Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog

R. Yeadon; N. Fitzpatrick; M. P. Kowaleski

doi:10.3415/VCOT-10-01-0015

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2011; 24(01): 18-26
DOI: 10.3415/VCOT-10-01-0015

Original Research

Schattauer GmbH

Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog

Surgical technique, radiographic and clinical outcomes

R. Yeadon

¹Fitzpatrick Referrals, Halfway Lane, Eashing, Surrey, UK

,

N. Fitzpatrick

¹Fitzpatrick Referrals, Halfway Lane, Eashing, Surrey, UK

,

M. P. Kowaleski

²Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA

› Author Affiliations

Abstract

Summary

Objective: To report surgical technique, morphometric effects and clinical outcomes for tibial tuberosity transposition-advancement (TTTA), sulcoplasty and para-patellar fascial imbrication for management of concomitant medial patellar luxation (MPL) and cranial cruciate ligament (CCL) disease in 32 dogs.

Study design: Case series.

Methods: A previous technique for tibial tuberosity advancement was modified to incorporate lateral and distal tibial tuberosity transposition. Preoperative, immediate, and six to eight week postoperative radiographs were reviewed with morphometry of a range of tibial and stifle anatomic parameters. Findings of sequential clinical examinations to six to 20 months postoperatively were recorded.

Results: Thirty-nine stifles were treated by surgery. Medial patellar luxation grade ranged from II to IV/IV. The CCL rupture was complete in 17/39 stifles, and incomplete in 22/39. Complications occurred in 11/39 stifles including MPL recurrence (n = 4). Resolution of subjectively-assessed lameness occurred in 29/39 stifles at the six to eight week assessment. Resolution of lameness was eventually documented in 35/39 stifles (4/39 lost to follow-up), and was maintained at the six to 20 month reassessment where available. The TTTA induced relative patella baja in 31/39 stifles. Magnitude of actual tibial tuberosity advancement was lower than that predicted by cage size.

Clinical significance: Tibial tuberosity transposition-advancement is a potential treatment modality for concomitant CCL disease and MPL in the dog, but refinement of planning is required, while biomechanical and kinematic effects remain unknown.

Keywords

Cruciate - patella - stifle - tibial tuberosity advancement - osteotomy

Full Text

References

References
1 Ness MG, Abercromby RH, May C. et al. A survey of orthopaedic conditions in small animal veterinary practice in Britain. Vet Comp Orthop Traumatol 1996; 9: 43-52.
2 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-69.
3 Gibbons SE, Macias C, Tonzing MA. et al. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
4 Piermattei DL, Flo GL, DeCamp CE. The Stifle Joint. In: Piermattei DL, Flo GL, DeCamp CE. editors Handbook of Small Animal Orthopedics and Fracture Repair Philadelphia: Saunders Elsevier; 2006: 562-632.
5 Remedios AM, Basher AWP, Runyon CL. et al. Medial patellar luxation in 16 large dogs. A retrospective study. Vet Surg 1992; 21: 5-9.
6 Willauer CC, Vasseur PB. Clinical results of surgical correction of medial luxation of the patella in dogs. Vet Surg 1987; 16: 31-36.
7 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patella luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
8 Langenbach A, Marcellin-Little DJ. Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling. J Small Anim Pract 2010; 51: 97-103.
9 Stein S, Schmoekel H. Short term and 8-12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. J Small Anim Pract 2008; 49: 398-404.
10 Mostafa AA, Griffon DJ, Thomas MW. et al. Proximo-distal alignment of the canine patella: Radiographic evaluation and association with medial and lateral patellar luxation. Vet Surg 2008; 37: 201-211.
11 Johnson AL, Probst CW, DeCamp CE. et al. Vertical position of the patella in the stifle joint of clinically normal large-breed dogs. Am J Vet Radiol 2002; 63: 42-46.
12 Towle HA, Griffon DJ, Thomas MW. et al. Pre- and post-operative radiographic and computed tomo-graphic evaluation of dogs with medial patella luxation. Vet Surg 2005; 34: 265-272.
13 Hoffmann DE, Miller JM, Ober CP. et al. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19: 219-227.
14 Lafaver S, Miller N, Stubbs P. et al. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament deficient stifle: early results and complications in 101 dogs. Vet Surg 2007; 36: 573-586.
15 Johnson AL, Broaddus KD, Hauptman JG. et al. Vertical patellar position in large-breed dogs with clinically normal stifles and large-breed dogs with medial patellar luxation. Vet Surg 2006; 35: 78-81.
16 Singleton WB. The surgical correction of stifle deformities in the dog. J Small Anim Pract 1969; 10: 59-69.
17 Putnam RW. Patellar luxation in the dog. MSc thesis 1968. University of Guelph; Canada:
18 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg [Br] 1961; 43: 752-757.
19 Johnson AL, Probst CW, DeCamp CE. et al. Comparison of trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model. Vet Surg 2001; 30: 140-150.
20 Ralphs SC, Whitney WO. Arthroscopic evaluation of menisci in dogs with cranial cruciate ligament injuries: 100 cases (1999–2000). J Am Vet Med Assoc 2002; 221: 1601-1604.
21 Burns CG, Boudrieau RJ. Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12mm in four large breed dogs with cranial cruciate ligament-deficient joints. Vet Comp Orthop Traumatol 2008; 21: 250-255.
22 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.
23 Kipfer NM, Tepic S, Damur DM. et al. Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles. An in vitro study. Vet Comp Orthop Traumatol 2008; 21: 385-390.
24 Kim SE, Pozzi A, Banks SA. et al. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics. Vet Surg 2009; 38: 33-39.
25 L'Eplattenier H, Montavon PM. Patellar luxation in dogs and cats: management and prevention. Compend Contin Educ Pract Vet 2002; 24: 292-298.
26 Daems R, Janssens L, Beosior Y. Grossly apparent cartilage erosion of the patellar articular surface in dogs with congenital medial patellar luxation. Vet Comp Orthop Traumatol 2009; 22: 222-224.
27 Ramappa AJ, Apreleva M, Harrold FR. et al. The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Med 2006; 34: 749-756.
28 Karlsson J, Sward L, Lansinger O. Bad results after anterior advancement of the tibial tubercle for patello-femoral pain syndrome. Arch Orthop Trauma Surg 1992; 111: 195-197.
29 Schiedel F, Probst A, Buller TC. et al. The post-operative patella height: a comparison of additive and subtractive high tibial osteotomy in correcting the genu varum. Arch Orthop Traum Surg 2009; 129: 1271-1277.
30 Backstein D, Meisami B, Gross AE. Patella baja after the modified Coventry-Maquet high tibial osteotomy. J Knee Surg 2003; 16: 203-208.
31 Noyes FR, Wojtys EM, Marshall MT. The early diagnosis and treatment of developmental patella infera syndrome. Clin Orthop Rel Res 1991; 265: 241-252.