Feasibility of Combined Tibial Plateau Levelling Osteotomy and Tibial Tuberosity Transposition for Treatment of Ipsilateral Cranial Cruciate Ligament Insufficiency and Medial Patellar Luxation in Small-Breed Dogs Weighing up to 15 kg

Abstract

Objective

The aim of this study was to investigate the short-term outcomes of tibial plateau levelling osteotomy (TPLO) and tibial tuberosity transposition (TTT) for the combined treatment of cranial cruciate ligament rupture and medial patellar luxation (MPL) in small-breed dogs weighing up to 15 kg.

Study Design

Retrospective case series of dogs treated with a single session TPLO–TTT from five referral centres between 2015 and 2023. Intraoperative and postoperative complications were assessed. Osteotomy healing, lameness and presence of patellar luxation or tibial thrust were assessed at a 6- to 12-week follow-up.

Results

A total of 37 stifles in 35 dogs. At the time of follow-up, the tibial compression test was negative in all stifles. The MPL grade improved from a median of 3/4 preoperatively to a median of 0/4 (p = 0.0001) postoperatively. Lameness grade improved from a median of 3/5 to 1/5. There were seven minor complications and seven major complications. No catastrophic complications occurred. Osteotomy healing was appropriate in all dogs. Three intraoperative complications related to a TPLO screw near the joint required replacement. Postoperative MPL was noted in three stifle joints (grade 1/4, 3/4 and 4/4). One distal tibial tuberosity fracture and one patella fracture were managed conservatively. Patella ligament desmitis was managed conservatively in five stifles.

Conclusion

Combined TPLO–TTT is an effective treatment of cranial cruciate ligament rupture and MPL in small-breed dogs, but surgical accuracy is needed to minimize complications. High-grade patellar luxation may require alternative methods of stabilization.

Keywords

canine cruciate ligament rupture - TPLO - tibial plateau levelling osteotomy - tibial tuberosity transposition - patella luxation

Contributors' Statement

E.B. and J.J. contributed to study conception and design. E.B., A.S., A.L.M., P.L., S.K. and A.C. contributed to data collection. E.B. and J.J. contributed to analysis and interpretation of results. E.B. and J.J. drafted the manuscript.

Publication History

Received: 25 February 2025

Accepted: 11 December 2025

Article published online:
26 December 2025

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