Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture

Etchepareborde, S.; Mills, Janith; Busoni, Valéria; Brunel, Laurencie; Balligand, Marc

doi:10.3415/vcot-10-01-0013

Cited by 27 publications

(10 citation statements)

References 15 publications

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“…However, it is has been shown that there is a theoretical discrepancy between the cage size and the resultant tibial tuberosity advancement, with the cage size consistently providing less tibial tuberosity advancement than predicted [ 12 ]. This occurs as the advancement distance required is measured in a direction parallel to the tibial plateau, whereas the plane of the tibial crest osteotomy is not perpendicular to the tibial plateau.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Tibial conformation, cage size and advancement achieved in TTA procedure

et al. 2018

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BackgroundPrevious studies have suggested that there is a theoretical discrepancy between the cage size and the resultant tibial tuberosity advancement, with the cage size consistently providing less tibial tuberosity advancement than predicted. The purpose of this study was to test and quantify this in clinical cases. The hypothesis was that the advancement of the tibial tuberosity as measured by the widening of the proximal tibia at the tibial tuberosity level after a standard TTA, will be less than the cage sized used, with no particular cage size providing a relative smaller or higher under-advancement, and that the conformation of the proximal tibia will have an influence on the amount of advancement achieved.ResultsOne hundred sixty-four dogs met the inclusion criteria. The mean percentage under-advancement was 15.5%. All dogs had an advancement less than the stated cage size inserted. An association between the proximal tibial tuberosity angle (increased in cases with low patellar tendon insertion), and percentage under-advancement was found, with an increase of 0.45% under-advancement for every 1 degree increase in angle a (p = 0.003). There was also evidence of a difference between the mean percentage under-advancement in breeds (p = 0.001) with the Labrador having the biggest under-advancement. Cage size (p = 0.83) and preoperative tibial plateau angle (p = 0.27) did not affect under-advancement.ConclusionsThe conformation of the tibial tuberosity and therefore the relative cage positioning have an impact on mean percentage under-advancement of the tibial tuberosity after standard TTA. In all evaluated cases, the advancement of the tibial tuberosity was less than intended by the cage size selected.

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Section: Introductionmentioning

confidence: 99%

Relationship between Tibial conformation, cage size and advancement achieved in TTA procedure

et al. 2018

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“…A recent trigonometric study has shown that there is a discrepancy between preoperative PLA measurements and the actual PLA achieved by advancing the tibial tuberosity as calculated [20]. The findings of this study have since been substantiated clinically with actual tibial tuberosity advancement achieved during the MMP being 30% lower than the calculated wedge size used [14].…”

Section: Introductionmentioning

confidence: 68%

“…One study based on a MMP type procedure found that with larger cage sizes and steeper tibial plateau slopes, a larger discrepancy between preoperative measurements and postoperative outcome can be expected [20]. This seems to occur because the direction of the preoperative measurements along the axis of the tibial plateau or common tangent differs to the direction of advancement achieved clinically when the tibial tuberosity is rotated around its distal attachment.…”

Section: Discussionmentioning

confidence: 99%

“…This discrepancy is worse in dogs with a steep tibial plateau and when larger cage sizes are used. The consequence of this is a potential failure to achieve a 90 0 PLA postoperatively [20]. Discrepancies have also been noted between the tibial plateau slope and common tangent methods of determining PLA at varying degrees of stifle extension [21].…”

Section: Introductionmentioning

confidence: 99%

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Effect of proximal translation of the osteotomized tibial tuberosity during tibial tuberosity advancement on patellar position and patellar ligament angle

et al. 2016

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BackgroundCranial cruciate ligament insufficiency is a common orthopaedic problem in canine patients. This cadaveric and radiographic study was performed with the aim of determining the effect of proximal translation of the tibial tuberosity during tibial tuberosity advancement (TTA) on patellar position (PP) and patellar ligament angle (PLA).ResultsDisarticulated left hind limb specimens harvested from medium to large breed canine cadavers (n = 6) were used for this study. Limbs were mounted to Plexiglass sheets with the stifle joint fixed in 135° of extension. The quadriceps mechanism was mimicked using an elastic band. Medio-lateral radiographs were obtained pre-osteotomy, after performing TTA without proximal translation of the tibial tuberosity, and after proximal translation of the tibial tuberosity by 3mm and 6mm. Radiographs were blinded to the observer for distance of tibial tuberosity proximalization following radiograph acquisition. Three independent observers recorded PP and PLA (tibial plateau method and common tangent method). Comparisons were made between the stages of proximalization using repeated measures ANOVA. Patellar position was found to be significantly more distal than pre-osteotomy, if the tibial tuberosity was not translated proximally (P = 0.001) and if it was translated proximally by 3mm (P = 0.005). The difference between pre-osteotomy PP and 6mm proximalization was not significant. The PLA was significantly larger if the tibial tuberosity was not translated proximally compared to tibial tuberosity proximalization of 6mm using the tibial plateau and the common tangent methods (P = 0.006 and P = 0.015 respectively).ConclusionsProximalizing the tibial tuberosity during TTA helps in maintaining vertical position of the patella in the patellar groove. Proximalization of the tibial tuberosity reduces PLA when compared to TTA without tibial tuberosity proximalization.

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“…Rzeczywisty przebieg plateau kości piszczelowej ma ogromne znacznie podczas określania kąta inklinacji więzadła prostego rzepki (patellar tendon angle -PTA), wykorzystywanego w procedurze wysunięcia guzowatości kości piszczelowej (TTA -tibial tuberosity advancement) oraz jej modyfikacjach (TTA Rapid) (7,12,15,17,37), a wartość TPA wyższa niż 30° sprawia, że metoda nie jest odpowiednio skuteczna (8,20).…”

Section: Zastosowanie Pomiaruunclassified

Tibial plateau angle: methods of measurement, value, applicability

Przeworski¹,

Głodek²,

Adamiak³

2017

Medycyna Weterynaryjna

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The tibial plateau angle measurement and its applicability have been reviewed based on the literature. The measurement was made on radiographs of the stifle joint with superimposition of the femoral condyles (with maximum tolerance of 2.0-4.0mm). Due to great variation among dog populations (size, breed), mean tibial plateau angles were found to be between 16.9° and 34°, but an excessive angle was described as >35°. An appropriate measurement of the tibial plateau angle can be made at about 108 days of age. The influence on the magnitude of the measured tibial plateau angle were the limb position during radiographic examination, the measurement technique (with modifications) and the experience level of the observer. Differences in magnitudes of the tibial plateau angles in dogs with and without cranial cruciate ligament rupture were not observed. The tibial plateau angle is commonly used in osteotomy of the tibia and its magnitude in order to select the proper surgical technique. The significance of the tibial plateau angle on the aetiopathogenesis of cranial cruciate ligament disease is questionable. Other measurements of the proximal tibia were attained to determine the risk factor of cranial cruciate ligament insufficiency. Knowledge of the tibial plateau angle and factors influencing measurement errors have great clinical importance.

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Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture

Cited by 27 publications

References 15 publications

Relationship between Tibial conformation, cage size and advancement achieved in TTA procedure

Relationship between Tibial conformation, cage size and advancement achieved in TTA procedure

Effect of proximal translation of the osteotomized tibial tuberosity during tibial tuberosity advancement on patellar position and patellar ligament angle

Tibial plateau angle: methods of measurement, value, applicability

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