Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: Complications, owner satisfaction, and midterm to long‐term outcomes

Terreros, Alex; Daye, R. Mark

doi:10.1111/vsu.13431

Cited by 11 publications

(14 citation statements)

References 22 publications

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“…In our study, precise planning of the osteotomy allowed us to superimpose the AA and MA axes postoperatively, thus reducing the median TLAS to 0°; this resulted in 82.5% of the dogs having strictly aligned axes with consecutive, predictable postoperative TPAs. Furthermore, the reduced angle of correction compared to previous recommendations for standard CCWO [ 4 , 9 , 10 , 12 , 23 ] and the positioning of the tip of the wedge at the caudodistal insertion of the medial collateral ligament rather than at the caudal cortex of the tibia, as described in previous studies [ 6 – 9 ], reduced the size of the wedge and limited lowering of the patella. As a result of the reduced size and precise positioning of the wedge, the median tibial shortening, even in this cohort of large dogs with large TPAs, was 3.5 mm, comparable to the mean difference in tibial length of 2.5–3 mm for CCWO documented in previous publications [ 6 – 9 , 16 ].…”

Section: Discussionmentioning

confidence: 84%

“…PB could be a result of tibial shortening following wedge reduction with standard CCWO and has been reported to be a critical disadvantage of CCWO compared to TPLO [ 11 – 13 ]. Such shortening could increase the strain on the patellar ligament and increase the likelihood of secondary inflammation, but these are theoretical suggestions that have not been proven or documented in practice [ 6 , 7 , 9 , 10 ]. In our study, precise planning of the osteotomy allowed us to superimpose the AA and MA axes postoperatively, thus reducing the median TLAS to 0°; this resulted in 82.5% of the dogs having strictly aligned axes with consecutive, predictable postoperative TPAs.…”

Section: Discussionmentioning

confidence: 99%

“…These treatments include extracapsular stabilization and procedures in which osteotomies are used to modify the biomechanics of the stifle [ 1 ]. Tibial plateau levelling osteotomy (TPLO) [ 1 – 3 ] and cranial closing wedge osteotomy (CCWO) are common osteotomy procedures [ 4 – 10 ] that alter the tibial plateau slope (TPS) [ 11 ]. Although numerous studies in which the clinical outcomes and complication rates of these procedures were compared have failed to demonstrate the superiority of any one technique [ 4 , 6 ], one major disadvantage of CCWO that has been cited is that it produces a change in proximodistal patellar position resulting from a more craniodistal position of the tibial crest, leading to stifle and hock hyperextension to compensate for patella baja (PB) [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than 30° and clinically normal Labradors retrievers

Guénégo¹,

Vezzoni²,

Vezzoni³

2021

BMC Vet Res

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Background The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) > 30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed 2 months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after 2 months. Results Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P = 0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (− 1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)). At 8 weeks, PLT grade differed significantly in the two operated groups (P = 0.000) (TPLO 40% 0–2, 20% 2–4, 40% > 4; CCWO 98.8% 0). Conclusions TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results 2 months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA > 30°.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than 30° and clinically normal Labradors retrievers

Guénégo¹,

Vezzoni²,

Vezzoni³

2021

BMC Vet Res

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“…The authors comment that given the very proximal position of the osteotomy with this technique, they recommend to always supplement plate fixation with cranial pin and figureof-eight tension band wire to protect the tibial tuberosity and prevent loss of reduction at the osteotomy site in the postoperative period (Frederick & Cross 2017). Christ et al (2018) and Terreros & Daye (2020) reported the short-term and long-term outcome after another modification of the CCWO technique aimed at minimising the length of the cranial tibial wedge and optimising bone contact at the osteotomy. We refer the readers to the original papers for a full description of the surgical technique.…”

Section: Surgical Management: Cranial Closing Wedge Ostectomymentioning

confidence: 99%

Cranial cruciate ligament rupture in small dogs (<15 kg): a narrative literature review

