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Tierarztl Prax Ausg K Kleintiere Heimtiere 2018; 46(04): 223-235
DOI: 10.15654/TPK-170486
Originalartikel – Original Article
Georg Thieme Verlag KG Stuttgart · New York

Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review

Tibial Plateau Leveling Osteotomy und Tibial Tuberosity Advancement – eine systematische Literaturübersicht
Patricia Beer
1   Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine Vienna, Austria
,
Barbara Bockstahler
2   Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section for Physical Therapy, University of Veterinary Medicine, Austria
,
Eva Schnabl-Feichter
1   Department for Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, University of Veterinary Medicine Vienna, Austria
› Institutsangaben
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Publikationsverlauf

Received: 24. Juli 2017

Accepted after revision: 20. März 2018

Publikationsdatum:
27. August 2018 (online)

Auch verfügbar aufVetCenter
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Summary

Objective: The optimal surgical technique for treatment of cranial cruciate ligament rupture in canine has been scientifically discussed for decades. Despite the continuous debate, proximal tibial osteotomies such as tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) are increasingly common. The objective of this review was to systematically evaluate the literature reporting outcome and complications associated with TPLO and TTA. Materials and methods: A systematic search of literature databases identified articles published from August 2004 to February 2016 describing evaluations of short- or longterm outcomes as well as complications following TPLO or TTA. Results: Ninety-one studies were included in this review and assigned to one out of four evidence levels. Of those, 89 studies provided the lowest evidence level and only two were assigned to the third-best evidence level. A comparison of subjective gait analyses could not detect differences in the decrease of lameness between TPLO and TTA, while objective gait analysis supports the superiority of TPLO. Fewer patients treated with TPLO were diagnosed with postoperative joint instability and TPLO had a lower percent increase of osteoarthritis (OA) after surgery. Owner satisfaction was high for both techniques. For TPLO and TTA the average total, minor, major and catastrophic complication rates were 15.9 % and 20.8 %, 7.9 % and 11.6 %, 5.2 % and 13.2 % as well as 0.8 % and 5.6 %, respectively. Conclusion and clinical significance: The assessed literature supports the hypothesis that TPLO is associated with lower complication rates, an improved clinical-functional outcome and less increase of OA compared to TTA. The results are indicative for a long-term restoration of normal limb function after TPLO. However, the strength of available evidence and the comparability of each study’s results were poor and more comparative studies are needed to draw strong conclusions towards the superiority of the TPLO over the TTA.

Zusammenfassung

Gegenstand und Ziel: Die optimale chirurgische Technik zur Behandlung der Ruptur des vorderen Kreuzbands beim Hund ist seit Jahrzehnten ein viel diskutiertes Thema in der Kleintierorthopädie. Trotz anhaltender Diskussionen werden Osteotomietechniken der Tibia, die Tibial Plateau Leveling Osteotomy (TPLO) und das Tibial Tuberosity Advance ment (TTA), immer häufiger angewendet. In diesem Artikel werden die in der Literatur beschriebenen Ergebnisse und Komplikationen nach einer TPLO und TTA systematisch zusammengefasst und verglichen. Material und Methoden: Nach systematischer Literaturrecherche zu klinischen Studien über TPLO oder TTA wurden zwischen August 2004 und Februar 2016 publizierte Studien inkludiert, die über Kurz- oder Langzeitergebnisse und Komplikationen berichteten. Ergebnisse: Die 91 analysierten Studien wurden einer von vier Evidenzklassen zugeteilt. Zwei Studien entsprachen der drittbesten Evidenzklasse, 89 der niedrigsten Evidenzklasse. Ein Vergleich der Ergebnisse subjektiver Lahmheitsuntersuchungen zeigte keine eindeutigen Unterschiede zwischen den Techniken. Objektive Ganganalysen wiesen auf bessere Resultate nach TPLO hin. Die TPLO war mit einer geringeren postoperativen Zunahme der Osteoarthritis (OA) verbunden und bei weniger Patienten wurde postoperativ eine Gelenkinstabilität diagnostiziert. Die durchschnittlichen Gesamtkomplikationsraten betrugen für die TPLO und TTA 15,9 % bzw. 20,8 %, die gering-, mittel- und hochgradigen Komplikationsraten 7,9 % bzw. 11,6 %, 5,2 % bzw. 13,2 % sowie 0,8 % bzw. 5,6 %. Schlussfolgerung und klinische Rele vanz: Aktuelle Publikationen stützen die Hypothese, dass die TPLO mit besseren klinisch-funktionellen und radiologischen Ergebnissen, einer geringeren Zunahme der OA sowie geringeren Komplikationsraten einhergeht. Die Resultate der Studie lassen auf eine Lang-zeitwiederherstellung der normalen Giedmaßenfunktion nach einer TPLO schließen. Zu beachten sind jedoch das niedrige Evidenzniveau und die limitierte Vergleichbarkeit der Resultate verschiedener Studien. Um eindeutige Aussagen bezüglich der Überlegenheit der TPLO gegenüber der TTA ziehen zu können, bedarf es weiterer Vergleichsstudien.

