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Vet Comp Orthop Traumatol 2017; 30(01): 37-45
DOI: 10.3415/VCOT-16-01-0002
Original Research
Schattauer GmbH

Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide

Andrew Craig
1   Southern Counties Veterinary Specialists, Hangersley, Ringwood, Hampshire, UK
,
Philip Georg Witte
1   Southern Counties Veterinary Specialists, Hangersley, Ringwood, Hampshire, UK
,
Harry William Scott
1   Southern Counties Veterinary Specialists, Hangersley, Ringwood, Hampshire, UK
› Author Affiliations
Further Information

Publication History

Received: 08 January 2016

Accepted: 22 September 2016

Publication Date:
26 December 2017 (online)

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Summary

Objectives: To assess the accuracy of tibial osteotomy location for tibial plateau levelling osteotomy (TPLO) in the sagittal plane and its effect on the postoperative tibial plateau angle (TPA), when performed without an alignment jig and saw guide. Also, to document the improvement gained with experience.

Methods: Medical records and stifle radio-graphs of dogs undergoing TPLO, without the use of an alignment jig and saw guide, by one surgeon were reviewed (2010–2014). Postoperative radiographs were reviewed to record the distance and direction of eccentricity. Postoperative TPA was also recorded.

Results: In a series of 401 TPLO procedures, 231 met the inclusion criteria. The absolute distance of eccentricity (DOE) for all dogs was 3.0 ± 1.6 mm. When evaluating surgical experience, the DOE for the final 77 cases (2.72 ± 1.43 mm), the middle 77 cases (3.18 ± 1.49 mm), and the first 77 cases (3.24 ± 1.7 mm) were not significantly different (p = 0.07157). There was a very weak correlation between DOE and postoperative TPA (R = 0.029).

Clinical significance: The location of the tibial osteotomy when performing TPLO without an alignment jig and saw guide compared favourably with previously documented use of an alignment jig and saw guide. Whilst the location of the tibial osteo -tomy has a theoretical impact on the post -operative TPA, other factors appear to be of greater importance. Surgeon experience did not result in significant improvement in accuracy up to 231 procedures.

Keywords

Cranial cruciate ligament - tibial plateau levelling osteotomy (TPLO) - free-hand osteo -tomy - dog - stifle
 