Brioschi

Arthurs

2021

J of Small Animal Practice

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Small breed dogs (<15 kg) affected by cranial cruciate ligament rupture secondary to cranial cruciate ligament disease are usually middle-aged (mean age at presentation: 5.4 to 9.8 years); terrier breeds, miniature and toy poodles are over-represented. Small breed dogs have a different morphology of the proximal tibia compared to medium and large breed dogs with a steep tibial plateau angle (mean tibial plateau angle 28.8° to 36.3°), absent base of the flare of the tibial tuberosity and a caudally bowed fibula. There is a lack of evidence regarding the optimal management of cranial cruciate ligament rupture in small dogs. The treatment options consist of conservative management, extracapsular stabilisation, cranial closing wedge ostectomy, tibial plateau levelling osteotomy and tibial tuberosity advancement. The limited evidence available shows that conservative management is likely to result in prolonged recovery time (average time to recovery approximately 4 months). There is paucity of reports focussing on extracapsular stabilisation in small breed dogs, and questions have been raised regarding the early failure of the extracapsular suture subject to higher loads due to the steep tibial plateau angle of small breed dogs. Cranial closing wedge ostectomy and tibial plateau levelling osteotomy have been reported to have low major complication rates and good subjective outcomes. It is controversial whether tibial tuberosity advancement is a suitable technique in dogs with steep tibial plateau angle, which includes most small breed dogs. *These studies included dogs with bodyweight <18 kg † These studies defined minor complications as those complications that resolved without any intervention and major complications as those complications that resolved with surgical or medical management ‡ This study included a small proportion of medium breed dogs, median bodyweight was 12.5 kg (range 4.5 to 31.9 kg) * This study included a small proportion of medium breed dogs, median bodyweight was 12.5 kg (range 4.5 to 31.9 kg) † These studies included dogs with bodyweight <18 kg * This study included a small proportion of medium breed dogs, median bodyweight was 12.5 kg (range 4.5 to 31.9 kg)

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“…In our study, precise planning of the osteotomy allowed us to superimpose the AA and MA axes postoperatively, thus reducing the median TLAS to 0°; this resulted in 82.5% of the dogs having strictly aligned axes with consecutive, predictable postoperative TPAs. Furthermore, the reduced angle of correction compared to previous recommendations for standard CCWO [4,9,10,12,23] and the positioning of the tip of the wedge at the caudodistal insertion of the medial collateral ligament rather than at the caudal cortex of the tibia, as described in previous studies [6 -9], reduced the size of the wedge and limited lowering of the patella. As a result of the reduced size and precise positioning of the wedge, the median tibial shortening, even in this cohort of large dogs with large TPAs, was 3.5 mm, comparable to the mean difference in tibial length of 2.5-3 mm for CCWO documented in previous publications [6 -9, 16].…”

Section: Discussionmentioning

confidence: 85%

Comparison of Tibial Anatomical-mechanical Axis Angles and Patellar Positions Between Tibial Plateau Levelling Osteotomy (TPLO) and Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) for the Treatment of Cranial Cruciate Ligament Disease in Large Dogs With Tibial Plateau Slopes Greater Than 30° and Clinically Normal Labradors Retrievers

Guénégo¹,

Vezzoni²,

Vezzoni³

2021

Preprint

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Background: The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) >30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed two months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after two months.Results: Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P=0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (-1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)).At 8 weeks, PLT grade differed significantly in the two operated groups (P=0.000) (TPLO 40% 0–2, 20% 2–4, 40% >4; CCWO 98.8% 0).Conclusions: TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results two months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA >30°.

show abstract

Modified cranial closing wedge osteotomy to treat cranial cruciate ligament deficient stifles with excessive tibial plateau angles: Complications, owner satisfaction, and midterm to long‐term outcomes

Cited by 11 publications

References 22 publications

Cranial cruciate ligament rupture in small dogs (<15 kg): a narrative literature review

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