Download PDF
Vet Comp Orthop Traumatol 2014; 27(04): 271-276
DOI: 10.3415/VCOT-13-12-0150
Original Research
Schattauer GmbH

Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: An ex vivo canine study

M. Newman
1   University Veterinary Teaching Hospital- Sydney University of Sydney, New South Wales, Australia
,
N. Bertollo
2   Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Prince of Wales Hospital, Randwick, New South Wales, Australia
,
W. Walsh
2   Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Prince of Wales Hospital, Randwick, New South Wales, Australia
,
K. Voss
1   University Veterinary Teaching Hospital- Sydney University of Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

Received: 12 December 2013

Accepted: 19 May 2014

Publication Date:
20 December 2017 (online)

    Permissions and Reprints

Summary

Objectives: To evaluate the degree of lateralization achievable and strength of tibial tuberosity transposition and advancement (TTTA) relative to pin and tension band wiring (PTBW) for lateral tibial tuberosity transposition.

Methods: Six pairs of cadaveric tibiae were used. Tibial tuberosity position was determined with computed tomography (CT); bones were then randomly assigned into TTTA and PTBW groups. The PTBW group had a tibial tuberosity osteotomy and fixation with pin and tension band wiring. The TTTA group had a tibial tuberosity advancement performed with lateralization of the tibial tuberosity by 50% of cage depth, using spacers on the cranial cage screw. Postoperative CT images showed lateralization and craniocaudal deviation. Single axial distractive loading was applied to the patella at 90° to the tibial plateau, and peak load, energy, and stiffness were calculated.

Results: There were significant differences in lateralization (PTBW: 67.92 ± 5.1 %; TTTA: 88.51 ± 5.5 %) (p = 0.0173) and craniocaudal deviation (PTBW: –8.30 ± 1.4 %; TTTA: 6.83 ± 0.6) (p = 0.0001). There were no significant differences in peak load to failure (N) (PTBW: 1448 ± 121; TTTA: 1597 ± 43) (p = 0.4541), energy to failure (N/mm) (PTBW: 15013 ± 2719; TTTA: 17314 ± 887) (p = 0.646), or stiffness (N/mm)(PTBW: 102.8 ± 4.7; TTTA: 92.9 ± 4.8) (p = 0.2716).

Clinical significance: The TTTA was more effective at lateralization of the tibial tuberosity, and of comparable strength to PTBW. Greater support of the osteotomized fragment with TTTA may resist cyclic loading, and requires evaluation.

Keywords

Tibial tuberosity advancement - medial patellar luxation - tibial tuberosity transposition - orthopaedic implants
 

  • References

  • 1 Kaiser S, Cornely D, Golder W. et al. Magnetic resonance measurements of the deviation of the angle of force generated by contraction of the quadriceps muscle in dogs with congenital medial patellar luxation. Vet Surg 2001; 30: 552-558.
    CrossrefPubMedGoogle Scholar
  • 2 Miles JE, Frederiksen JV, Jensen B. et al. The quadriceps angle: reliability and accuracy in a fox (Vulpes vulpes) pelvic limb model. Vet Surg 2012; 41: 422-429.
    PubMedGoogle Scholar
  • 3 Mortari AC, Rahal SC, Vulcano LC. et al. Use of radiographic measurements in the evaluation of dogs with medial patellar luxation. Can Vet J 2009; 50: 1064-1068.
    PubMedGoogle Scholar
  • 4 Towle HA, Griffon DJ, Thomas MW. et al. Pre- and postoperative radiographic and computed tomographic evaluation of dogs with medial patellar luxation. Vet Surg 2005; 34: 265-272.
    CrossrefPubMedGoogle Scholar
  • 5 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle Joint. In: Tobias KM, Johnston SA. editors. Veterinary Surgery: Small Animal. St. Loius: Saunders; 2012. pg. 2012-906.
    Google Scholar
  • 6 Gibbons SE, Macias C, Tonzing MA. et al. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
    CrossrefPubMedGoogle Scholar
  • 7 Linney WR, Hammer DL, Shott S. Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009). J Am Vet Med Assoc 2011; 238: 1168-1172.
    CrossrefPubMedGoogle Scholar
  • 8 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
    CrossrefPubMedGoogle Scholar
  • 9 Willauer CC, Vasseur PB. Clinical results of surgical correction of medial luxation of the patella in dogs. Vet Surg 1987; 16: 31-36.
    CrossrefPubMedGoogle Scholar
  • 10 Yeadon R, Fitzpatrick N, Kowaleski MP. Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Vet Comp Orthop Traumatol 2011; 24: 18-26.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Swiderski JK, Palmer RH. Long-term outcome of distal femoral osteotomy for treatment of combined distal femoral varus and medial patellar luxation: 12 cases (1999-2004). J Am Vet Med Assoc 2007; 231: 1070-1075.
    CrossrefPubMedGoogle Scholar
  • 12 Lafaver S, Miller NA, Stubbs WP. et al. Tibial tuberosity advancement for stabilisation of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
    CrossrefPubMedGoogle Scholar
  • 13 Etchepareborde S, Barthelemy N, Mills J. et al. Mechanical testing of a modified stabilisation method for tibial tuberosity advancement. Vet Comp Orthop Traumatol 2010; 23: 400-405.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Schmöckel HG, Montavon PM. Die Versetzung der Tuberositas Tibiae mit einer Kranialisation bei der Patellaluxation beim Hund (The displacement of the tibial tuberosity with cranialisation in medial patellar luxation in dogs). Kleintierpraxis 1993; 38: 805-808.
    PubMedGoogle Scholar
  • 15 Guerrero TG, Pozzi A, Dunbar N. et al. Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints. Vet Surg 2011; 40: 839-848.
    PubMedGoogle Scholar
  • 16 Hoffmann DE, Kowaleski MP, Johnson KA. et al. Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement. Vet Surg 2011; 40: 311-320.
    CrossrefPubMedGoogle Scholar
  • 17 Rue JH, Colton A, Zare SM. et al. Trochlear contact pressures after straight anteriorization of the tibial tuberosity. Am J Sports Med 2008; 36: 1952-1959.
    PubMedGoogle Scholar
  • 18 Singerman R, White C, Davy DT. Reduction of patellofemoral contact forces following anterior displacement of the tibial tubercle. J Orthop Res 1995; 13: 279-285.
    CrossrefPubMedGoogle Scholar
  • 19 Beck PR, Thomas AL, Farr J. et al. Trochlear contact pressures after anteromedialization of the tibial tubercle. Am J Sports Med 2005; 33: 1710-1715.
    CrossrefPubMedGoogle Scholar
  • 20 Daems R, Janssens LA, Béosier TM. Grossly apparent cartilage erosion of the patellar articular surface in dogs with congenital medial patellar luxation. Vet Comp Orthop Traumatol 2009; 22: 222-224.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Roy RG, Wallace LJ, Johnston GR. A retrospective evaluation of stifle osteoarthritis in dogs with medial patellar luxation and unilateral surgical repair. Vet Surg 1992; 21: 475-479.
    CrossrefPubMedGoogle Scholar
  • 22 Alexander R. The mechanics of jumping by a dog (Canis Familiaris). J Zool 1974; 173: 549-573.
    PubMedGoogle Scholar
  • 23 Biskup J, Freeman A, Camisa W. et al. Mechanical properties of canine patellar-ligament-tibia segment. Vet Surg 2014; 43: 136-141.
    CrossrefPubMedGoogle Scholar