Vet Comp Orthop Traumatol 2011; 24(06): 457-462
DOI: 10.3415/VCOT-10-11-0159
Original Research
Schattauer GmbH

Modification of the cranial closing wedge ostectomy technique for the treatment of canine cruciate disease

Description and comparison with standard technique
A. M. Wallace
1   Langford Veterinary Services, School of Clinical Veterinary Science, University of Bristol, Langford House, Langford, North Somerset, United Kingdom
,
E. S. Addison
2   Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
,
B. A. Smith
3   Brisbane Veterinary Specialist Centre, Albany Creek, QLD, Australia
,
H. Radke
4   Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
,
S. J. Hobbs
4   Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
› Author Affiliations
Further Information

Publication History

Received: 30 November 2010

Accepted: 02 July 2011

Publication Date:
17 December 2017 (online)

Summary

Objective: To describe a modification of the cranial closing wedge ostectomy (CCWO) technique and to compare its efficacy to the standard technique on cadaveric specimens.

Methods: The standard and modified CCWO technique were applied to eight pairs of cadaveric tibiae. The following parameters were compared following the ostectomy: degrees of plateau levelling achieved (degrees), tibial long axis shift (degrees), reduction in tibial length (mm), area of bone wedge removed (cm2), and the area of proximal fragment (cm2).

Results: The size of the removed wedge of bone and the reduction in tibial length were significantly less with the modified CCWO technique.

Clinical significance: The modified CCWO has two main advantages. Firstly a smaller wedge is removed, allowing a greater preservation of bone stock in the proximal tibia, which is advantageous for implant placement. Secondly, the tibia is shortened to a lesser degree, which might reduce the risk of recurvatum, fibular fracture and patella desmitis. These factors are particularly propitious for the application of this technique to Terrier breeds with excessive tibial plateau angle, where large angular corrections are required. The modified CCWO is equally effective for plateau levelling and results in an equivalent tibial long-axis shift. A disadvantage with the modified technique is that not all of the cross sectional area of the distal fragment contributes to load sharing at the osteotomy.

 
  • References

  • 1 Innes JF, Bacon D, Lynch C. et al Long-term outcome of surgery for dogs with cranial cruciate ligament deficiency. Vet Rec 2000; 147: 325-328.
  • 2 Hayashi K, Manley PA, Muir P. Cranial cruciate ligament pathophysiology in dogs with cruciate disease: a review. J Am Anim Hosp Assoc 2004; 40: 385-390.
  • 3 Arnoczky SP, Tarvin GP, Marshall JL. The over – the – top procedure: a technique for anterior cruciate ligament substitution in the dog. J Am Anim Hosp Assoc 1979; 15: 283-290.
  • 4 Denny HR, Goodship AE. Replacement of the anterior cruciate ligament with carbon fibre in the dog. J Small Anim Pract 1980; 21: 279-286.
  • 5 Curtis RJ, Delee JC, Drez Jr DJ. Reconstruction of the anterior cruciate ligament with freeze dried fascia lata allografts in dogs. A preliminary report. Am J Sports Med 1985; 13: 408-414.
  • 6 Flo GL. Modification of the lateral retinacular imbrication technique for stabilizing cruciate ligament injuries. J Am Anim Hosp Assoc 1975; 11: 570-576.
  • 7 Gambardella PC WL, Cassidy F. Lateral suture technique for management of anterior cruciate ligament rupture in dogs: a retrospective study. J Am Anim Hosp Assoc 1981; 17: 33-38.
  • 8 Smith GK, Torg JS. Fibular head transposition for repair of cruciate-deficient stifle in the dog. J Am Vet Med Assoc 1985; 187: 375-383.
  • 9 Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-569.
  • 10 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: 777-795.
  • 11 Leighton RL. Preferred method of repair of cranial cruciate ligament rupture in dogs: a survey of ACVS diplomates specializing in canine orthopedics. American College of Veterinary Surgery. Vet Surg 1999; 28: 194
  • 12 Selmi AL, Padilha Filho JG. Rupture of the cranial cruciate ligament associated with deformity of the proximal tibia in five dogs. J Small Anim Pract 2001; 42: 390-393.
  • 13 Read RA, Robins GM. Deformity of the proximal tibia in dogs. Vet Rec 1982; 111: 295-298.
  • 14 Talaat MB, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle. Vet Surg 2006; 35: 729-739.
  • 15 Warzee CC, Dejardin LM, Arnoczky SP. et al Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30: 278-286.
  • 16 Shahar R, Milgram J. Biomechanics of tibial plateau leveling of the canine cruciate-deficient stifle joint: a theoretical model. Vet Surg 2006; 35: 144-149.
  • 17 Macias C, McKee WM, May C. Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs. J Small Anim Pract 2002; 43: 433-438.
  • 18 Duerr FM, Duncan CG, Savicky RS. et al Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37: 49-62.
  • 19 Reif U, Dejardin LM, Probst CW. et al Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle. Vet Surg 2004; 33: 368-375.
  • 20 Kowaleski MP, McCarthy RJ. Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope. Vet Comp Orthop Traumatol 2004; 17: 30-34.
  • 21 Bailey CJ, Smith BA, Black AP. Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs. Vet Comp Orthop Traumatol 2007; 20: 169-174.
  • 22 Apelt D, Pozzi A, Marcellin-Little DJ. et al Effect of cranial tibial closing wedge angle on tibial subluxation: an ex vivo study. Vet Surg 2010; 39: 454-459.
  • 23 Corr SA, Brown C. A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures. Vet Comp Orthop Traumatol 2007; 20: 312-319.
  • 24 Bruce WJ, Rose A, Tuke J. et al Evaluation of the triple tibial osteotomy. A new technique for the management of the canine cruciate-deficient stifle. Vet Comp Orthop Traumatol 2007; 20: 159-168.
  • 25 Kuan S, Smith B, Black A. Tibial wedge ostectomy: complications of 300 surgical procedures. Aust Vet J 2009; 87: 438-444.
  • 26 Robinson DA, Mason DR, Evans R. et al The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau leveling osteotomy in Labrador Retrievers. Vet Surg 2006; 35: 294-299.
  • 27 Tuttle TA, Manley PA. Risk factors associated with fibular fracture after tibial plateau leveling osteotomy. Vet Surg 2009; 38: 355-360.
  • 28 Johnson AL, Hulse DA. Fundamentals of Orthopaedic Surgery and Fracture Management. In: Fossum TW, Hedlund CS, Hulse DA, et al, editors. Small Animal Surgery. 2nd Edition St Louis: Mosby; 2002: 857.
  • 29 Filipowicz D, Lanz O, McLaughlin R. et al A bio-mechanical comparison of 3.5 locking compression plate fixation to 3.5 limited contact dynamic compression plate fixation in a canine cadaveric distal humeral metaphyseal gap model. Vet Comp Orthop Traumatol 2009; 22: 270-277.