. For cases of CCLR with medial patellar luxation and up to 15 degrees of proximal tibial torsion, a modified TPLO technique (TPLO-m) can align the patellar ligament insertion with a single osteotomy. In cases where the TPA exceeds 35 degrees, TPLO is often combined with cranial closing wedge osteotomy (CCWO), though a combination of CCWO and TPLO-M has not yet been described. A 3-year-old, 3.9 kg Pomeranian dog presented with left pelvic limb lameness due to grade III patellar luxation and cranial cruciate ligament rupture. Computed tomography confirmed 15 degrees of proximal tibial torsion and a TPA of 37.5 degrees. The surgery involved a CCWO to reduce the TPA by 10 degrees, followed by TPLO-M to achieve a final angle of 5 degrees. Fixation was achieved with pin and cerclage wires, along with a noncompressive locking plate. The dog showed excellent recovery without lameness, with bone consolidation at 90 days and implant removal at 110 days. This case documents the effectiveness of combining TPLO-m and CCWO techniques to treat CCLR with high TPA and medial patellar luxation, showing promising results.

Acknowledgment

None.

Publication History

Article published online:
15 July 2025