Keywords

Stifle joint - complications - TPLO - TTA - cranial cruciate ligament

Schlüsselwörter

Kniegelenk - Komplikationen - TPLO - TTA - vorderes Kreuzband

 

  • References

  • 1 Apelt D, Kowaleski MP, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study.. Vet Surg 2007; 36 (02) 170-177.
    CrossrefPubMedSuche in Google Scholar
  • 2 Aragon CL, Budsberg SC. Applications of evidence-based medicine: cranial cruciate ligament injury repair in the dog.. Vet Surg 2005; 34 (02) 93-98.
    CrossrefPubMedSuche in Google Scholar
  • 3 Au KK, Gordon-Evans WJ, Dunning D, O‘Dell-Anderson KJ, Knap KE, Griffon D. et al Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization.. Vet Surg 2010; 39 (02) 173-180.
    CrossrefPubMedSuche in Google Scholar
  • 4 Berger B. Vergleichende Evaluierung der Therapieergebnisse nach Ruptur des vorderen Kreuzbandes bei Hunden kleinwüchsiger Rassen nach chirurgischer Versorgung mittels Umstellungsosteotomie (TPLO) oder extrakapsulärer Technik.. Thesis: Ludwig-Maximilian University Munich; 2014
    Suche in Google Scholar
  • 5 Bergh MS, Sullivan C, Ferrell CL, Troy J, Budsberg SC. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs.. J Am Anim Hosp Assoc 2014; 50 (05) 315-321.
    CrossrefPubMedSuche in Google Scholar
  • 6 Binder E. A comparison of two locking plate systems in clinical use in a tibial plateau leveling osteotomy with special focus on their application characteristics.. Thesis: Justus-Liebig University of Giessen; 2012
    Suche in Google Scholar
  • 7 Boddeker J, Druen S, Meyer-Lindenberg A, Fehr M, Nolte I, Wefstaedt P. Computer-assisted gait analysis of the dog: comparison of two surgical techniques for the ruptured cranial cruciate ligament.. Vet Comp Orthop Traumatol 2012; 25 (01) 11-21.
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 Boyd DJ, Miller CW, Etue SM, Monteith G. Radiographic and functional evaluation of dogs at least 1 year after tibial plateau leveling osteotomy.. Can Vet J 2007; 48 (04) 392-396.
    PubMedSuche in Google Scholar
  • 9 Brahm T. Umstellungsosteotomie des Tibiaplateaus nach B. Slocum zur Behandlung der vorderen Kreuzbandruptur beim Hund: retrospektive Erhebungen bei 115 Fällen.. Thesis: Ludwig-Maximilian University Munich; 2004
    Suche in Google Scholar
  • 10 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 (03) 250-255.
    Thieme ConnectPubMedSuche in Google Scholar
  • 11 Bush MA, Sibley P, Owen MA, Burton NJ, Owen MR, Colborne GR. Inverse dynamics analysis evaluation of tibial tuberosity advancement for cranial cruciate ligament failure in dogs.. Vet Surg 2012; 41 (04) 471-481.
    CrossrefPubMedSuche in Google Scholar
  • 12 Chauvet AE, Johnson AL, Pijanowski GJ, Homco L, Smith RD. Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: a retrospective study.. J Am Anim Hosp Assoc 1996; 32 (03) 247-255.
    CrossrefPubMedSuche in Google Scholar
  • 13 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs.. Vet Surg 2013; 42 (03) 329-334.
    CrossrefPubMedSuche in Google Scholar
  • 14 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.
    PubMedSuche in Google Scholar
  • 15 Conzemius MG, Evans RB, Besancon MF, Gordon WJ, Horstman CL, Hoefle WD. et al Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs.. J Am Vet Med Assoc 2005; 226 (02) 232-236.
    CrossrefPubMedSuche in Google Scholar
  • 16 Cook JL, Evans R, Conzemius MG, Lascelles BD, McIlwraith CW, Pozzi A. et al Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine.. Vet Surg 2010; 39 (08) 905-908.
    CrossrefPubMedSuche in Google Scholar
  • 17 Cook JL, Luther JK, Beetem J, Karnes J, Cook CR. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs.. Vet Surg 2010; 39 (03) 315-323.
