Técnica de placa dupla para fixação concomitante da osteotomia de nivelamento do platô tibial e ostectomia modificada em cunha de fechamento cranial da tíbia em um cão com doença do ligamento cruzado cranial e ângulo de platô tibial excessivo: relato de caso

B.W Minto,L.G.G.G Dias,G.G Franco,C.R.G.P Lopes,A.G Sprada,P.P Rossignoli,F.Y.K Kawamoto

doi:10.1590/1678-4162-12168

Abstract

ABSTRACT Tibial plateau leveling osteotomy (TPLO) associated to cranial wedge closing ostectomy (CCWO) has been one of the best options to manage cranial cruciate ligament (CCL) disease and excessive tibial plateau angle (TPA) in large dogs, however, the complication rate is potentially high. It is believed that a more robust fixation is necessary to stabilize them and decrease the risk of implant failure. A 6-year-old male American Pit Bull, weighing 36kg, with 90-day history of right hind limb lameness, was diagnosed with CCL disease. Due to the excessive tibial plateau angle (42°), TPLO was associated with a modified CCWO using a double plating technique. A final TPA of 12⁰ was accomplished, and a restricted level of exercises and physiotherapy were recommended. The patient was followed monthly until the fifth month postoperatively, when radiographic bone consolidation and no lameness were observed. By the date of this submission, 3 years after the procedure, the owner has reported no complications. The double plating technique for fixing TPLO and modified CCWO proved to be effective for the treatment of CrCL deficiency in a large dog with an excessive TPA.

Highlights

Cranial cruciate ligament (CCL) disease is one of the most common causes of hind limb lameness in dogs and it leads, potentially, to progressive osteoarthritis of the stifle joint (Powers et al, 2005)
Several surgical techniques have been described for the treatment of CCL disease and, among them, Tibial plateau leveling osteotomy (TPLO) seems to be superior to others (Bergh et al, 2014; Livet et al, 2019)
In view of how challenging combining TPLO and cranial closing wedge ostectomy (CCWO) would be and its potential for postoperative complications, the aim of this paper was to report the case of a dog with excessive tibial plateau angle and cruciate ligament disease treated with TPLO and CCWO using a double plating technique

Summary

Introduction

Cranial cruciate ligament (CCL) disease is one of the most common causes of hind limb lameness in dogs and it leads, potentially, to progressive osteoarthritis of the stifle joint (Powers et al, 2005). Some risk factors may be associated with the disease such as breed, excessive tibial plateau angle, obesity and sedentary lifestyle (Kowaleski et al, 2012; Bergh et al, 2014). The level of inclination of the tibial plateau (TPA) can be considered a primary developmental or congenital abnormality that may lead to partial rupture of cranial cruciate ligament and, the more inclined it is the more likely for the cranial cruciate ligament to be overloaded (Morris and Lipowitz, 2001). Some dogs are considered to have an excessive TPA when it is greater than 34° (Talaat et al, 2006) In these cases, TPLO requires large proximal tibial fragment rotation, increasing, substantially, the risk for fractures and insufficient rotation (Talaat et al, 2006; Duerr et al, 2008)

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