Tibial Plateau Leveling Following Tibial Tuberosity Advancement: A Case Series.

Daniele Serrani,Philip Witte,Pierre Picavet,Bernard Bouvy,Marc Balligand,Juan Marti

doi:10.3390/vetsci9010016

Abstract

Persistent stifle instability is a recognized complication following tibial tuberosity advancement techniques (TTAT). The aim of this study is to report the feasibility and outcome of tibial plateau leveling techniques (TPLT) to treat dogs with persistent lameness, suspected to be secondary to persistent stifle instability, following (TTAT). Medical records of dogs presented for persistent lameness after TTAT were reviewed. Preoperative data included orthopedic examination, lameness score and radiographs. Inclusion criteria included performance of a surgery to address persistent lameness and suspected instability. Short-term follow up data included orthopedic examination and radiographs of the stifle. Long-term follow up was based on postoperative Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Seven dogs were included in the study. Mean subjective preoperative lameness score was 3 ± 1.53. Mean preoperative patellar ligament angle relative to the tibial plateau (PLATP) was 94° and mean tibial plateau angle (TPA) was 28°. Six dogs had tibial plateau leveling osteotomy and one had modified cranial closing wedge ostectomy. Mean postoperative PLATP was 79° and mean TPA was 5°. Mean subjective lameness score at follow up was 0.57 ± 0.49. Minor complications were present in 2 dogs and major complication in 1 dog. Mean LOAD questionnaire score was 6.6/52. TPLT can be performed after TTAT and may improve clinical function and stability in these cases in which persistent instability is suspected.

Highlights

Cranial cruciate ligament disease (CCLD) is the most common orthopaedic pathology affecting the hind limb of the dog [1]
Between the formers, tibial plateau levelling osteotomy (TPLO) and cranial closing wedge ostectomy (CCWO) have been largely investigated. These techniques will be defined in this paper as tibial plateau levelling techniques (TPLT)
To the best of our knowledge, this is the first study documenting the feasibility of TPLT to treat persistent lameness and suspected instability following tuberosity advancement techniques (TTAT)

Summary

Introduction

Cranial cruciate ligament disease (CCLD) is the most common orthopaedic pathology affecting the hind limb of the dog [1]. According to two biomechanical theories, several techniques have been proposed to abolish cranial tibial thrust (CTT) associated with deficiency of the cranial cruciate ligament (CCL), either modifying the tibial plateau angle (TPA) or the patellar ligament angle (PLA) [2,3,4,5,6,7,8,9]. Between the formers, tibial plateau levelling osteotomy (TPLO) and cranial closing wedge ostectomy (CCWO) have been largely investigated. These techniques will be defined in this paper as tibial plateau levelling techniques (TPLT). The latter will be defined as tibial tuberosity advancement techniques (TTAT). Few studies have compared the long-term outcome following these procedures, both TPLT and TTAT have been reported to be associated with excellent long-term outcomes [10,11,12]

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