    CrossrefPubMedSuche in Google Scholar
  • 18 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 (04) 312-319.
    Thieme ConnectPubMedSuche in Google Scholar
  • 19 Cosenza G, Reif U, Martini FM. Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates. A clinical and radiographic retrospective assessment.. Vet Comp Orthop Traumatol 2015; 28 (05) 347-354.
    Thieme ConnectPubMedSuche in Google Scholar
  • 20 Costa M, Craig D, Cambridge T, Sebestyen P, Su Y, Fahie MA. Major complications of tibial tuberosity advancement in 1613 dogs.. Vet Surg 2017; 46 (04) 494-500.
    CrossrefPubMedSuche in Google Scholar
  • 21 de Medeiros M, Sanchez Bustinduy M, Radke H, Langley-Hobbs S, Jeffery N. Early kinematic outcome after treatment of cranial cruciate ligament rupture by tibial plateau levelling osteotomy in the dog.. Vet Comp Orthop Traumatol 2011; 24 (03) 178-184.
    Thieme ConnectPubMedSuche in Google Scholar
  • 22 DeLuke AM, Allen DA, Wilson ER, Lineberger JA, Lehenbauer TW, Fabiani M. et al Comparison of radiographic osteoarthritis scores in dogs less than 24 months or greater than 24 months following tibial plateau leveling osteotomy.. Can Vet J 2012; 53 (10) 1095-1099.
    PubMedSuche in Google Scholar
  • 23 Duerr FM, Martin KW, Rishniw M, Palmer RH, Selmic LE. Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians.. Vet Comp Orthop Traumatol 2014; 27 (06) 478-483.
    Thieme ConnectPubMedSuche in Google Scholar
  • 24 Dymond NL, Goldsmid SE, Simpson DJ. Tibial tuberosity advancement in 92 canine stifles: initial results, clinical outcome and owner evaluation.. Aust Vet J 2010; 88 (10) 381-385.
    CrossrefPubMedSuche in Google Scholar
  • 25 Evans R, Horstman C, Conzemius M. Accuracy and optimization of force platform gait analysis in Labradors with cranial cruciate disease evaluated at a walking gait.. Vet Surg 2005; 34 (05) 445-449.
    CrossrefPubMedSuche in Google Scholar
  • 26 Ferreira MP, Ferrigno CRA, de Souza ANA, Caquias DFI, de Figueiredo AV. Short-term comparison of tibial tuberosity advancement and tibial plateau levelling osteotomy in dogs with cranial cruciate ligament disease using kinetic analysis.. Vet Comp Orthop Traumatol 2016; 29 (03) 209-213.
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Fitzpatrick N, Johnson J, Hayashi K, Girling S, Yeadon R. Tibial plateau leveling and medial opening crescentic osteotomy for treatment of cranial cruciate ligament rupture in dogs with tibia vara.. Vet Surg 2010; 39 (04) 444-453.
    CrossrefPubMedSuche in Google Scholar
  • 28 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.
    CrossrefPubMedSuche in Google Scholar
  • 29 Garnett SD, Daye RM. Short-term complications associated with TPLO in dogs using 2.0 and 2.7 mm plates.. J Am Vet Med Assoc 2014; 50 (06) 396-404.
    PubMedSuche in Google Scholar
  • 30 Gatineau M, Dupuis J, Plante J, Moreau M. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent ‚pivot shift‘, meniscal tear and other complications.. Vet Comp Orthop Traumatol 2011; 24 (05) 333-341.
    Thieme ConnectPubMedSuche in Google Scholar
  • 31 Gordon-Evans WJ, Griffon DJ, Bubb C, Knap KM, Sullivan M, Evans RB. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease.. J Am Vet Med Assoc 2013; 243 (05) 675-680.
    CrossrefPubMedSuche in Google Scholar
  • 32 Hans EC, Barnhart MD, Kennedy SC, Naber SJ. Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight.. Vet Comp Orthop Traumatol 2017; 30 (04) 299-305.
    Thieme ConnectPubMedSuche in Google Scholar
