Modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angles: Technique and complications in 19 cases

Abstract

Modified CCWO should be considered for the treatment of cranial cruciate ligament disease in dogs with eTPA. In this case series, the described technique was associated with uneventful osteotomy healing without implant failures in all dogs, although radiographic follow-up was limited in some cases.

Modified cranial closing wedge ostectomy in 25 dogs

“…Early reports of CCWO in dogs with high TPA caused by proximal tibial procurvatum yielded variable TPA postop . Our mean TPA postop was within 1 ° (0.66 ± 0.047) of our mean TPA target , similarly to those reported by Frederick et al (8.3 ° ± 4.8 °) and Campbell et al (7.5 ° ± 0.75 °). The magnitude of difference between the TPA target and TPA postop was within 3 ° in 27 of 32 (84.4%) dogs in our study.…”

“…This procedure resulted in TPA postop of > 6.5 ° in 12 of 19 operated stifles, without apparent adverse effect . Bone contact at the osteotomy was not evaluated by Frederick, but images suggest that the full cross‐sectional area of the distal fragment was not used, similarly to that reported by Wallace…”

“…Oxley et al reported that a modified CCWO (mCCWO) resulted in TPA reduction and clinical outcomes comparable to those of a tibial plateau leveling osteotomy (TPLO). Frederick et al also reported good clinical outcomes in cranial cruciate ligament (CCL)‐deficient dogs with excessive TPA (eTPA) treated with mCCWO.…”

“…Several modifications to Slocum's original description of CCWO have been described to address the concerns mentioned above . Bailey et al observed TPA postop greater than anticipated in a series of cases, prompting recommendations for more proximal osteotomies, alignment of the cranial cortices, and adding 2‐3 degrees to the planned wedge.…”

“…Campbell et al described a proximally located CCWO in 55 cases with eTPA. Finally, a juxta‐articular neutral wedge osteotomy has been performed with an intraoperative aiming device to remove a wedge with an angle equal to the TPA . This procedure resulted in TPA postop of > 6.5 ° in 12 of 19 operated stifles, without apparent adverse effect .…”