Planned wedge size compared to achieved advancement in dogs undergoing the modified Maquet procedure

Summary

Objectives: To evaluate the patellar ligament to tibial plateau angle (PL-TPA) and amount of achieved advancement in dogs that underwent the modified Maquet procedure; compare wedge sizes recommended using two different planning techniques (Orthomed and modified tibial tuberosity advancement); and evaluate anatomical factors that predict the wedge size required to obtain a 90° PL-TPA.

Methods: Pre- and postoperative radio-graphs of dogs that had a modified Maquet procedure performed were evaluated for the following: calculated wedge size using two different planning techniques, the actual wedge size used, the achieved tibial tuberosity advancement, and the changes in PL-TPA. Anatomical measurements of the tibia were evaluated and correlated with the actual wedge size.

Results: Of the 38 modified Maquet procedures identified, 53% (n = 20) had a PLTPA of 90° ± 5°. Actual achieved advancement of the tibial tuberosity was 30% less than the wedge size used. Changes in PL-TPA and tibial width persisted at eight weeks postoperatively without loss of advancement. The two planning techniques did not result in a significantly different selection of wedge size.

Clinical relevance: Current planning techniques for the modified Maquet procedure result in under-advancement of the tibial tuberosity. Both measurement techniques evaluated do not result in appropriate advancement.

Keywords

Cranial cruciate ligament - MMP - stifle - Maquet procedure

• References

• 1 Apelt D, Kowaleski MP, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study. Vet Surg 2007; 36: 170-177.
• 2 Apelt D, Pozzi A, Marcellin-Little DJ. et al. Effect of cranial tibial closing wedge angle on tibial subluxation: an ex vivo study. Vet Surg 2010; 39: 454-459.
• 3 Warzee CC, Dejardin LM, Arnoczky SP. et al. 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: 278-286.
• 4 Etchepareborde S, Brunel L, Bollen G. et al. Preliminary experience of a modified Maquet technique for repair of cranial cruciate ligament rupture in dogs. Vet Comp Orthop Traumatol 2011; 24: 223-227.
• 5 Brunel L, Etchepareborde S, Barthelemy N. et al. Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique. Vet Comp Orthop Traumatol 2013; 26: 47-53.
• 6 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.
• 7 Ness MG.. Orthofoam MMP Wedge. For Canine Cruciate Disease. User Guide (Version V1.1). Orthomed; March Available from: 2011 www.Orthomed.co.uk/download
• 8 Cadmus J, Palmer RH, Duncan C. The effect of preoperative planning method on recommended tibial tuberosity advancement cage size. Vet Surg 2014; 43: 995-1000.
• 9 Millet M, Bismuth C, Labrunie A. et al. Measurement of the patellar tendon-tibial plateau angle and tuberosity advancement in dogs with cranial cruciate ligament rupture. Reliability of the common tangent and tibial plateau methods of measurement. Vet Comp Orthop Traumatol 2013; 26: 469-478.
• 10 Ness MG.. Orthofoam MMP Wedge. For Canine Cruciate Disease. User Guide (Version V1.2). Orthomed; October Available from: 2014 www.orthomed.co.uk/orthofoam-mmp-curuciate-repair-system/mmp-implants/orthofoam-mmp-wedge
• 11 Mostafa AA, Griffon DJ, Thomas MW. et al. Proximodistal alignment of the canine patella: radiographic evaluation and association with medial and lateral patellar luxation. Vet Surg 2008; 37: 201-211.
• 12 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: 777-795.
• 13 Vedrine B, Guillemot A, Fontaine D. et al. Comparative anatomy of the proximal tibia in healthy Labrador Retrievers and Yorkshire Terriers. Vet Comp Orthop Traumatol 2013; 26: 266-270.
• 14 Etchepareborde S, Mills J, Busoni V. et al. Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 2011; 24: 27-31.
• 15 Wolf RE, Scavelli TD, Hoelzler MG. et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007-2009). J Am Vet Med Assoc 2012; 240: 1481-1487.
• 16 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
• 17 Renwick AI, Mckee WM, Emmerson TD. et al. Preliminary experiences of the triple tibial osteotomy procedure: tibial morphology and complications. J Small Anim Pract 2009; 50: 212-221.
• 18 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: 729-739.