  • 33 Headrick JF, Zhang S, Millard RP, Rohrbach BW, Weigel JP, Millis DL. Use of an inverse dynamics method to compare the three-dimensional motion of the pelvic limb among clinically normal dogs and dogs with cranial cruciate ligament-deficient stifle joints following tibial plateau leveling osteotomy or lateral fabellar-tibial suture stabilization.. Am J Vet Res 2014; 75 (06) 554-564.
    CrossrefPubMedSuche in Google Scholar
  • 34 Hirshenson MS, Krotscheck U, Thompson MS, Knapp-Hoch HM, Jay-Silva AR, McConkey M. et al Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs.. Vet Comp Orthop Traumatol 2012; 25 (05) 402-409.
    Thieme ConnectPubMedSuche in Google Scholar
  • 35 Hoffmann DE, Miller JM, Ober CP, Lanz OI, Martin RA, Shires PK. Tibial tuberosity advancement in 65 canine stifles.. Vet Comp Orthop Traumatol 2006; 19 (04) 219-227.
    Thieme ConnectPubMedSuche in Google Scholar
  • 36 Hurley CR, Hammer DL, Shott S. Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001-2005).. J Am Vet Med Assoc 2007; 230 (11) 1674-1679.
    CrossrefPubMedSuche in Google Scholar
  • 37 Imholt KM, Moller S, Fehr M, Meyer-Lindenberg A. Lameness and osteoarthritis development following Tibial Plateau Leveling Osteotomy (TPLO) and potential prognostic predictors. A long-term retrospective study.. Tierarztl Prax 2011; 39 (K) 323-335.
    PubMedSuche in Google Scholar
  • 38 Jandi AS, Schulman AJ. Incidence of motion loss of the stifle joint in dogs with naturally occurring cranial cruciate ligament rupture surgically treated with tibial plateau leveling osteotomy: longitudinal clinical study of 412 cases.. Vet Surg 2007; 36 (02) 114-121.
    CrossrefPubMedSuche in Google Scholar
  • 39 Kim SE, Lewis DD, Pozzi A. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing.. Vet Surg 2012; 41 (04) 465-470.
    CrossrefPubMedSuche in Google Scholar
  • 40 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial plateau leveling osteotomy on femorotibial contact mechanics and stifle kinematics.. Vet Surg 2009; 38 (01) 23-32.
    CrossrefPubMedSuche in Google Scholar
  • 41 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics.. Vet Surg 2009; 38 (01) 33-39.
    CrossrefPubMedSuche in Google Scholar
  • 42 Kim SE, Pozzi A, Kowaleski MP, Lewis DD. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs.. Vet Surg 2008; 37 (02) 111-125.
    CrossrefPubMedSuche in Google Scholar
  • 43 Kloene P. Therapy results in dogs with a (partial) rupture of the cranial cruciate ligament after arthroscopy and minimally invasive lateral retinacular imbrication as well as after Tibial Plateau Leveling Osteotomy (TPLO).. Thesis: University of Veterinary Medicine Hannover, Foundation; 2005
    Suche in Google Scholar
  • 44 König T, Scholz M, Bollert N, Höhner F. Modified TTA using a spacer: Advantages and limitations of a simplified surgical technique for cranial cruciate rupture in dogs.. Kleintierprax 2013; 58: 221-238.
    PubMedSuche in Google Scholar
  • 45 Krotscheck U, Nelson SA, Todhunter RJ, Stone M, Zhang Z. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs.. Vet Surg 2016; 45 (02) 261-268.
    CrossrefPubMedSuche in Google Scholar
  • 46 Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. 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 (06) 573-586.
    CrossrefPubMedSuche in Google Scholar
  • 47 Langenbach A, Marcellin-Little DJ. Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling.. J Small Anim Pract 2010; 51 (02) 97-103.
    CrossrefPubMedSuche in Google Scholar
  • 48 Lazar TP, Berry CR, deHaan JJ, Peck JN, Correa M. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog.. Vet Surg 2005; 34 (02) 133-141.
    CrossrefPubMedSuche in Google Scholar
