Effect of tibial plateau levelling osteotomy on patellar tendon angle: A prospective clinical study

S. Sathya; P. Gilbert; A. Sharma; S. Hendrick

doi:10.3415/VCOT-14-01-0013

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2014; 27(05): 346-350
DOI: 10.3415/VCOT-14-01-0013

Original Research

Schattauer GmbH

Effect of tibial plateau levelling osteotomy on patellar tendon angle: A prospective clinical study

Authors

S. Sathya

¹Small Animal Clinical Sciences, Western College of Veterinary Medicine, Saskatoon, SK, Canada
P. Gilbert

¹Small Animal Clinical Sciences, Western College of Veterinary Medicine, Saskatoon, SK, Canada

⁴Current: Veterinary Specialist Services, Brisbane, Australia
A. Sharma

²Department of Veterinary Biosciences & Diagnostic Imaging, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA
S. Hendrick

³Large Animal Clinical Sciences, Western College of Veterinary Medicine, Saskatoon, SK, Canada

Abstract

Summary

Objective: To evaluate the effect of the tibial plateau levelling osteotomy (TPLO) procedure on the patellar tendon angle (PTA) in dogs with naturally occurring cranial cruciate ligament rupture.

Study design: Prospective observational clinical study.

Animals: Dogs with naturally occurring CrCL rupture that had a TPLO performed (n = 40).

Methods: Preoperative tibial plateau angle (TPA) and PTA were measured on radiographic images of affected stifle joints at 90° and standing angle (135°) respectively. The TPA and PTA were measured after TPLO was performed. Regression analysis was performed to evaluate the effect of preoperative TPA and PTA and postoperative TPA on postoperative PTA. Linear regression analysis was performed to evaluate the correlation between postoperative TPA and PTA.

Results: The mean (± SD) preoperative TPA and PTA were 26.5 ± 3.8° and 105.7 ± 3.8° respectively. The postoperative TPA and PTA values were 7.6 ± 3.3° and 91.4 ± 5.5°, respectively. Regression analysis showed that higher preoperative PTA and postoperative TPA are associated with a larger difference between the postoperative PTA and 90°. There was a positive correlation between postoperative TPA and PTA.

Conclusion: The TPLO procedure alters the PTA to 90° in dogs with cranial cruciate ligament rupture similar to tibial tuberosity advancement (TTA).

Clinical significance: The TPLO may provide dynamic stability to the cranial cruciate deficient stifle by altering the TPA relative to the patellar tendon and creating a PTA of 90°. The biomechanical principle and mechanism of action of TPLO may be similar to TTA.

Keywords

Tibial plateau levelling osteotomy - TPLO - tibial tuberosity advancement - TTA - patellar tendon angle - PTA - biomechanics - clinical study

