Abstract
ObjectivesTo evaluate the ability of an alignment jig/saw guide to reproduce appropriate osteotomy positions in the tibial plateau leveling osteotomy (TPLO) in the dog.MethodsLateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005–Dec 2007 and Nov 2013–Nov 2015 were reviewed. The freehand osteotomy position was compared to potential osteotomy positions using the alignment jig/saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the osteotomy performed. The guide-to-osteotomy fit was categorized by the distance between the actual osteotomy and proposed saw guide osteotomy at its greatest offset (≤1 mm = excellent; ≤2 mm = good; ≤3 mm = satisfactory; >3 mm = poor).ResultsSixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3–4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-osteotomy fit (P = 0.021 and P = 0.047, respectively).Clinical SignificanceThe alignment jig/saw guide can be used to reproduce appropriate freehand osteotomy position for TPLO. Furthermore, an ideal osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.
Highlights
One of the more common surgical procedures in the dog for treatment of the cranial cruciate ligament deficient stifle joint is the tibial plateau leveling osteotomy (TPLO)
98.4% of the clinical freehand TPLO and 100% of the proposed ideal osteotomy location (IOL) positions were satisfactorily reproducible with the saw guide
Our data showed a wide variability in jig arm angles for the clinical cases, but this was not found to be a significant contributor to the guide-to-osteotomy fit
Summary
One of the more common surgical procedures in the dog for treatment of the cranial cruciate ligament deficient stifle joint is the tibial plateau leveling osteotomy (TPLO). Subjective guidelines were originally established to avoid these technical errors: orientation of the osteotomy parallel to the joint surface and perpendicular to the sagittal plane of the tibia, and placement sufficiently caudal to preserve tibial tuberosity bone support [1]. The osteotomy necessitates a footprint only sufficiently large to accommodate the head of the plate such that the screws placed to secure it are not directed intra-articularly and/or in the osteotomy [3,6,7]. Despite knowledge of these guidelines, the technical aspect in accurately executing these aspects of the technique may be difficult, for novice surgeons. Accurate positioning and angulation of the osteotomy can be difficult to perform; in addition, initiation of the osteotomy is especially challenging given the irregular shape of the proximal tibia and tendency for the saw to “walk” on the sloped medial cortex
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