  • 49 Lee JY, Kim G, Kim JH, Choi SH. Kinematic gait analysis of the hind limb after tibial plateau levelling osteotomy and cranial tibial wedge osteotomy in ten dogs.. J Vet Med A Physiol Pathol Clin Med 2007; 54 (10) 579-584.
    CrossrefPubMedSuche in Google Scholar
  • 50 Leitch BJ, Worth AJ. Tibial tuberosity advancement with lateralisation for treatment of cranial cruciate ligament disruption and concurrent medial patella luxation in six dogs.. Aust Vet Pract 2011; 41 (03) 100-106.
    PubMedSuche in Google Scholar
  • 51 Lineberger JA, Allen DA, Wilson ER, Tobias TA, Shaiken LG, Shiroma JT. et al Comparison of radiographic arthritic changes associated with two variations of tibial plateau leveling osteotomy.. Vet Comp Orthop Traumatol 2005; 18 (01) 13-17.
    Thieme ConnectPubMedSuche in Google Scholar
  • 52 MacDonald TL, Allen DA, Monteith GJ. Clinical assessment following tibial tuberosity advancement in 28 stifles at 6 months and 1 year after surgery.. Can Vet J 2013; 54 (03) 249-254.
    PubMedSuche in Google Scholar
  • 53 Moeller EM, Allen DA, Wilson ER, Lineberger JA, Lehenbauer T. Long-term outcomes of thigh circumference, stifle range-of-motion, and lameness after unilateral tibial plateau levelling osteotomy.. Vet Comp Orthop Traumatol 2010; 23 (01) 37-42.
    Thieme ConnectPubMedSuche in Google Scholar
  • 54 Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament.. Am J Vet Res 2006; 67 (03) 529-536.
    CrossrefPubMedSuche in Google Scholar
  • 55 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate ligamnet deficient canine stifle. Proceedings of the 1st World Orthopaedic Veterinary Congress; September 5-8.; Munich. Germany: European Society of Veterinary Orthopaedics and Traumatology, Veterinary Orthopaedic Society; 2002: 152
    Suche in Google Scholar
  • 56 Morgan JP, Voss K, Damur DM, Guerrero T, Haessig M, Montavon PM. Correlation of radiographic changes after tibial tuberosity advancement in dogs with cranial cruciate-deficient stifles with functional outcome.. Vet Surg 2010; 39 (04) 425-432.
    CrossrefPubMedSuche in Google Scholar
  • 57 Nelson SA, Krotscheck U, Rawlinson J, Todhunter RJ, Zhang Z, Mohammed H. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs.. Vet Surg 2013; 42 (01) 38-50.
    CrossrefPubMedSuche in Google Scholar
  • 58 Oxley B, Gemmill TJ, Renwick AR, Clements DN, McKee WM. Comparison of complication rates and clinical outcome between tibial plateau leveling osteotomy and a modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament disease in dogs.. Vet Surg 2013; 42 (06) 739-750.
    CrossrefPubMedSuche in Google Scholar
  • 59 Pfeil K. Langzeitergebnisse nach Tibiaplateau Leveling Osteotomie zur Behandlung der Ruptur des Ligamentum cruciatum craniale beim Hund – retrospektive Erhebungen bei 93 Fällen.. Thesis: University of Veterinary Medicine Hannover, Foundation; 2015
    Suche in Google Scholar
  • 60 Proot JL, 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 (04) 280-284.
    Thieme ConnectPubMedSuche in Google Scholar
  • 61 Quinn MM, Keuler NS, Lu Y, Faria ML, Muir P, Markel MD. Evaluation of agreement between numerical rating scales, visual analogue scoring scales, and force plate gait analysis in dogs.. Vet Surg 2007; 36 (04) 360-367.
    CrossrefPubMedSuche in Google Scholar
  • 62 Robinson DA, Mason DR, Evans R, Conzemius MG. The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau leveling osteotomy in Labrador Retrievers.. Vet Surg 2006; 35 (03) 294-299.
    PubMedSuche in Google Scholar
  • 63 Samoy Y, Verhoeven G, Bosmans T, Van der Vekens E, de Bakker E, Verleyen P. et al TTA rapid: description of the technique and short term clinical trial results of the first 50 cases.. Vet Surg 2015; 44 (04) 474-484.