Full Text

References

References
1 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-69.
2 Arnoczky S, Marshall J. The cruciate ligaments of the canine stifle: An anatomical and functional analysis. Am J Vet Res 1977; 38: 1807-1814.
3 Elkins AD. A retrospective study evaluating the degree of degenerative joint disease in stifles of dogs following surgical repair of anterior cruciate ligament rupture. J Am Anim Hosp Assoc 1991; 27: 533-539.
4 Vasseur PB, Berry CR. Progression of stifle osteoarthritis following reconstruction of the cranial cruciate ligament in 21 dogs. J Am Anim Hosp Assoc 1992; 28: 129-136.
5 Kim SE, Pozzi A, Kowaleski MP. et al Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125.
6 Warzee CC, Dejardin LM, Arnoczky SP. et al Effect of tibial plateau levelling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifle: an in vitro experimental study. Vet Surg 2001; 30: 278-286.
7 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: 170-177.
8 Kim SE, Pozzi A, Banks SA. et al Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. 2009; 38: 33-39.
9 Henderson RA, Milton JL. The tibial compression mechanism: a diagnostic aid in stifle injuries. J Am Anim Hosp Assoc 1978; 14: 474-479.
10 Slocum B, Devine T. Cranial tibial thrust: a primary force in the canine stifle. J Am Vet Med Assoc 1983; 183: 456-459.
11 Slocum B, Slocum TD. Tibial plateau levelling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am 1993; 23: 777-795.
12 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle joint. In Tobias KA, Johnston SA. editors Veterinary Surgery Small Animal. Vol 1. St. Louis, Missouri: Elsevier; 2012: 906-998.
13 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 Orthopedic Veterinary Congress. 2002 September 5-8; Munich, Germany. 152
14 Tepic S, Damur DM, Montaven PM. Biomechanics of the stifle joint. Proceedings of the 1st World Orthopedic Veterinary Congress. 2002. September 5-8 Munich, Germany: 189-190.
15 Tepic S, Montaven PM. Is cranial tibial advancement relevant in the cruciate deficient stifle? Proceedings of the 12th ESVOT Congress. 2004. September 10-12 Munich, Germany: 132-133.
16 Nisell R, Nemeth G, Ohlsen H. Joint forces in the extension of the knee: analysis of a mechanical model. Acta Orthop Scand 1986; 57: 41-46.
17 Boudrieau RJ. Tibial plateau levelling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
18 Drygas KA, Pozzi A, Goring RL. et al Effect of tibial plateau levelling osteotomy on patellar tendon angle: A radiographic cadaveric study. Vet Surg 2010; 39: 418-424.
19 Robinson DA, Mason DR, Evans R. et al The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau levelling osteotomy in Labrador retrievers. Vet Surg 2006; 35: 294-299.
20 Lafaver S, Miller NA, Stubbs WP. et al 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; 37: 573-586.
21 Bush MA, Bowlt K, Gines JA. et. al Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement. Vet Comp Orthop Traumatol 2011; 24: 205-210.
22 Fettig AA, Rand WM, Sato AF. et al Observer variability of tibial plateau slope measurement in 40 dogs with cranial cruciate ligament deficient stifle joints. Vet Surg 2003; 32: 471-478.
23 Caylor KB, Zumpano CA, Evans LM. et al Intra- and interobserver measurement variability of tibial plateau slope from lateral radiographs in dogs. J Am Anim Hosp Assoc 2001; 37: 263-268.
24 Millet M, Bismuth C, Labrunie A. et. al Measurement of the patellar tendon-tibial plateau angle and tuberosity advancement in dogs with cranial cruciate ligament rupture. Reliability of the common tangent and tibial plateau methods of measurement. Vet Comp Orthop Traumatol 2013; 6: 469-478.
25 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 84: 564-569.
26 Damur DM, Tepic S, Montavon PM. Proximal tibial osteotomy for the repair of cranial cruciate-deficient stifle joints in dogs. Vet Comp Orthop Traumatol 2003; 6: 211-216.
27 Talaat MB, Kowaleski MP, Boudrieau RJ. Combination tibial plateau levelling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. Vet Surg 2006; 35: 729-739.
28 Bruce WJ, Rose A, Tuke J. et al Evaluation of the triple tibial osteotomy (TTO): a new technique for the management of the canine cruciate-deficient stifle. Vet Comp Orthop Traumatol 2007; 20: 159-168.
29 Hildreth BE, Marcellin-Little DJ, Roe SC. et al In vitro evaluation of five canine tibial plateau levelling methods. Am J Vet Res 2006; 67: 693-700.
30 Nisell R, Ericson MO, Németh G. et al Tibiofemoral joint forces during isokinetic knee extension. Am J Sports Med 1989; 17: 49-54.
31 Kim SE, Pozzi A, Banks SA. et al Effect of cranial cruciate ligament deficiency, tibial plateau levelling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion. Vet Surg 2010; 39: 363-370.
32 Windolf M, Leitner M, Schwieger K. et al Accuracy of fragment positioning after TPLO and effect on biomechanical stability. Vet Surg 2008; 37: 366-373.
33 Tuttle TA, Manley PA. Risk factors associated with fibular fracture after tibial plateau levelling osteotomy. Vet Surg 2009; 38: 355-360.