Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja

Abstract

Caudal cruciate ligament injury can be a complication following tibial plateau leveling osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge osteotomy of 23 degree and a fibular ostectomy were performed. The osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the osteotomy site and no implant failure. The diaphyseal CORA based osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.

Caudal Cruciate Ligament Rupture in an Adult Dog 8.5 Years Post Juvenile Tibial Plateau Cranial Hemiepiphysiodesis

“…A case with rupture of both CrCL and CaCL with a negative TPA was treated through a reverse TPLO. 9,30 Since the target of 6.5 degrees TPA is contraindicated in case of CaCL disease, 15 Vincenzi and colleagues aimed for 15 degrees TPA nullifying the CaTT and obtaining normal limb function. 9,31 Overcorrection after TPCHE was documented in this dog.…”

“…9,30 Since the target of 6.5 degrees TPA is contraindicated in case of CaCL disease, 15 Vincenzi and colleagues aimed for 15 degrees TPA nullifying the CaTT and obtaining normal limb function. 9,31 Overcorrection after TPCHE was documented in this dog. Based on this case report, we conclude that it is prudent to frequently re-evaluate puppies undergoing TPCHE to minimize the risk of tibial plateau over-levelling.…”

“…5 The most common reported conformational variation as a potential contributor to cranial or CaCLs rupture is the tibial plateau angle (TPA) variation. [6][7][8][9] The dogs' normal TPA ranges from 18 to 26 degrees. 10 During weight-bearing, the forces transmitted by the femoral condyles to the tibial plateau result in a force directed cranially, known as cranial tibial thrust (CTT), counteracted in a healthy stifle by the CrCL.…”

“…A dog affected by limb deformity, including negative TPA, had concomitant partial rupture of the CaCL. 9 With the same purpose of the TPLO, screw fixation of capital tibial physis for tibial plateau levelling in growing dogs was first introduced by Slocum 15 and later reported by Vezzoni and colleagues as 'proximal tibial epiphysiodesis'. 16 There are two growth plates in the proximal tibia as the tibial-tuberosity apophysis and the tibial plateau physis.…”

Evaluation of depth gauge accuracy in a canine tibial plateau leveling osteotomy model

“…During surgery, a bone plate is secured to the tibia using 6–10 screws, depending on plate type and size. Several manufacturers produce bone plates designed to stabilize the proximal portion of the tibia by use of nonlocking or locking screws 2–4 . The geometry of TPLO plate holes varies based on whether or not screws have a locking thread: holes can be circular, oval, or have a geometry that allow users to select a nonlocking cortical or cancellous screw or a locking screw, with side‐by‐side or superimposed screw placement.…”