Ex Vivo Evaluation of a Novel Tibial Tuberosity Advancement Surgical Guidance System for the Treatment of Canine Cranial Cruciate Ligament Disease

Introduction: Cranial cruciate ligament disease (CrCLD), a common cause of lameness, is frequently treated via tibial tuberosity advancement (TTA). Osteotomy technical errors are linked to complications that may be more prevalent amongst inexperienced surgeons. A novel surgical guidance system (adjustable cutting-guide and patient-specific instructions) was evaluated to determine if it improved osteotomy accuracy performed by inexperienced surgeons.

Materials and Methods: Veterinary students (n = 30) each performed one guided-TTA (G-group) and one conventional unguided-TTA (U-group). Ideal osteotomy position for each group was determined by a specialist surgeon experienced with both techniques. Deviation of actual osteotomy from ideal was determined at the tibial tuberosity, bone hinge, and for osteotomy length. Levene's test evaluated homogeneity of variance where p <0.05 indicated statistical significance. Specimens were photographed in a custom-positioner to permit qualitative visual assessment of each osteotomy relative to ideal for each group.

Results: Standard deviations from ideal osteotomy were significantly smaller for each measurement in the G-group compared with the U-group. Differences in variance from ideal were smaller in the G-group compared with the U-group for tibial tuberosity width (p = 4.157 × 10⁻⁷), bone hinge width (p = 1.093 × 10⁻⁷), and osteotomy length (p = 6.175 × 10⁻⁴).

Discussion/Conclusion: In this single tibial morphology model, the novel guidance system improved TTA osteotomy accuracy for inexperienced surgeons as compared with unguided-TTA. While there are limitations that should be considered, more consistent performance of ideal TTA osteotomy is likely to favour more effective restoration of patient comfort and joint function through complication-free convalescence.

Acknowledgement: Funding and resources were provided by CSU's Veterinary Summer Scholar Program, CSU's Centre for Companion Animal Studies’ Young Investigator Grant, and OssAbility Ltd.

Publication History

Article published online:
26 October 2022