Tibial Tuberosity Transposition Stabilization Using a Cortical Screw Placed Adjacent to the Tuberosity in Dogs with Patellar Luxation

Abstract

Objectives The aim of this study was to describe a screw fixation method of the tibial tuberosity after transposition during surgical treatment of patellar luxation and to report complications and outcome of the procedure.

Materials and Methods Medical records (2010–2016) of dogs treated for patellar luxation with tibial tuberosity transposition stabilization using a cortical bone screw placed adjacent to the tuberosity were retrospectively reviewed. Radiographs acquired immediately after surgery were evaluated for fissures. Proximal tibial dimensions and tibial tuberosity segments were measured. Intraoperative and postoperative complications were recorded.

Results One-hundred and six dogs and 131 stifle surgeries were included. Implant complications associated with the screw occurred in 2/106 dogs (1.9%). Two dogs developed tibial tuberosity fracture and proximal displacement within 1 week of surgery and required stabilization with pin and tension band. Patellar reluxation rate following surgery was 6.9% (9/131 procedures). Presence of a fissure on postoperative radiographs increased the odds of tibial tuberosity fracture development (p < 0.001), while greater tibial tuberosity size (p = 0.023) and larger distal cortical attachment (p = 0.018) decreased the odds of fissure formation.

Clinical significance Tibial tuberosity transposition can be achieved with a cortical screw placed lateral or medial to the tibial tuberosity.

Keywords

patellar luxation - tibial tuberosity transposition - complications - tibial tuberosity size - canine

Author Contribution

Barbro Filliquist contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Sivert Viskjer contributed to conception of study, study design and acquisition of data. Dr Susan M. Stover contributed to study design and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.

• References

• 1 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-59
• 2 Ness MG, Abercromby 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
• 3 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35 (06) 559-566
• 4 Alam MR, Lee JI, Kang HS. , et al. Frequency and distribution of patellar luxation in dogs. 134 cases (2000 to 2005). Vet Comp Orthop Traumatol 2007; 20 (01) 59-64
• 5 Clerfond P, Huneault L, Dupuis J, Moreau M, Auger J. Unilateral or single-session bilateral surgery for correction of medial patellar luxation in small dogs: short and long-term outcomes. Vet Comp Orthop Traumatol 2014; 27 (06) 484-490
• 6 Cashmore RG, Havlicek M, Perkins NR. , et al. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs. Vet Comp Orthop Traumatol 2014; 27 (04) 263-270
• 7 Brower BE, Kowaleski MP, Peruski AM. , et al. Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs. Vet Comp Orthop Traumatol 2017; 30 (01) 20-27
• 8 Roush JK. Canine patellar luxation. Vet Clin North Am Small Anim Pract 1993; 23 (04) 855-868
• 9 Wangdee C, Theyse LF, Techakumphu M, Soontornvipart K, Hazewinkel HA. Evaluation of surgical treatment of medial patellar luxation in Pomeranian dogs. Vet Comp Orthop Traumatol 2013; 26 (06) 435-439
• 10 Stanke NJ, Stephenson N, Hayashi K. Retrospective risk factor assessment for complication following tibial tuberosity transposition in 137 canine stifles with medial patellar luxation. Can Vet J 2014; 55 (04) 349-356
• 11 Pugliese LC, Pike FS, Aiken SW. Distal tibial tuberosity translation using TTA implants for the treatment of patella alta in large breed dogs. Surgical technique and clinical outcome. Vet Comp Orthop Traumatol 2015; 28 (04) 274-281
• 12 Gallegos J, Unis M, Roush JK, Agulian L. Postoperative complications and short-term outcome following single-session bilateral corrective surgery for medial patellar luxation in dogs weighing <15 kg: 50 cases (2009–2014). Vet Surg 2016; 45 (07) 887-892
• 13 Fullagar BA, Rajala-Schultz P, Hettlich BF. Comparison of complication rates of unilateral, staged bilateral, and single-session bilateral surgery for the treatment of bilateral medial patellar luxation in dogs. Can Vet J 2017; 58 (01) 39-44
• 14 Singleton WB. The surgical correction of stifle deformities in the dog. J Small Anim Pract 1969; 10 (02) 59-69
• 15 Linney WR, Hammer DL, Shott S. Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009). J Am Vet Med Assoc 2011; 238 (09) 1168-1172
• 16 Bosio F, Bufalari A, Peirone B, Petazzoni M, Vezzoni A. Prevalence, treatment and outcome of patellar luxation in dogs in Italy. A retrospective multicentric study (2009-2014). Vet Comp Orthop Traumatol 2017; 30 (05) 364-370
• 17 Inauen R, Koch D, Bass M, Haessig M. Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog. Vet Comp Orthop Traumatol 2009; 22 (01) 16-20
• 18 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