Tendon Plating for Revision of Tibial Tuberosity Fragmentation in Two Dogs

Medial patellar luxation (MPL) is a common orthopedic problem. Surgical correction of this condition includes transposition of the tibial tuberosity to restore alignment of the patella within the distal femoral trochlea. Fragmentation and avulsion of the proximal tibia after tibial tuberosity transposition is a reported complication. Due to small quantity and quality of remaining bone stock in this area, repair options can be very limited and challenging. Two dogs presented to a tertiary facility with tibial tuberosity fragmentation after previous MPL surgeries. Both dogs had one attempted corrective surgery to repair the failure of tibial tuberosity transpositions. With the second of revision surgeries, each case was managed with reduction of the remaining fragment of the tibial tuberosity and a contoured locking plate over the proximal aspect of the tendon and patella (tendon plating). The plate was secured with a combination of locking screws distally and suture in each proximal hole. Bone graft was utilized in both cases around the site of the tibial tuberosity fragmentation. Radiographs documented healing of the tibial crest. Both dogs recovered uneventfully from surgery and returned to full function despite cyclic breakage of the plate at the most proximal tibial screw hole in one case. Owners also reported positive outcomes for both cases. The implants were partially or completely removed in both cases. The clinical outcome is promising for this technique as a possible option for complicated tibial tuberosity fragmentation and subsequent avulsions.