Tibial tuberosity advancement in 65 canine stifles

Summary

The tibial tuberosity advancement (TTA) procedure was developed to treat dogs with cranial cruciate ligament deficient stifles. A retrospective, descriptive study was performed on 57 dogs that underwent unilateral or bilateral TTA. Medical records were reviewed and pre-, postoperative and follow-up radiographs were evaluated for patellar ligament-tibial plateau angle (α), distance of the tibial tuberosity advancement and progression of degenerative joint disease. A questionnaire was sent to all owners to obtain their assessment of the procedural outcome. Sixty-five stifles in 57 dogs received a TTA. Mean age was 5.2 ± 2.5 years while mean weight was 39.7 ± 11.9 kg. Eighteen breeds were represented with Labrador retrievers and mixed breeds predominating. The mean duration of lameness prior to surgery was 6.2 ± 6.7 months, with a median lameness score of 3/4. Fifty-nine percent of cases encountered complications, the majority of which were minor. Major post-operative complications were uncommon but consisted of implant failure, tibial crest displacement and medial meniscal tears. The mean radiographic preoperative angle α was 100°, while the postoperative was 95.5°. Mean osteoarthrosis scores were significantly different between preoperative and follow-up radiographs with 67% of cases showing radiographic progression. Seventy percent of owners responded to the survey with overall outcome considered good to excellent in 90%. Activity level was improved in 90% of responses. TTA subjectively appears to be a useful alternative in the management of cranial cruciate ligament disease. Few severe complications were encountered. Good clinical outcome and owner satisfaction was reported with the procedure in this set of cases.

Keywords

Cranial cruciate ligament - tibial tuberosity advancement - TTA - stifle

• References

• 1 Moore KW, Read RA. Rupture of the cranial cruciate ligament in dogs – Part II. Diagnosis and management. Compend Contin Educ Pract Vet 1996; 18: 381-91.
• 2 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicularmusculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-69.
• 3 Lampman TJ, Lund EM, Lipowitz AJ. Cranial cruciate disease: current status of diagnosis, surgery, and risk of disease. Vet Comp Orthop Traumatol 2003; 16: 122-6.
• 4 Arnoczky SP. Pathomechanics of cruciate ligament andmeniscal injuries. In: Bojrab MJ ed. Disease Mechanisms in Small Animal Surgery. Philadelphia, Lea & Febiger, 1993; 764-77.
• 5 Korvick DL, Pijanowski GJ, Schaeffer DJ. Three-dimensional kinematics of the intact and cranial cruciate ligament-deficient stifle of dogs. J Biomech 1994; 27: 77-87.
• 6 Hayashi K, Manley PA, Muir P. Cranial cruciate ligament pathophysiology in dogs with cruciate disease: a review. J Am Anim Hosp Assoc 2004; 40: 385-90.
• 7 Johnson JM, Johnson AL. Cranial cruciate ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Vet ClinNorth Am 1993; 23: 717-33.
• 8 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am 1993; 23: 777-95.
• 9 Montavon PM, Damur DM, Tepic S. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. 1st World Orth Vet Congress. 2002: 152.
• 10 Montavon PM, Damur DM, Tepic S. Tibial tuberosity advancement (TTA) for the treatment of cranial cruciate disease in dogs: evidences, technique and initial clinical results. 12“ ESVOT Congress. 2004: 254-5.
• 11 Beals TC. So who was Gerdy and how did he get his own tubercle?. Am J Orthop 1996; 25: 750-2.
• 12 Watson C, Rochat M, Payton M. Effect of weight bearing on the joint angles of the fore- and hind limb of the dog. Vet Comp Orthop Traumatol 2003; 16: 250-4.
• 13 Milgram J, Slonim E, Kass PH. et al. A radiographic study of joint angles in standing dogs. Vet Comp Orthop Traumatol 2004; 17: 82-90.
• 14 Rayward RM, Thomson DG, Davies JV. et al. Progression of osteoarthritis following TPLO surgery: a prospective radiographic study of 40 dogs. J Small Anim Prac 2004; 45: 92-7.
• 15 Duval JM, Budsberg SC, Flo GL. et al. Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs. J Am Vet Med Assoc 1999; 215: 811-4.
• 16 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-93.
• 17 Priddy NH, Tomlinson JL, Dodam JR. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs:193 cases (1997-2001). J Am Vet Med Assoc 2003; 222: 1726-32.
• 18 Lazar TP, Berry CR. et al. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34: 133-41.
• 19 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 2003; 32: 471-8.
• 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: 1601-4.
• 21 Jerram RM, Walker AM, Warman CGA. Proximal tibial intraarticular ostectomy for treatment of canine cranial cruciate ligament injury. Vet Surg 2005; 34: 196-205.
• 22 Mullen HS, Matthiesen DT. Complications of transposition of the fibular head for stabilization of the cranial cruciate-deficient stifle in dogs: 80 cases (1982-1986). J Am Vet Med Assoc 1989; 195: 1267-71.
• 23 Martinez SA, Walker T. Bone grafts. Vet Clin North Am 1999; 29: 1207-19.
• 24 Maquet P. Advancement of the tibial tuberosity. Clin Orthop Rel Res 1976; 115: 225-30.
• 25 L'Eplattenier H, Montavon P. Patella luxation in dogs and cats: Pathogenesis and diagnosis. Compend Contin Educ Pract Vet 2002; 24: 234-40.
• 26 Tepic S, Montavon PM. Is cranial tibial advancement relevant in the cruciate deficient stifle? 12th ESVOT Congress. 2004; 132-3.
• 27 Innes JF, Barr ARS. Can owners assess outcome following treatment of canine cruciate ligament deficiency?. J Small Anim Prac 1998; 39: 373-8.