Comparison of Outcome and Complications in Dogs Weighing Less Than 12 kg Undergoing Miniature Tibial Tuberosity Transposition and Advancement versus Extracapsular Stabilization with Tibial Tuberosity Transposition for Cranial Cruciate Ligament Disease with Concomitant Medial Patellar Luxation

Abstract

Objective The aim of this study was to describe a technique for performing miniature tibial tuberosity transposition and advancement (mTTTA). The secondary objective of this study was to compare the short-term outcome and complications in small breed dogs weighing less than 12 kg undergoing surgical correction of cranial cruciate ligament disease with concurrent medial patellar luxation via either extracapsular stabilization with tibial tuberosity transposition (ECS + TTT) or mTTTA.

Study Design This is a retrospective case comparison study.

Results There was no significant difference in overall outcome between the ECS + TTT group and the mTTTA group when comparing 8-week postoperative radiographic healing scores as well as 2- and 8-week postoperative lameness scores.

Conclusion This study concluded that the mTTTA procedure was feasible and the overall outcome and complications for the dogs that underwent ECS + TTT and those that underwent mTTTA were comparable.

Keywords

cruciate ligament disease - orthopaedic surgery - dog - tibial tuberosity advancement - patellar luxation

Authors' Contributions

All authors contributed to conception of study, study design, acquisition of data, and data analysis and interpretation. They drafted, revised and approved the submitted manuscript and are publically accountable for relevant content.

Publication History

Received: 13 November 2019

Accepted: 31 July 2020

Article published online:
30 November 2020

• References

• 1 Ness MN, Abercomby 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 Gibbons SE, Macias C, Tonzing MA, Pinchbeck GL, McKee WM. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47 (01) 3-9
• 3 Piermattei DL, Flo GL, De Camp CE. The stifle joint. In: Brinker, Piermattei and Flo's Handbook of Small Animal Orthopaedics and Fracture Repair. 4th edition. St. Louis, MO: Saunders Elsevier; 2006: 562-632
• 4 Remedios AM, Basher AWP, Runyon CL, Fries CL. Medial patellar luxation in 16 large dogs. A retrospective study. Vet Surg 1992; 21 (01) 5-9
• 5 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35 (06) 559-566
• 6 Willauer CC, Vasseur PB. Clinical results of surgical correction of medial luxation of the patella in dogs. Vet Surg 1987; 16 (01) 31-36
• 7 Korvick DL, Johnson AL, Schaeffer DJ. Surgeons' preferences in treating cranial cruciate ligament ruptures in dogs. J Am Vet Med Assoc 1994; 205 (09) 1318-1324
• 8 Comerford E, Forster K, Gorton K, Maddox T. Management of cranial cruciate ligament rupture in small dogs: a questionnaire study. Vet Comp Orthop Traumatol 2013; 26 (06) 493-497
• 9 Conzemius MG, Evans RB, Besancon MF. et al. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226 (02) 232-236
• 10 Moore KW, Read RA. Cranial cruciate ligament rupture in the dog--a retrospective study comparing surgical techniques. Aust Vet J 1995; 72 (08) 281-285
• 11 Witte PG. Tibial anatomy in normal small breed dogs including anisometry of various extracapsular stabilizing suture attachment sites. Vet Comp Orthop Traumatol 2015; 28 (05) 331-338
• 12 Roe SC, Kue J, Gemma J. Isometry of potential suture attachment sites for the cranial cruciate ligament deficient canine stifle. Vet Comp Orthop Traumatol 2008; 21 (03) 215-220
• 13 Olmstead ML. The use of orthopedic wire as a lateral suture for stifle stabilization. Vet Clin North Am Small Anim Pract 1993; 23 (04) 735-753
• 14 Störk CK, Gibson NR, Owen MR. et al. Radiographic features of a lateral extracapsular wire suture in the canine cranial cruciate deficient stifle. J Small Anim Pract 2001; 42 (10) 487-490
• 15 Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). J Am Vet Med Assoc 2009; 234 (02) 229-235
• 16 Cosenza G, Reif U, Martini M. Tibial plateau leveling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5mm locking plates. Vet Comp Orthop Traumatol 2015; 28: 347-354
• 17 Witte PG, Scott HW. Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate. Vet Surg 2014; 43 (05) 549-557
• 18 Fauron AH, Bruce M, James DR, Owen MA, Perry KL. Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease. Effect of fixation method on postoperative complication rate and clinical outcome. Vet Comp Orthop Traumatol 2017; 30 (03) 209-218
• 19 Hoffmann DE, Miller JM, Ober CP, Lanz OI, Martin RA, Shires PK. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006; 19 (04) 219-227
• 20 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle joint. In: Tobias KM, Johnston SA. eds. Veterinary Surgery: Small Animal, vol. 1. St. Louis: Elsevier/Saunders; 2018: 1071-1168
• 21 Talcott KW, Goring RL, de Haan JJ. Rectangular recession trochleoplasty for treatment of patellar luxation in dogs and cats. Vet Comp Orthop Traumatol 2000; 13: 39-43
• 22 Slocum B, Devine T. Trochlear recession for correction of luxating patella in the dog. J Am Vet Med Assoc 1985; 186 (04) 365-369
• 23 Montavon PM, Damur DM, Tepic S. Tibial tuberosity advancement (TTA) for the treatment of cranial cruciate disease in dogs: evidence, technique and initial clinical results. 12th ESVOT Congress 2004: 254-255
• 24 Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs. Vet Surg 2007; 36 (06) 573-586
• 25 DeAngelis M, Lau RE. A lateral retinacular imbrication technique for the surgical correction of anterior cruciate ligament rupture in the dog. J Am Vet Med Assoc 1970; 157 (01) 79-84
• 26 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: 250-254
• 27 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
• 28 Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am 1987; 18 (02) 213-225
• 29 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
• 30 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
• 31 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23 (04) 777-795
• 32 Cadmus J, Palmer RH, Duncan C. The effect of preoperative planning method on recommended tibial tuberosity advancement cage size. Vet Surg 2014; 43 (08) 995-1000
• 33 Hoffmann DE, Kowaleski MP, Johnson KA, Evans RB, Boudrieau RJ. Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement. Vet Surg 2011; 40 (03) 311-320
• 34 Guerrero TG, Pozzi A, Dunbar N. et al. Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints. Vet Surg 2011; 40 (07) 839-848
• 35 Vezzoni A. TTA (tibial tuberosity advancement) in the treatment of cranial cruciate ligament injuries. Proceedings of the North American Veterinary Conference; 2006 January 7–11; Orlando, FL, United States 949-952
• 36 Ferreira AJA, Bom RM, Tavares SO. Tibial tuberosity advancement technique in small breed dogs: study of 30 consecutive dogs (35 stifles). J Small Anim Pract 2019; 60 (05) 305-312
• 37 Samoy Y, Verhoeven G, Bosmans T. et al. TTA rapid: description of the technique and short term clinical trial results of the first 50 cases. Vet Surg 2015; 44 (04) 474-484