Radiographic Comparison of Virtual Surgical Corrective Options for Excessive Tibial Plateau Angle in the Dog

Natalie J. Worden; Bill Oxley; Jaron Naiman; William Michael Karlin; Tiffany M. Chen; Scott J. Hetzel; Jason Bleedorn

doi:10.1055/s-0043-1768229

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2023; 36(05): 225-235
DOI: 10.1055/s-0043-1768229

Original Research

Radiographic Comparison of Virtual Surgical Corrective Options for Excessive Tibial Plateau Angle in the Dog

Natalie J. Worden

¹Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States

²Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States

,

Bill Oxley

³Vet3D, Coventry, West Midlands, United Kingdom

,

Jaron Naiman

⁴Department of Small Animal Surgery, ACCESS Specialty Animal Hospital – Pasadena, Pasadena, California, United States

,

William Michael Karlin

⁵Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University North Grafton, Massachusetts, United States

,

Tiffany M. Chen

¹Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States

,

Scott J. Hetzel

⁶Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States

,

Jason Bleedorn

¹Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States

⁷Department of Veterinary Clinical Sciences, Colorado State University, Fort Collins, Colorado, United States

› Institutsangaben

Abstract

Objective The main aim of this study is to compare the impact of six proximal tibial osteotomies on the geometry and alignment of tibias with and without excessive tibial plateau angle (TPA).

Study Design Mediolateral radiographs of 30 canine tibias were divided into three groups (n = 10/group): moderate TPA (≤34 degrees), severe TPA (34.1–44 degrees) and extreme TPA (>44 degrees). Six proximal tibial osteotomies were simulated on each tibia using orthopaedic planning software: cranial closing wedge ostectomy (CCWO), modified CCWO (mCCWO), isosceles CCWO (iCCWO), neutral isosceles CCWO (niCCWO), tibial plateau levelling osteotomy with CCWO (TPLO/CCWO) and coplanar centre of rotation of angulation-based levelling osteotomy (coCBLO). All tibias were reduced to a standard target TPA. Pre- and postoperative measurements were obtained for each virtual correction. Compared outcome measures included tibial long axis shift (TLAS), cranial tibial tuberosity shift (cTTS), distal tibial tuberosity shift (dTTS), tibial shortening and osteotomy overlap.

Results Across all TPA groups, TPLO/CCWO had the lowest mean TLAS (1.4 mm) and dTTS (6.8 mm); coCBLO had the largest TLAS (6.5 mm) and cTTS (13.1 mm); CCWO had the largest dTTS (29.5 mm). CCWO had the largest degree of tibial shortening of 6.5 mm, while mCCWO, niCCWO and coCBLO resulted in minimal tibial lengthening (1.8–3.0 mm). These trends were generally conserved across different TPA groups. All findings had a p-value less than 0.05.

Conclusion mCCWO balances moderate alterations to tibial geometry while preserving osteotomy overlap. The TPLO/CCWO has the least effect on tibial morphology alteration, whereas the coCBLO results in the largest alteration.

Keywords

dog - excessive tibial plateau angle - cranial cruciate ligament - closing wedge - tibial osteotomy

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Referenzen

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