Long-term assessment of a modified tibial tuberosity advancement technique in dogs

Abstract

The purpose of study was to assess long-term clinical and radiographic aspects of dogs’ stifle joints which had undergone a modified tibial tuberosity advancement technique (mTTA). A total of 15 stifles that had undergone mTTA for CCL disease of 11 patients were included in this study. Assessments involved patient’s gait analysis, cranial drawer and tibial compression tests, stifle goniometry range of articular motion, thigh and leg girth and radiographic evidence of progression of osteoarthrosis. Variables were compared between operated and healthy limbs and among moments (M0) on the early postop; (M1) 120 days postop; and (M2) approximately 5 years following surgery. A questionnaire regarding owner’s perceptions after approximately 5 years of surgery was assessed. Most dogs presented positive response to cranial drawer and tibial compression tests on operated knees. There was also decrease on goniometry and thigh girth and increase in leg girth. Radiographic evidence of progression of osteoarthritis was seen especially on the long-term follow-up (M2). On gait analysis, most animals presented some degree of lameness in different conditions, in contrast to owners’ perceptions. Osteoarthritis still develops in dogs following mTTA surgery for CCL disease. However, owners were overall satisfied with their recovery and would be willing to accept indication of mTTA for dogs with ruptured CCL.

Prospective clinical assessment of tibial tuberosity advancement for the treatment of cranial cruciate ligament rupture in dogs

“…The results obtained in the questionnaire (Table 1) were similar to those observed by other authors, who showed that more than 90% of owners classified their dog's gait as good or excellent after surgery 7,18 .…”

“…Bruce et al 23 observed that 89% (57/64) of stifles were positive on the tibial compression test 6 to 12 weeks after triple tibial osteotomy, and this rate increased to 91% (50/55) after 11 to 26 weeks. Similarly, Medeiros et al 7 affirmed that all of the operated knees were positive after modified TTA. However in our study, only 5% of patients were positive on the tibial compression test, 38% partially positive, and 57% were negative, and no dogs showed pain.…”

“…Crepitation occurs due to the presence of osteophytes in the joint from OA. Medeiros et al 7 , observed radiographic signs of OA mainly at five years after modified TTA.…”

“…Multiple surgical techniques have been described to treat CCL rupture, although none are ideal, because they all allow for progression of stifle osteoarthritis (OA) 4-6 . OA occurs due to the inaccuracy of the techniques, which allow for movement of the joint 7 .…”

Lyophilized and gamma-sterilized allogeneic bone implant used as a spacer for advancement of a modified tibial tuberosity in the treatment of cranial cruciate ligament disease in dogs

“…Since mTTA involves only two screws and uses the lyophilized bone implant as a cage, in comparison with the several specific implants required to perform conventional TTA, it is a simpler alternative technique. Additionally, it is important to note that in the case of mTTA, after complete bone healing, the screws can be easily removed from the tibia [12]. In addition, the titanium implant allows magnetic resonance examinations to be performed even while the equipment is present in the patient.…”