Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation

Katherine C. Leonard; Michael P. Kowaleski; William B. Saunders; Robert J. McCarthy; Randy J. Boudrieau

doi:10.3415/VCOT-15-12-0195

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2016; 29(06): 536-540
DOI: 10.3415/VCOT-15-12-0195

Clinical Communication

Schattauer GmbH

Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation

Authors

Katherine C. Leonard

¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
Michael P. Kowaleski

¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
William B. Saunders

²Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences at Texas A&M University, College Station, TX, USA
Robert J. McCarthy

¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
Randy J. Boudrieau

¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA

Abstract

Summary

Objectives: To describe the surgical technique and report short-term outcome for combined tibial plateau levelling osteotomy and tibial tuberosity transposition (TPLO-TTT) as an option in the treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation.

Methods: Medical records were reviewed (2011–2013) of dogs that underwent a standard tibial plateau levelling osteotomy followed by a tibial tuberosity transposition in the frontal plane and stabilized with pin and tension-band wire fixation as a component of surgical treatment for combined cranial cruciate ligament insufficiency and medial patellar luxation. Signalment, fixation method together with any ancillary procedures, function at the in-hospital follow-up examinations, and any complications were recorded. Healing was assessed retrospectively based on the grading criteria of the International Society Of Limb Salvage.

Results: Fifteen stifle joints in 11 dogs were identified; 13 stifles were available for in hospital follow-up. All 13 achieved union (3 with grade III/IV and 10 with grade IV/IV radiographic healing scores); mean time to healing was 10.6 (± 2.9) weeks. Patellar ligament thickening was also identified radio-graphically in seven of the 13 of stifle joints. All dogs were reported to have mild or no lameness at their last follow-up examination. No catastrophic or major postoperative complications occurred that required additional surgery. Patellar re-luxation did not occur in any of the 13 stifles available for in-hospital follow-up.

Clinical significance: The TPLO-TTT was found to be a reliable and effective technique when used as a part of the treatment of combined cranial cruciate ligament insufficiency with concomitant medial patellar luxation in this series of dogs.

Supplementary Material to this article is available online at http://dx.doi.org/10.3415/VCOT-15-12-0195.

Keywords

Tibial tuberosity transposition - tibial plateau levelling osteo tomy - patellar luxation - TPLO - cranial cruciate ligament insufficiency - medial patellar luxation

Full Text

References

References
1 Kowaleski MP, Boudrieau RJ, Pozzi A. The stifle joint. In Tobias KM, Johnston SA. editors Veterinary Surgery: Small Animal, vol. 1. St. Louis: Elsevier/Saunders; 2012: 906-998.
2 Olmstead ML. The stifle joint. In: Small Animal Orthopedics. St. Louis: Mosby-Year Book; 1995: 395-416.
3 Millis DL, Levine D, Taylor RA. Common orthopedic conditions and their physical rehabilitation. In: Canine Rehabilitation and Physical Therapy. St. Louis: Elsevier; 2004: 355-387.
4 Campbell CA, Horstman CL, Mason DR. et al. Severity of patellar luxation and frequency of concomitant cranial cruciate ligament in dogs: 162 cases (2004-2007). J Am Vet Med Assoc 2010; 236: 887-891.
5 Towle HA, Griffon DJ, Thomas MW. et al. Pre- and postoperative radiographic and computed tomographic evaluation of dogs with medial patellar luxation. Vet Surg 2005; 34: 265-272.
6 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-193.
7 Priddy NH, Tomlinson JL, Dodam JR. et al. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). J Am Vet Med Assoc 2003; 222: 1726-1732.
8 Stauffer KD, Tuttle TA, Elkins AD. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
9 Bergh MS, Rajala-Schultz P, Johnson KA. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37: 374-382.
10 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
11 Talaat MB, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling 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.
12 Langenback A, Marcellin-Little DJ. Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling. J Sm Anim Pract 2010; 51: 97-103.
13 Weh JL, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs. Vet Surg 2011; 40: 670-686.
14 Kowaleski MP, Boudrieau RJ, Beale BS. et al. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. Vet Surg 2013; 42: 847-852.
15 Glasser D, Langlais F. The ISOLS radiological implants evaluation system. In Langlais F, Tomeno B. editors Limb Salvage: Major Reconstructions in Oncologic and Nontumoral Conditions. Berlin, Germany: Springer; 1991: 23-31.
16 Carey K, Aiken SW, DiResta GR. et al. Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy: 94 Cases (2001-2003). Vet Comp Orthop Traumatol 2005; 4: 235-242.
17 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39: 905-908.
18 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: 30-34.
19 Tan CJ, Bergh MS, Schembri MA. et al. Accuracy of tibial osteotomy placement using two different tibial plateau leveling osteotomy jigs. Vet Surg 2014; 43: 525-533.
20 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: 18-26.
21 Kowaleski MP, Apelt D, Matoon JS. et al. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study. Vet Surg 2005; 34: 332-336.

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