Subscribe to RSS
Radiographic Comparison of Virtual Surgical Corrective Options for Excessive Tibial Plateau Angle in the DogFunding None declared.
Objective The main aim of this study is to compare the impact of six proximal tibial osteotomies on the geometry and alignment of tibias with and without excessive tibial plateau angle (TPA).
Study Design Mediolateral radiographs of 30 canine tibias were divided into three groups (n = 10/group): moderate TPA (≤34 degrees), severe TPA (34.1–44 degrees) and extreme TPA (>44 degrees). Six proximal tibial osteotomies were simulated on each tibia using orthopaedic planning software: cranial closing wedge ostectomy (CCWO), modified CCWO (mCCWO), isosceles CCWO (iCCWO), neutral isosceles CCWO (niCCWO), tibial plateau levelling osteotomy with CCWO (TPLO/CCWO) and coplanar centre of rotation of angulation-based levelling osteotomy (coCBLO). All tibias were reduced to a standard target TPA. Pre- and postoperative measurements were obtained for each virtual correction. Compared outcome measures included tibial long axis shift (TLAS), cranial tibial tuberosity shift (cTTS), distal tibial tuberosity shift (dTTS), tibial shortening and osteotomy overlap.
Results Across all TPA groups, TPLO/CCWO had the lowest mean TLAS (1.4 mm) and dTTS (6.8 mm); coCBLO had the largest TLAS (6.5 mm) and cTTS (13.1 mm); CCWO had the largest dTTS (29.5 mm). CCWO had the largest degree of tibial shortening of 6.5 mm, while mCCWO, niCCWO and coCBLO resulted in minimal tibial lengthening (1.8–3.0 mm). These trends were generally conserved across different TPA groups. All findings had a p-value less than 0.05.
Conclusion mCCWO balances moderate alterations to tibial geometry while preserving osteotomy overlap. The TPLO/CCWO has the least effect on tibial morphology alteration, whereas the coCBLO results in the largest alteration.
Keywordsdog - excessive tibial plateau angle - cranial cruciate ligament - closing wedge - tibial osteotomy
J.B. contributed to study conception. N.J.W., W.M.K., J.B. and T.M.C. collected data; N.J.W. and S.H. analysed data. N.J.W., J.B., B.O. and J.N. helped in study design and interpretation of results. N.J.W. and J.B. helped in manuscript writing. All authors revised and approved the submitted manuscript.
Received: 01 June 2022
Accepted: 14 March 2023
Article published online:
02 May 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 07 (02) 56-69
- 2 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
- 3 von Pfeil DJF, Kowaleski MP, Glassman M, Dejardin LM. Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds). J Am Vet Med Assoc 2018; 253 (05) 586-597
- 4 Duerr FM, Martin KW, Rishniw M, Palmer RH, Selmic LE. Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians. Vet Comp Orthop Traumatol 2014; 27 (06) 478-483
- 5 Duerr FM, Duncan CG, Savicky RS, Park RD, Egger EL, Palmer RH. Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37 (01) 49-62
- 6 Read RA, Robins GM. Deformity of the proximal tibia in dogs. Vet Rec 1982; 111 (13) 295-298
- 7 Binversie EE, Baker LA, Engelman CD. et al. Analysis of copy number variation in dogs implicates genomic structural variation in the development of anterior cruciate ligament rupture. PLoS One 2020; 15 (12) e0244075
- 8 Talaat MB, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. Vet Surg 2006; 35 (08) 729-739
- 9 Warzee CC, Dejardin LM, Arnoczky SP, Perry RL. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30 (03) 278-286
- 10 Shahar R, Milgram J. Biomechanics of tibial plateau leveling of the canine cruciate-deficient stifle joint: a theoretical model. Vet Surg 2006; 35 (02) 144-149
- 11 Macias C, Mckee WM, May C. Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs. J Small Anim Pract 2002; 43 (10) 433-438
- 12 Witte PG, Scott HW. Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate. Vet Surg 2014; 43 (05) 549-557
- 13 Barnes DC, Trinterud T, Owen MR, Bush MA. Short-term outcome and complications of TPLO using anatomically contoured locking compression plates in small/medium-breed dogs with “excessive” tibial plateau angle. J Small Anim Pract 2016; 57 (06) 305-310
- 14 Schlag AN, Peycke LE, Hulse DA. Center of rotation of angulation-based leveling osteotomy combined with a coplanar cranial closing wedge ostectomy to manage cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angle. Vet Surg 2020; 49 (06) 1125-1131
- 15 Wallace AM, Addison ES, Smith BA, Radke H, Hobbs SJ. Modification of the cranial closing wedge ostectomy technique for the treatment of canine cruciate disease. Description and comparison with standard technique. Vet Comp Orthop Traumatol 2011; 24 (06) 457-462
- 16 Oxley B, Gemmill TJ, Renwick AR, Clements DN, McKee WM. Comparison of complication rates and clinical outcome between tibial plateau leveling osteotomy and a modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42 (06) 739-750
- 17 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
- 18 Inauen R, Koch D, Bass M, Haessig M. Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog. Vet Comp Orthop Traumatol 2009; 22 (01) 16-20
- 19 Osmond CS, Marcellin-Little DJ, Harrysson OLA, Kidd LB. Morphometric assessment of the proximal portion of the tibia in dogs with and without cranial cruciate ligament rupture. Vet Radiol Ultrasound 2006; 47 (02) 136-141
- 20 Frederick SW, Cross AR. Modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angles: Technique and complications in 19 cases. Vet Surg 2017; 46 (03) 403-411
- 21 Kishi EN, Hulse D. Owner evaluation of a CORA-based leveling osteotomy for treatment of cranial cruciate ligament injury in dogs. Vet Surg 2016; 45 (04) 507-514
- 22 Bailey CJ, Smith BA, Black AP. Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs. Vet Comp Orthop Traumatol 2007; 20 (03) 169-174
- 23 Christ JP, Anderson JR, Youk AO. Modified cranial closing wedge ostectomy in 25 dogs. Vet Surg 2018; 47 (05) 683-691
- 24 Kowaleski MP, McCarthy RJ. Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope. Vet Comp Orthop Traumatol 2004; 17 (01) 30-34
- 25 Guénégo L, Payot M, Charru P, Verwaerde P. Comparison of tibial anatomical-mechanical axis angle between predisposed dogs and dogs at low risk for cranial cruciate ligament rupture. Vet J 2017; 225: 35-41
- 26 Campbell KA, Payne JT, Doornink MT, Haggerty J. Outcome of tibial closing wedge osteotomy in 55 cranial cruciate ligament-deficient stifles of small dogs (<15 kg). Vet Surg 2016; 45 (08) 1056-1062