Outcome after Tibial Plateau Levelling Osteotomy and Modified Maquet Procedure in Dogs with Cranial Cruciate Ligament Rupture
15 November 2018
13 December 2019
21 April 2020 (online)
Objective The aim of this study was to compare outcomes after tibial plateau levelling osteotomy (TPLO) and modified Maquet procedure (MMP) for the treatment of cranial cruciate ligament rupture (CCLR) in dogs using clinical and radiographic evaluation and treadmill-based force plate gait analysis.
Study Design This study was a prospective, randomized, controlled study.
Materials and Methods Sixty-one dogs (76 joints) with CCLR were treated with TPLO (n = 30 dogs, 41 joints) or MMP (n = 31 dogs, 35 joints) and compared with a control group of 16 healthy Labrador Retrievers. Outcomes after surgery were compared by clinical orthopaedic assessment, radiographic evaluation and force plate gait analysis performed preoperatively, and then at 6 weeks, 3 and 6 months postoperatively. For objective comparison of ground reaction forces, the data were compared with the control group. Major complications were reported.
Results A significant improvement in ground reaction forces was reached in all surgically treated dogs. No significant difference was found between the surgical methods at any postoperative re-examination. With regard to peak vertical force (PVF), there were significantly more patients with TPLO within the reference range of healthy dogs at the 3 months re-examination than dogs with MMP. There was no significant difference in mean value comparisons between TPLO and control groups 6 months postoperatively. Compared with the control group, mean values of 93.9% (PVF) and 85.9% (vertical impulse [VI]) were reached by the TPLO group and 89.4% (PVF) and 79.9% (VI) by the MMP group, 6 months postoperatively.
No significant differences were found regarding major complications or progression of osteoarthritis.
Conclusions Although no significant differences were found between the surgical methods, TPLO patients showed superiority with regard to clinical outcome.
Keywordscranial cruciate ligament rupture - tibial plateau levelling osteotomy - modified Maquet procedure - force plate gait analysis - dog
Julia Knebel and Andrea Meyer-Lindenberg contributed to the conception of study, study design, acquisition of data and data analysis and interpretation. Daniela Eberle and Stephanie Steigmeier-Raith contributed to the acquisition of data and data analysis and interpretation. Sven Reese contributed to the study design and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.
* Current address: Small Animal Clinic Lueneburg, Lueneburg, Germany.
# These authors contributed equally.
- 1 Kipfer NM, Tepic S, Damur DM, Guerrero T, Hässig M, Montavon PM. Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles. An in vitro study. Vet Comp Orthop Traumatol 2008; 21 (05) 385-390
- 2 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
- 3 Nelson SA, Krotscheck U, Rawlinson J, Todhunter RJ, Zhang Z, Mohammed H. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42 (01) 38-50
- 4 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
- 5 Berger B, Knebel J, Steigmeier-Raith S, Reese S, Meyer-Lindenberg A. Long-term outcome after surgical treatment of cranial cruciate ligament rupture in small breed dogs. Comparison of tibial plateau leveling osteotomy and extra-articular stifle stabilization. Tierarztl Prax Ausg K Klientiere Heimtiere 2015; 43 (06) 373-380
- 6 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. In: Proceedings. Munich, Germany: 2002: 152
- 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 Hoffmann DE, Miller JM, Ober CP, Lanz OI, Martin RA, Shires PK. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19 (04) 219-227
- 9 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
- 10 Ness MG. OrthoFoam MMP Wedge. For Canine Cruciate Disease. User Guide (Version V1.2). UK: Orthomed; 2014
- 11 Ness MG. The Modified Maquet Procedure (MMP) in Dogs: technical development and initial clinical experience. J Am Anim Hosp Assoc 2016; 52 (04) 242-250
- 12 Headrick JF, Zhang S, Millard RP, Rohrbach BW, Weigel JP, Millis DL. Use of an inverse dynamics method to compare the three-dimensional motion of the pelvic limb among clinically normal dogs and dogs with cranial cruciate ligament-deficient stifle joints following tibial plateau leveling osteotomy or lateral fabellar-tibial suture stabilization. Am J Vet Res 2014; 75 (06) 554-564
