Technique and Outcome of a Modified Tibial Plateau Levelling Osteotomy for Treatment of Concurrent Medial Patellar Luxation and Cranial Cruciate Ligament Rupture in 76 Stifles

Abstract

Objectives The main aim of this article is to describe the technique and outcome of a modified tibial plateau levelling osteotomy (TPLO) that simultaneously levels the tibial plateau and realigns the quadriceps mechanism through medial translation of the proximal tibial segment in dogs less than 15 kg.

Materials and Methods A retrospective medical records search identified dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL). A study group (76 stifles) treated with a modified TPLO was compared with a non-tibial translation group (45 stifles) corrected with traditional surgical technique. Signalment, arthroscopic findings, adjunctive surgical procedures, osteotomy healing time and complications were recorded. Tibial plateau angle, proximal tibial segment medialization, width of the tibial osteotomy, mechanical medial proximal tibial angle and mechanical medial distal tibial angle were measured and recorded on preoperative and postoperative radiographs.

Results Overall complication rate was 18.4% in the treatment group and 28.9% in the non-tibial translation group. Reluxation occurred in 6.6% of cases in the study group and in 8.8% of cases in the non-tibial translation group. There was no statistical difference in healing time between groups.

Clinical Significance A modified TPLO can be used to treat patients with concurrent MPL and CCLR with good clinical outcome. Complication rates are comparable to traditional repairs for MPL. No major differences were appreciated between study and a non-tibial translation groups for variables compared.

Keywords

canine cruciate ligament rupture - dog - tibial plateau levelling osteotomy - medial patellar luxation

Author Contribution

Kathryn Flesher contributed to study design, acquisition of data and data analysis and interpretation. Brian S. Beale contributed to conception of study, study design and acquisition of data. Caleb C. Hudson contributed to conception of study, study design, acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.

• References

• 1 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 (02) 97-103
• 2 Yeadon R, Fitzpatrick N, Kowaleski MP. 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. Vet Comp Orthop Traumatol 2011; 24 (01) 18-26
• 3 Campbell CA, Horstman CL, Mason DR, Evans RB. Severity of patellar luxation and frequency of concomitant cranial cruciate ligament rupture in dogs: 162 cases (2004-2007). J Am Vet Med Assoc 2010; 236 (08) 887-891
• 4 Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am Vet Med Assoc 2002; 220 (09) 1325-1330
• 5 DeAngelis M, Hohn RB. Evaluation of surgical correction of canine patellar luxation in 142 cases. J Am Vet Med Assoc 1970; 156 (05) 587-594
• 6 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
• 7 Slocum B, Devine T. Cranial tibial thrust: a primary force in the canine stifle. J Am Vet Med Assoc 1983; 183 (04) 456-459
• 8 Arthurs GI, Langley-Hobbs SJ. Patellar luxation as a complication of surgical intervention for the management of cranial cruciate ligament rupture in dogs. A retrospective study of 32 cases. Vet Comp Orthop Traumatol 2007; 20 (03) 204-210
• 9 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35 (06) 559-566
• 10 Priddy II NH, Tomlinson JL, Dodam JR, Hornbostel JE. 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 (12) 1726-1732
• 11 Kergosien DH, Barnhart MD, Kees CE. , et al. Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy. Vet Surg 2004; 33 (05) 468-474
• 12 Weh JL, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs. Vet Surg 2011; 40 (06) 670-686
• 13 Beale B, Hulse D, Schulz K. Arthroscopically assisted surgery of the stifle joint. In: Small Animal Arthroscopy. 1st ed. Philadelphia, PA: Elsevier Science; 2003: 121-130
• 14 Putnam RW. Patellar luxation in the dog. [PhD thesis]. University of Guelph, Ontario, Canada; 1968
• 15 Dismukes DI, Tomlinson JL, Fox DB, Cook JL, Song KJ. Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. Vet Surg 2007; 36 (07) 699-704
• 16 Kowaleski MP, Boudrieau RJ, Beale BS, Piras A, Hulse D, Johnson KA. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate. Vet Surg 2013; 42 (07) 847-852
• 17 Krotscheck U, Thompson MS, Ryan KK, Mohammed HO. Comparison of TPA, bone healing, and intra-articular screw placement using conventional nonlocked application of surgeon-contoured versus locked application of precontoured TPLO plates in dogs. Vet Surg 2012; 41 (08) 931-937
• 18 Leonard KC, Kowaleski MP, Saunders WB, McCarthy RJ, Boudrieau RJ. Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation. Vet Comp Orthop Traumatol 2016; 29 (06) 536-540