Subscribe to RSS
Comparison of Outcomes Associated with Tibial Plateau Levelling Osteotomy and a Modified Technique for Tibial Tuberosity Advancement for the Treatment of Cranial Cruciate Ligament Disease in Dogs: A Randomized Clinical StudyFunding The authors received no financial support for the research, authorship and/or publication of this article.
23 April 2018
23 February 2019
03 April 2019 (online)
Objectives This study aimed to compare outcomes between the tibial plateau levelling osteotomy (TPLO) procedure and a modified tibial tuberosity advancement (TTA Rapid) in dogs with cranial cruciate ligament rupture.
Materials and Methods Twenty-six dogs were prospectively randomized into two groups: a TPLO group (n = 13) and a TTA Rapid group (n = 13). A lameness score evaluation, gait analysis and radiographical examination were performed before surgery, the 3 days after surgery, and then at 1, 3 and 6 months postoperatively. Finally, owners were asked to subjectively rate their level of satisfaction.
Results The duration of surgery was significantly shorter for the TTA Rapid procedure (p < 0.0001). There was no significant difference in the occurrence of complications between groups. Lameness scores were significantly higher during the first 3 days after surgery for the TPLO group (p = 0.01 at day 1, p = 0.01 at day 2 and p = 0.003 at day 3). One month after surgery, the symmetry index between healthy and affected limbs for the relative stance time during the gait cycle (symmetry index/%) was significantly higher for the TTA Rapid group (p < 0.01). No gait parameters were significantly different between the two groups 6 months after surgery. All of the owners of dogs in the TPLO group were completely satisfied, whereas only 11/13 owners of dogs in the TTA rapid group were completely satisfied.
Clinical Significance Tibial plateau levelling osteotomy and TTA Rapid were associated with high long-term success rates in dogs. The immediate postoperative recovery seemed faster with TTA Rapid, but thereafter there was no difference.
Keywordsdogs - cruciate ligament disease - tibial plateau levelling osteotomy - tibial tuberosity advancement - lameness score
Véronique Livet and Thibaut Cachon contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Arnaud Baldinger and Éric Viguier contributed to study design, acquisition of data and data analysis and interpretation. Mathieu Harel contributed to acquisition of data and data analysis and interpretation. Mathieu Taroni and Claude Carozzo contributed to data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.
- 1 Kim SE, Pozzi A, Kowaleski MP, Lewis DD. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37 (02) 111-125
- 2 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38 (01) 1-22
- 3 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23 (04) 777-795
- 4 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. In Proceedings of the 1st World Orthopaedic Veterinary Congress; Munich, Germany; September 5–8; 2002 : 152
- 5 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42 (03) 329-334
- 6 Krotscheck U, Nelson SA, Todhunter RJ, Stone M, Zhang Z. Long term functional outcome of tibial tuberosity advancement vs. tibial plateau leveling osteotomy and extracapsular repair in a heterogeneous population of dogs. Vet Surg 2016; 45 (02) 261-268
- 7 Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36 (06) 573-586
- 8 Lazar TP, Berry CR, deHaan JJ, Peck JN, Correa M. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34 (02) 133-141
- 9 Rayward RM, Thomson DG, Davies JV, Innes JF, Whitelock RG. Progression of osteoarthritis following TPLO surgery: a prospective radiographic study of 40 dogs. J Small Anim Pract 2004; 45 (02) 92-97
- 10 Morgan JP, Voss K, Damur DM, Guerrero T, Haessig M, Montavon PM. Correlation of radiographic changes after tibial tuberosity advancement in dogs with cranial cruciate-deficient stifles with functional outcome. Vet Surg 2010; 39 (04) 425-432
- 11 Ferreira MP, Ferrigno CR, de Souza AN, Caquias DF, de Figueiredo AV. Short-term comparison of tibial tuberosity advancement and tibial plateau levelling osteotomy in dogs with cranial cruciate ligament disease using kinetic analysis. Vet Comp Orthop Traumatol 2016; 29 (03) 209-213
- 12 Samoy Y, Verhoeven G, Bosmans T. , et al. TTA Rapid: description of the technique and short term clinical trial results of the first 50 cases. Vet Surg 2015; 44 (04) 474-484
- 13 Butterworth SJ, Kydd DM. TTA-Rapid in the treatment of the canine cruciate deficient stifle: short- and medium-term outcome. J Small Anim Pract 2017; 58 (01) 35-41
- 14 Dyall B, Schmökel H. Tibial tuberosity advancement in small-breed dogs using TTA Rapid implants: complications and outcome. J Small Anim Pract 2017; 58 (06) 314-322
- 15 Viguier E, Lequang T, Maitre P. , et al. The validity and reliability of the GAITRite system's measurement of the walking dog. Comput Methods Biomech Biomed Engin 2007; 10: 113-114
- 16 Light VA, Steiss JE, Montgomery RD, Rumph PF, Wright JC. Temporal-spatial gait analysis by use of a portable walkway system in healthy Labrador Retrievers at a walk. Am J Vet Res 2010; 71 (09) 997-1002
- 17 Taroni M, Cabon Q, Fèbre M. , et al. Evaluation of the effect of a single intra-articular injection of allogeneic neonatal mesenchymal stromal cells compared to oral non-steroidal anti-inflammatory treatment on the postoperative musculoskeletal status and gait of dogs over a 6-month period after tibial plateau leveling osteotomy: a pilot study. Front Vet Sci 2017; 4: 83
- 18 Bielecki MJ, Schwandt CS, Scharvogel S. Effect of tibial subluxation on the measurements for tibial tuberosity advancement in dogs with cranial cruciate ligament deficiency. An ex vivo study. Vet Comp Orthop Traumatol 2014; 27 (06) 470-477
- 19 D'Anjou MA, Moreau M, Troncy E. , et al. Osteophytosis, subchondral bone sclerosis, joint effusion and soft tissue thickening in canine experimental stifle osteoarthritis: comparison between 1.5 T magnetic resonance imaging and computed radiography. Vet Surg 2008; 37 (02) 166-177
- 20 Kowaleski MP, Boudrieau RJ, Beale BS, Piras A, Hulse D, Johnson KA. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. Vet Surg 2013; 42 (07) 847-852
- 21 Cook JL, Evans R, Conzemius MG. , et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
- 22 Singh A, Weese JS. Wound infections and antimicrobial use. In Johnson SA, Tobias KM. , eds: Veterinary surgery small animal, Vol. 1 (ed. 2). St. Louis, MO: Elsevier; 2017: 148-155
- 23 Hans EC, Barnhart MD, Kennedy SC, Naber SJ. Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight. Vet Comp Orthop Traumatol 2017; 30 (04) 299-305
- 24 Brown DC, Conzemius MG, Shofer F, Swann H. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997; 210 (09) 1302-1306
- 25 Shires PK, Lanz O, Martin RA. , et al. Early post-operative outcomes in unilateral cranial cruciate ligament deficient dogs treated with tibial tuberosity advancement or tibial plateau levelling osteotomy. Vet Surg 2007; 36: E24
- 26 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion. Vet Surg 2010; 39 (03) 363-370
- 27 Cox JS, Nye CE, Schaefer WW, Woodstein IJ. The degenerative effects of partial and total resection of the medial meniscus in dogs' knees. Clin Orthop Relat Res 1975; (109) 178-183
- 28 Kim SE, Pozzi A, Banks SA, Conrad BP, Lewis DD. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38 (01) 33-39