A retrospective study of tibial plateau translation following tibial plateau levelling osteotomy stabilisation using three different plate types

Summary

Objective:To retrospectively evaluate mediolateral translation of the proximal tibial segment (tibial plateau) after tibial plateau levelling osteotomy (TPLO), stabilised with three types of plate.

Method: Pre- and postoperative radiographs of 79 dogs that had TPLO surgery using three different types of plates were reviewed. Two plate types incorporated non-locking screws: Slocum (22 cases) and Orthomed Delta (33 cases) plates. The third plate type incorporated locking screws: Synthes TPLO Locking Compression Plate (LCP) (24 cases). The radio-graphs were viewed by three Diplomate surgeons who were blinded to the type of implant used. Medial or lateral translation of the proximal tibial plateau relative to the tibial diaphysis was assessed and measured at the lateral tibial cortex at the osteotomy site.

Results: Mean lateral translation of the tibial plateau was significantly greater when using the Synthes TPLO LCP with locking screws (+2.1 mm) compared to the non-locking Slocum (+0.4 mm) or Orthomed Delta (0.0 mm) plates.

Clinical significance: The use of the Synthes TPLO LCP will maintain a malalignment of the tibial plateau. Accurate alignment of the tibial plateau must be ensured prior to application of the Synthes TPLO LCP.

Keywords

Tibial plateau - translation - osteotomy - locking plate

• References

• 1 Lampman TJ, Lund EM, Lipowitz AJ. Cranial cruciate disease: Current status of diagnosis, surgery, and risk of disease. Vet Comp Orthop Traumatol 2003; 16: 122-126.
• 2 Kim SE, Pozzi A, Kowaleski MP. et al Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. J Vet Surg 2008; 37: 111-125.
• 3 Henderson R, Milton J. The tibial compression mechanism: A diagnostic aid in stifle injuries. J Am Hosp Assoc 1978; 14: 474-479.
• 4 Slocum B, Slocum TD. Tibial plateau levelling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
• 5 Wagner M. General principles for the clinical use of the LCP. Injury Int J. Care of injured 2003; 34: S-B31-S-B42.
• 6 Smith WR, Ziran BH, Anglen JO. et al Locking plates: Tips and tricks. J Bone Joint Surg Am 2007; 89: 2298-2307.
• 7 Synthes USA. Tibial plateau levelling osteotomy (TPLO) Plate. Technique Guide. [document on the Internet]. Synthes USA; 2006 [updated June 2006; cited on January 2010]. Available from. http://productlit.synthes.com/prod_support/Product%20Support%20Materials/Technique%20Guides/VET/SUTGTPLOPlateJ6544A.pdf
• 8 Leitner L, Pearce SG, Windolf M. et al Comparison of locking and conventional screws for maintenance of tibial plateau positioning and biochemical stability after locking tibial plateau levelling osteotomy plate fixation. J Vet Surg 2008; 37: 357-365.
• 9 Wheeler JL, Cross AR, Gingrich W. In vitro effects of osteotomy angle and osteotomy reduction on tibial angulation and rotation during the tibial plateau levelling osteotomy procedure. Vet Surg 2003; 32: 371-377.
• 10 Perren MS. Backgrounds of the technology of internal fixators. Injury Int J. Care injured 2003; 34: SB1-SB3.
• 11 Synthes USA. Large Fragment LCP Instrument and Implant Set. Part of the Synthes locking compression plate (LCP) system. Technique Guide. [document on the Internet]. Synthes USA; 2003 [updated 2003; cited on January 2010]. Available from. http://www.synthes.com/MediaBin/US%20DATA/Product%20Support%20Materials/Technique%20Guides/SUSA/SUTGLargeLCPJ4331H.pdf