- 13 Conzemius MG, Evans RB, Besancon MF. , et al. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226 (02) 232-236
- 14 Krotscheck U, Todhunter RJ, Nelson SA, Sutter NB, Mohammed HO. Precision and accuracy of ground reaction force normalization in a heterogeneous population of dogs. Vet Surg 2014; 43 (04) 437-445
- 15 Evans R, Horstman C, Conzemius M. Accuracy and optimization of force platform gait analysis in Labradors with cranial cruciate disease evaluated at a walking gait. Vet Surg 2005; 34 (05) 445-449
- 16 Wessely M, Brühschwein A, Schnabl-Feichter E. Evaluation of intra-and inter-observer measurement variability of a radiographic stifle osteoarthritis scoring system in dogs. Vet Comp Orthop Traumatol 2017; 30 (06) 377-384
- 17 Mager FW. Zur Kniegelenksarthrose des Hundes nach vorderer Kreuzbandruptur - ein retrospektiver Vergleich dreier Operationsmethoden, Doctoral thesis, Clinic for Small Animal and Reproduction. Ludwig-Maximilians-Universit; Munich; Germany; 2000
- 18 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
- 19 Piermattei DLJK. Approach to the stifle joint through medial incision. In: Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Philadelphia: Saunders; 2004: 342-345
- 20 Bland JM. An Introduction to Medical Statistics. OUP Oxford; 2000
- 21 Layer A. , Ganganalytische Untersuchung der Rückenbewegung von gesunden Hunden der Rassen Dackel und Labrador Retriever, doctoral thesis, Clinic for Small Animal and Reproduction, Ludwig-Maximilians-University; Munich; Germany; 2012
- 22 Whitehair JG, Vasseur PB, Willits NH. Epidemiology of cranial cruciate ligament rupture in dogs. J Am Vet Med Assoc 1993; 203 (07) 1016-1019
- 23 Bennett D, May C. Meniscal damage associated with cruciate disease in the dog. J Small Anim Pract 2008; 32 (03) 111-117
- 24 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39 (04) 460-474
- 25 Waxman AS, Robinson DA, Evans RB, Hulse DA, Innes JF, Conzemius MG. Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness. Vet Surg 2008; 37 (03) 241-246
- 26 Conzemius MG, Evans RB. Caregiver placebo effect for dogs with lameness from osteoarthritis. J Am Vet Med Assoc 2012; 241 (10) 1314-1319
- 27 Voss K, Damur DM, Guerrero T, Haessig M, Montavon PM. Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthop Traumatol 2008; 21 (03) 243-249
- 28 Headrick JF, Zhang S, Millard RP, Rohrbach BW, Weigel JP, Millis DL. Use of an inverse dynamics method to describe the motion of the canine pelvic limb in three dimensions. Am J Vet Res 2014; 75 (06) 544-553
- 29 Wucherer KL, Conzemius MG, Evans R, Wilke VL. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. J Am Vet Med Assoc 2013; 242 (10) 1364-1372
- 30 Gatineau M, Dupuis J, Planté J, Moreau M. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent 'pivot shift', meniscal tear and other complications. Vet Comp Orthop Traumatol 2011; 24 (05) 333-341
- 31 Pacchiana PD, Morris E, Gillings SL, Jessen CR, Lipowitz AJ. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222 (02) 184-193
- 32 Thieman KM, Tomlinson JL, Fox DB, Cook C, Cook JL. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35 (08) 705-710
- 33 Pozzi A, Hildreth III BE, Rajala-Schultz PJ. Comparison of arthroscopy and arthrotomy for diagnosis of medial meniscal pathology: an ex vivo study. Vet Surg 2008; 37 (08) 749-755
- 34 Barrett E, Barr F, Owen M, Bradley K. A retrospective study of the MRI findings in 18 dogs with stifle injuries. J Small Anim Pract 2009; 50 (09) 448-455
- 35 Blond L, Thrall DE, Roe SC, Chailleux N, Robertson ID. Diagnostic accuracy of magnetic resonance imaging for meniscal tears in dogs affected with naturally occurring cranial cruciate ligament rupture. Vet Radiol Ultrasound 2008; 49 (05) 425-431
- 36 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
- 37 Grierson J, Asher L, Grainger K. An investigation into risk factors for bilateral canine cruciate ligament rupture. Vet Comp Orthop Traumatol 2011; 24 (03) 192-196
- 38 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
- 39 Evans R, Gordon W, Conzemius M. Effect of velocity on ground reaction forces in dogs with lameness attributable to tearing of the cranial cruciate ligament. Am J Vet Res 2003; 64 (12) 1479-1481