    CrossrefPubMedSuche in Google Scholar
  • 64 Santesso N, Maxwell L, Tugwell PS, Buchbinder R, Johnston R. Systematic reviews from the Cochrane Musculoskeletal Group.. J Can Chiropract Assoc 2006; 50 (04) 238-243.
    PubMedSuche in Google Scholar
  • 65 Skinner OT, Kim SE, Lewis DD, Pozzi A. In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs.. Vet J 2013; 196 (01) 86-91.
    CrossrefPubMedSuche in Google Scholar
  • 66 Skytte D, Schmokel H, Miles J. Partial rupture of the cranial cruciate ligament treated with tibial tuberosity advancement without debridement of the remaining ligament: a clinical study of 18 cases.. Schweiz Arch Tierheilk 2014; 156 (09) 447-449.
    CrossrefPubMedSuche in Google Scholar
  • 67 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.
    CrossrefPubMedSuche in Google Scholar
  • 68 Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003).. J Am Vet Med Assoc 2006; 42 (01) 44-50.
    PubMedSuche in Google Scholar
  • 69 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 Pract 2008; 49 (08) 398-404.
    CrossrefPubMedSuche in Google Scholar
  • 70 Steinberg EJ, Prata RG, Palazzini K, Brown DC. Tibial tuberosity advancement for treatment of CrCL injury: complications and owner satisfaction.. J Am Anim Hosp Assoc 2011; 47 (04) 250-257.
    CrossrefPubMedSuche in Google Scholar
  • 71 Thieman KM, Tomlinson JL, Fox DB, Cook C, Cook JL. 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 (08) 705-710.
    CrossrefPubMedSuche in Google Scholar
  • 72 Vasseur PB. Clinical results following nonoperative management for rupture of the cranial cruciate ligament in dogs.. Vet Surg 1984; 13 (04) 243-466.
    CrossrefPubMedSuche in Google Scholar
  • 73 Vezzoni A. Tibial plateau leveling osteotomy versus tibial tuberosity advancement. Proceedings of the North American Veterinary Conference, Small animal and exotics. 5-19 January. Orlando, Florida, USA. Gainseville: The North American Veterinary Conference; 2011: 1063-1064.
    Suche in Google Scholar
  • 74 von Pfeil DJ, Edwards MR, Nelson NC. Handling of the tibial muscle envelope in tibial plateau levelling osteotomy – to elevate or not? A clinical study of 40 dogs.. Vet Comp Orthop Traumatol 2013; 26 (05) 392-398.
    Thieme ConnectPubMedSuche in Google Scholar
  • 75 Voss K, Damur DM, Guerrero T, Haessig M, Montavon PM. 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 (03) 243-249.
    Thieme ConnectPubMedSuche in Google Scholar
  • 76 Waxman AS, Robinson DA, Evans RB, Hulse DA, Innes JF, Conzemius MG. Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness.. Vet Surg 2008; 37 (03) 241-246.
    CrossrefPubMedSuche in Google Scholar
  • 77 Wilke VL, Robinson DA, Evans RB, Rothschild MF, Conzemius MG. Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States.. J Am Vet Med Assoc 2005; 227 (10) 1604-1607.
    CrossrefPubMedSuche in Google Scholar
  • 78 Witte PG, Scott HW. Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate.. Vet Surg 2014; 43 (05) 549-557.
    CrossrefPubMedSuche in Google Scholar
  • 79 Wolf RE, Scavelli TD, Hoelzler MG, Fulcher RP, Bastian RP. 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 (12) 1481-1487.
    CrossrefPubMedSuche in Google Scholar
  • 80 Wucherer KL, Conzemius MG, Evans R, Wilke VL. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically.. J Am Vet Med Assoc 2013; 242 (10) 1364-1372.
    CrossrefPubMedSuche in Google Scholar
  • 81 Yeadon R, Fitzpatrick N, Kowaleski MP. Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Surgical technique, radiographic and clinical outcomes.. Vet Comp Orthop Traumatol 2011; 24 (01) 18-26.
    Thieme ConnectPubMedSuche in Google Scholar