  • References

  • 1 Witsberger TH., Villamil JA., Schultz LG.. et al. Prevalence of and risk factors for hip dysplasia and cranial cruciate ligament deficiency in dogs. J Am Vet Med Assoc 2008; 232: 1818-1824.
    CrossrefPubMedGoogle Scholar
  • 2 Kowaleski MP., Boudrieau RJ., Pozzi A.. Stifle Joint. In: Tobias KM., Johnston SA.. editors. Veterinary Surgery Small Animal. Vol 1 St. Louis (MO): Elsevier; 2012: 906-998.
    Google Scholar
  • 3 Slocum B., Devine T.. 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.
    CrossrefPubMedGoogle Scholar
  • 4 Bergh MS., Sullivan C., Ferrel C.. et al. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. J Am Anim Hosp Assoc 2014; 50: 315-321.
    CrossrefPubMedGoogle Scholar
  • 5 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.
    CrossrefPubMedGoogle Scholar
  • 6 Reif U., Hulse DA., Hauptman JG.. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31: 147-154.
    CrossrefPubMedGoogle Scholar
  • 7 Kim SE., Lewis DD., Pozzi A.. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing. Vet Surg 2012; 41: 465-470.
    CrossrefPubMedGoogle Scholar
  • 8 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: 30-34.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Bell JC., Ness MG.. Does use of a jig influence the precision of tibial plateau leveling osteotomy surgery?. Vet Surg 2007; 36: 228-233.
    CrossrefPubMedGoogle Scholar
  • 10 Schmerbach KI., Boeltzig CKM., Reif U.. et al. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling Jig. Vet Surg 2007; 36: 156-163.
    CrossrefPubMedGoogle Scholar
  • 11 Tuttle TA., Manley PA.. Risk factors associated with fibular fracture after tibial plateau leveling osteotomy. Vet Surg 2009; 38: 355-360.
    CrossrefPubMedGoogle Scholar
  • 12 Tan CJ., Bergh MS., Schembri MA.. et al. Accuracy of tibial osteotomy placement using 2 different tibial plateau leveling osteotomy jigs. Vet Surg 2014; 43: 525-533.
    CrossrefPubMedGoogle Scholar
  • 13 Grierson J., Sanders M., Guitan J.. et al. Comparison of anatomical tibial plateau angle versus observer measurement from lateral radiographs in dogs. Vet Comp Orthop Traumatol 2005; 4: 215-219.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Fettig AA., Rand WM., Sato AF.. et al. Observer variability of tibial plateau slope measurement in 40 dogs with cranial cruciate ligament-deficient stifle joints. Vet Surg 2004; 32: 471-478.
    PubMedGoogle Scholar
  • 15 Hayes GM., Ramirez J., Langley-Hobbs SJ.. Use of the cumulative summation technique to quantitatively assess a surgical learning curve: Canine total hip replacement. Vet Surg 2010; 40: 1-5.
    PubMedGoogle Scholar
  • 16 Proot JJ., Corr SA.. Clinical audit for the tibial tuberosity advancement procedure. Vet Comp Orthop Traumatol 2013; 26: 280-284.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Salai M., Mintz Y., Giveon U.. et al. The ‘‘learning curve’’ of total hip arthroplasty. Arch Orthop Trauma Surg 1997; 116: 420-422.
    CrossrefPubMedGoogle Scholar
  • 18 Coletti TJ., Anderson M., Gorse MJ.. et al. Complications associated with tibial plateau leveling osteotomy: A retrospective of 1519 procedures. Can Vet J 2014; 55: 249-254.
    PubMedGoogle Scholar
  • 19 Fitzpatrick N., Solano MA.. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
    CrossrefPubMedGoogle Scholar
  • 20 Stauffer KD., Tuttle TA., Elkins AD.. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Vet Med Assoc 2006; 42: 44-50.
    PubMedGoogle Scholar
  • 21 Cartiaux O.. Computer-assisted and robot-assisted technologies to improve bone-cutting accuracy when integrated with a freehand process using an oscillating saw. J Bone Joint Surg Am 2010; 92: 2076-2078.
    CrossrefPubMedGoogle Scholar
  • 22 Marcellin-Little DJ., Harrysson OA., Cansizoglu O.. In vitro evaluation of a custom cutting jig and custom plate for canine tibial plateau leveling. Am J Vet Res 2008; 69: 961-966.
    CrossrefPubMedGoogle Scholar
  • 23 Kowaleski MP., Apelt D., Mattoon JS.. et al. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: An in vitro study. Vet Surg 2005; 34: 332-336.
    CrossrefPubMedGoogle Scholar
  • 24 Demianiuk RM., Guiot LP.. Reverse TPLO for asymmetrical -premature closure of the proximal tibial physis in a dog. J Small Anim Pract 2014; 55: 589-592.
    CrossrefPubMedGoogle Scholar
  • 25 Robinson DA., Mason DR., Evans R.. et al. The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau leveling osteotomy in Labrador Retrievers. Vet Surg 2006; 35: 294-299.
    CrossrefPubMedGoogle Scholar
  • 26 Bergh MS., Rajala-Schultz P., Johnson KA.. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37: 374-382.
    CrossrefPubMedGoogle Scholar
  • 27 Woodbridge N., Knuchel-Takano A., Brissot HN.. et al. Accuracy evaluation of a two-wire technique for osteotomy positioning in the tibial plateau levelling procedure. Vet Comp Orthop Traumatol 2014; 27: 8-13.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Hamilton K., Tarlton J., Parsons K.. et al. Effect of osteotomy position and tibial plateau rotation on the tensile force required for failure of the canine quadriceps mechanism. Vet Surg 2015; 44: 763-771.
    CrossrefPubMedGoogle Scholar
  • 29 Yap CH., Colson E., Watters DA.. Cumulative sum techniques for surgeons: a brief review. ANZ J Surg 2007; 77: 583-586.
    CrossrefPubMedGoogle Scholar
  • 30 Ospina ODA., Medina Á MR., Marulanda MC.. et al. Cumulative sum learning curves (CUSUM) in basic anaesthesia procedures. Rev Colomb Anestesiol 2014; 42: 142-153.
    CrossrefPubMedGoogle Scholar
  • 31 Bolsin S., Colson M.. The use of CUSUM technique in the assessment of trainee competence in new procedures. Int J Qual Health Care 2000; 12: 433-438.
    CrossrefPubMedGoogle Scholar
  • 32 Burton NJ., Fitzpatrick N., Wallace AM.. Evaluation of cut accuracy and cis cortical damage for tibial plateau leveling osteotomy performed with and without aid of a novel saw guide: an in vitro study. Vet Surg 2012; 42: 28-37.
    PubMedGoogle Scholar
  • 33 Mossman H., von Pfeil DJ., Nicholson M.. et al. Accuracy of three pre- and intra-operative measurement techniques for osteotomy positioning in the tibial plateau levelling procedure. Vet Comp Orthop Traumatol 2015; 28: 250-255.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Collins JE., Degner DA., Hauptman JG.. et al. Benefits of pre- and intraoperative planning for tibial plateau leveling osteotomy. Vet Surg 2014; 43: 142-149.
    CrossrefPubMedGoogle Scholar
  • 35 O’Brien CS., Martinez SA.. Potential iatrogenic medial meniscal damage during tibial plateau leveling osteotomy. Vet Surg 2009; 38: 868-873.
    CrossrefPubMedGoogle Scholar
  • 36 Wheeler JL., Cross AR., Gingrich W.. In vitro effects of osteotomy angle and osteotomy reduction on tibial angulation and rotation during the tibial plateau-leveling osteotomy procedure. Vet Surg 2003; 32: 371-377.
    CrossrefPubMedGoogle Scholar