Abstract
Objectives The aim of this study was to describe a screw fixation method of the tibial tuberosity after transposition during surgical treatment of patellar luxation and to report complications and outcome of the procedure. Materials and Methods Medical records (2010–2016) of dogs treated for patellar luxation with tibial tuberosity transposition stabilization using a cortical bone screw placed adjacent to the tuberosity were retrospectively reviewed. Radiographs acquired immediately after surgery were evaluated for fissures. Proximal tibial dimensions and tibial tuberosity segments were measured. Intraoperative and postoperative complications were recorded. Results One-hundred and six dogs and 131 stifle surgeries were included. Implant complications associated with the screw occurred in 2/106 dogs (1.9%). Two dogs developed tibial tuberosity fracture and proximal displacement within 1 week of surgery and required stabilization with pin and tension band. Patellar reluxation rate following surgery was 6.9% (9/131 procedures). Presence of a fissure on postoperative radiographs increased the odds of tibial tuberosity fracture development (p < 0.001), while greater tibial tuberosity size (p = 0.023) and larger distal cortical attachment (p = 0.018) decreased the odds of fissure formation. Clinical significance Tibial tuberosity transposition can be achieved with a cortical screw placed lateral or medial to the tibial tuberosity.
Highlights
Patellar luxation is one of the most common orthopaedic diseases affecting the canine stifle.[1,2] Common surgical methods for elimination of patellar luxation include releasing incisions of the retinaculum and joint capsule, imbrication of the joint capsule, modification of the femoral trochlear groove, and tibial tuberosity transposition (TTT).[3,4,5,6] Tibial tuberosity transposition corrects the malalignment of the quadriceps mechanism by realigning the quadriceps muscle over the cranial aspect of the femur and has been shown to reduce the incidence of reluxation and major complications after patellar luxation surgery.[3]
In dogs with a single cortical screw, the implant complication rate leading to implant removal was 1.9% (2/106 dogs)
The findings of our study show that the described TTT technique using a cortical screw adjacent to the tibial tuberosity was clinically successful and had a low complication rate
Summary
Patellar luxation is one of the most common orthopaedic diseases affecting the canine stifle.[1,2] Common surgical methods for elimination of patellar luxation include releasing incisions of the retinaculum and joint capsule, imbrication of the joint capsule, modification of the femoral trochlear groove, and tibial tuberosity transposition (TTT).[3,4,5,6] Tibial tuberosity transposition corrects the malalignment of the quadriceps mechanism by realigning the quadriceps muscle over the cranial aspect of the femur and has been shown to reduce the incidence of reluxation and major complications after patellar luxation surgery.[3] More complex cases may require a distal femoral osteotomy, which corrects quadriceps mechanism malalignment.[7]. Transposition of the tibial tuberosity requires a complete or incomplete osteotomy of the tuberosity including the insertion of the patellar ligament. Techniques used to reattach the osteotomized tibial tuberosity segment include wire suture, single pin fixation, multiple pin fixation, tension band wire with one or two pins, lag screw with pin and tibial tuberosity advancement plate.[6,8,9,10,11] All of these techniques transfix the received April 27, 2018 accepted after revision April 2, 2019
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