Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: Complications, owner satisfaction, and midterm to long‐term outcomes

2020 ◽  
Vol 49 (6) ◽  
pp. 1109-1117
Author(s):  
Alex Terreros ◽  
R. Mark Daye
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Wedge Osteotomy ◽  
Long Term Outcomes ◽  
Cranial Cruciate Ligament ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Owner Satisfaction

scholarly journals Use of a Modified Tibial Plateau Levelling Osteotomy with Double Cut and Medial Crescentic Closing Wedge Osteotomy to Treat Dogs with Cranial Cruciate Ligament Rupture and Tibial Valgus Deformity

2019 ◽  
Vol 33 (01) ◽  
pp. 059-065
Author(s):  
Luca Vezzoni ◽  
Sara Bazzo ◽  
Silvia Boiocchi ◽  
Aldo Vezzoni
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Wedge Osteotomy ◽  
Cranial Cruciate Ligament ◽  
Closing Wedge Osteotomy ◽  
Ligament Rupture ◽  
Closing Wedge ◽  
Cruciate Ligament Rupture ◽  
Tibial Valgus ◽  
Cranial Cruciate Ligament Rupture

Abstract Objective The aim of this study was to report efficacy of a modified tibial plateau levelling osteotomy (TPLO) with double cut and medial crescentic closing wedge osteotomy (TPLO/MCCWO) to treat dogs with cranial cruciate ligament rupture and concurrent tibial valgus. Study Design This study was a cases series. Materials and Methods Medical records of dogs that had TPLO with medial crescentic closing wedge osteotomy were reviewed. Data collected included signalment, body weight, pre- and postoperative tibial valgus angle, tibial plateau angle (TPA), surgical planning, corrective osteotomy technique, method of fixation, complications, and length of time to radiographic healing. Results Fifty-two surgical procedures performed in 45 dogs (7 bilateral) were included in the study. Mean age at surgery was 54 months, and body weight ranged from 5 to 63 kg (mean: 36.5 kg). Mean pre- and postoperative mechanical medial proximal tibial angle were 101° (98°–107°) and 92.80° (88°–97°) respectively. The mean pre- and postoperative TPA were 27.80° (16–35°) and 6.50° (3–11°) respectively. Intraoperative complications occurred in two stifles: in one stifle over-rotation of the proximal tibial segment resulted in a TPA of –8°, with immediate revision to a 5° TPA; in the second stifle a fissure of the lateral tibial cortex developed during insertion of a screw and required adjunctive fixation. No postoperative complications were recorded and all osteotomies healed uneventfully. Conclusions Tibial plateau levelling osteotomy/medial crescentic closing wedge osteotomy is an effective treatment for dogs with cranial cruciate ligament rupture and tibial valgus allowing accurate correction of the tibial deformity with a low complication rate.

scholarly journals Comparison of Tibial Anatomical-mechanical Axis Angles and Patellar Positions Between Tibial Plateau Levelling Osteotomy (TPLO) and Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) for the Treatment of Cranial Cruciate Ligament Disease in Large Dogs With Tibial Plateau Slopes Greater Than 30° and Clinically Normal Labradors Retrievers

2021 ◽  
Author(s):  
Laurent Guénégo ◽  
Aldo Vezzoni ◽  
Luca Vezzoni
Keyword(s):  
Tibial Plateau ◽  
Mechanical Axis ◽  
Cruciate Ligament ◽  
Patellar Height ◽  
Patellar Ligament ◽  
Wedge Osteotomy ◽  
Control Group ◽  
Closing Wedge Osteotomy ◽  
Clinically Normal ◽  
Closing Wedge

Abstract Background: The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) >30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed two months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after two months.Results: Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P=0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (-1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)).At 8 weeks, PLT grade differed significantly in the two operated groups (P=0.000) (TPLO 40% 0–2, 20% 2–4, 40% >4; CCWO 98.8% 0).Conclusions: TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results two months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA >30°.

scholarly journals Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than 30° and clinically normal Labradors retrievers

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Laurent Guénégo ◽  
Aldo Vezzoni ◽  
Luca Vezzoni
Keyword(s):  
Tibial Plateau ◽  
Mechanical Axis ◽  
Cruciate Ligament ◽  
Patellar Height ◽  
Patellar Ligament ◽  
Wedge Osteotomy ◽  
Control Group ◽  
Closing Wedge Osteotomy ◽  
Clinically Normal ◽  
Closing Wedge

Abstract Background The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) > 30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed 2 months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after 2 months. Results Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P = 0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (− 1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)). At 8 weeks, PLT grade differed significantly in the two operated groups (P = 0.000) (TPLO 40% 0–2, 20% 2–4, 40% > 4; CCWO 98.8% 0). Conclusions TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results 2 months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA > 30°.

Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs

2017 ◽  
Vol 30 (01) ◽  
pp. 20-27 ◽  
Author(s):  
Barry Brower ◽  
Ann Peruski ◽  
Antonio Pozzi ◽  
Jonathan Dyce ◽  
Kenneth Johnson ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cruciate Ligament ◽  
Wedge Osteotomy ◽  
Comprehensive Treatment ◽  
Angular Deformity ◽  
Cranial Cruciate Ligament ◽  
Closing Wedge ◽  
The Mean ◽  
Cranial Cruciate Ligament Disease

SummaryObjective: To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique.Methods: Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner.Results: A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51).Clinical significance: In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by fe-moral varus, and supports an association between stifle instability and medial patellar luxation.

Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review

2018 ◽  
Vol 46 (04) ◽  
pp. 223-235 ◽  
Author(s):  
Patricia Beer ◽  
Barbara Bockstahler ◽  
Eva Schnabl-Feichter
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Tuberosity ◽  
Complication Rates ◽  
Cranial Cruciate Ligament ◽  
Evidence Level ◽  
Lower Complication ◽  
Owner Satisfaction ◽  
Cranial Cruciate Ligament Rupture

Summary Objective: The optimal surgical technique for treatment of cranial cruciate ligament rupture in canine has been scientifically discussed for decades. Despite the continuous debate, proximal tibial osteotomies such as tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) are increasingly common. The objective of this review was to systematically evaluate the literature reporting outcome and complications associated with TPLO and TTA. Materials and methods: A systematic search of literature databases identified articles published from August 2004 to February 2016 describing evaluations of short- or longterm outcomes as well as complications following TPLO or TTA. Results: Ninety-one studies were included in this review and assigned to one out of four evidence levels. Of those, 89 studies provided the lowest evidence level and only two were assigned to the third-best evidence level. A comparison of subjective gait analyses could not detect differences in the decrease of lameness between TPLO and TTA, while objective gait analysis supports the superiority of TPLO. Fewer patients treated with TPLO were diagnosed with postoperative joint instability and TPLO had a lower percent increase of osteoarthritis (OA) after surgery. Owner satisfaction was high for both techniques. For TPLO and TTA the average total, minor, major and catastrophic complication rates were 15.9 % and 20.8 %, 7.9 % and 11.6 %, 5.2 % and 13.2 % as well as 0.8 % and 5.6 %, respectively. Conclusion and clinical significance: The assessed literature supports the hypothesis that TPLO is associated with lower complication rates, an improved clinical-functional outcome and less increase of OA compared to TTA. The results are indicative for a long-term restoration of normal limb function after TPLO. However, the strength of available evidence and the comparability of each study’s results were poor and more comparative studies are needed to draw strong conclusions towards the superiority of the TPLO over the TTA.

Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (<15 kg)

2016 ◽  
Vol 45 (8) ◽  
pp. 1056-1062 ◽  
Author(s):  
Kathryn A. Campbell ◽  
John T. Payne ◽  
Michael T. Doornink ◽  
Jamie Haggerty
Keyword(s):  
Cruciate Ligament ◽  
Wedge Osteotomy ◽  
Cranial Cruciate Ligament ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge

A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures

2007 ◽  
Vol 20 (04) ◽  
pp. 312-319 ◽  
Author(s):  
C. Brown ◽  
S. A. Corr
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Small Sample ◽  
Wedge Osteotomy ◽  
Complication Rates ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Cruciate Ligament Rupture ◽  
Significant Difference ◽  
Cranial Cruciate Ligament Rupture

SummaryThe objective of this study was to determine whether clinical outcomes were superior and complication rates were lower in dogs that had had a cranial cruciate ligament rupture treated by tibial plateau levelling osteotomy (TPLO), compared to those dogs that had been treated using the original cranial tibial wedge osteotomy (CTWO) procedure. Thirty-seven client-owned dogs with cranial cruciate ligament rupture were included in the study: 19 dogs underwent a TPLO procedure, and 18 dogs underwent a CTWO procedure. The study was retrospective, with the data being obtained from medical records and a review of radiographs. The long-term outcome was assessed by means of an owner questionnaire using a visual analogue scale. For the majority of factors that were reviewed, there was not a significant difference in outcome between the dogs that had a TPLO or those that had undergone a CTWO. All of the dogs showed a rapid return to weight bearing after surgery, and at the six week re-examination, the majority of the dogs did not have any pain on stifle palpation. They displayed a good stifle range of motion and significantly lower lameness scores than those prior to surgery. The complication rates did not differ between the procedures, however, within this small sample of dogs, complications following a CTWO were more likely to require revision surgery.

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