Abstract
BackgroundCranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals. An array of surgical techniques have been described to stabilize the stifle joint in dogs, including intraarticular stabilization, extraarticular stabilization, and tibial osteotomy techniques. Tibial plateau leveling osteotomy and tibial tuberosity advancement with a lot of modifications are the most common. In this study we report the possibility of fixing the novel titanium implant for tibial tuberosity advancement with two screws in a craniocaudal direction. The aim of our study was to improve the clinical benefit of the tibial tuberosity advancement surgical technique where an attempt was made to reduce the number of screws and obtain a strong implant fixation with minimal bone traumatization. This way of attachment allows to distribute the forces evenly on medial and lateral side of osteotomy gap.ResultsTibial tuberosity advancement with cranial implant fixation was performed in four sheep. Complete radiographic and clinical follow up was recorded. All four sheep had a complete osteotomy line healing at a mean of 10 weeks postoperative (range 8–12 weeks). None of the animals had osteotomy gap healing grades of poor. Minor complication included the minimally cracked Maquet hole on the postoperative radiographs, without displacement of the tibial crest which occurred in 2 sheep. Major complication grade 1, major complication grade 2 and catastrophic were not found.ConclusionsThe novel surgical technique for tibial tuberosity advancement with cranial implant fixation is technically comparable to the recent trend in tuberosity advancement techniques, where partial osteotomy of the cranial tibial tuberosity crest is performed. A cranial implant fixation allows to distribute the forces evenly on medial and lateral side of osteotomy gap, which may result in less number of major complications in dogs. A novel titanium implant decreases the tibial traumatisation by reducing the number of screws.
Highlights
Cranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals
Radiography and clinical follow up The operated leg was radiographed immediately postoperatively and after every 2 weeks up to 6 months in Results tuberosity advancement (TTA) Tibial tuberosity advancement with cranial fixation (CF) with the use of a 6 mm width titanium implant was performed in four sheep
Our modified technique with cranial fixation (TTA CF) technique is a modification of conventional TTA and TTA Rapid technique, where an attempt is made to reduce the number of screws and obtain a strong implant fixation only with two screws in craniocaudal direction
Summary
Cranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals. The aim of our study was to improve the clinical benefit of the tibial tuberosity advancement surgical technique where an attempt was made to reduce the number of screws and obtain a strong implant fixation with minimal bone traumatization. This way of attachment allows to distribute the forces evenly on medial and lateral side of osteotomy gap. Tibial tuberosity advancement was developed to reconstruct dynamic stability in CCL deficient stifles in dogs by reducing the patellar tendon angle (PTA). Experimental in vitro studies attested the biomechanics of TTA [17,18,19], and clinical reports proved satisfactory limb function after surgery [20,21,22,23]
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