The Effect of Variable Tibial Morphology on the Triple Tibial Osteotomy Procedure for Treatment of Canine Cranial Cruciate Rupture and Complications Encountered in a Case Series of 21 Dogs
A.I.C. Renwick1; T.D. Emmerson2; A.K. House3
Introduction
The triple tibial osteotomy is a recently described technique for the treatment of cranial cruciate ligament disease. The objective of this study was to document the potential effect of the TTO procedure on the post operative tibial plateau angle in clinical cases with variable tibial morphology and to document intra-operative and post-operative complications encountered whilst becoming familiar with the TTO procedure with assessment of the short-term outcomes in a case series of 21 dogs.
Methods
A retrospective analysis of 21 dogs undergoing the triple tibial osteotomy procedure (TTO) was performed. Preoperative radiographic measurements of the tibial plateau angle were compared with the calculated size of the wedge ostectomy required to perform the procedure as previously described. Intraoperative and postoperative complications were recorded. Short term outcome was assessed using 6 week post operative radiographs and a client based, visual analogue score questionnaire a minimum of six months post-operatively.
Results
The calculation of the size of the wedge ostectomy as previously described would have resulted in either over or under rotation of the tibial plateau in four cases. This effect was due to variable proximal tibial morphology, specifically a small or large tibial tuberosity. 77% of procedures had intraoperative complications. The majority of these were fractures through a cortex at the distal end of the tibial crest osteotomy 4 cases (19%) or at caudal end of the tibial wedge ostectomy 9 cases (41%). The intraoperative complications encountered did not appear to affect the outcome. Six cases (29%) experienced postoperative complications with half of these involving the surgical incision. The results of the client based questionnaire demonstrated significant improvements in all post injury parameters following TTO. Activity levels 6 months after surgery were not significantly different to those reported pre-injury.
Clinical Significance
Due to the variability of proximal tibial morphology, measurement of the tibial plateau angle is recommended when performing a triple tibial osteotomy to avoid over or under rotation of the tibial plateau. When becoming familiar with the technique cortical fracture associated with the osteotomies should be anticipated. This complication does not appear to affect the outcome for this technique.