Factors associated with early tibial tuberosity fracture after tibial plateau leveling osteotomy

Objectives The purpose of this study was to compare the load at failure, stiffness and mode of failure between three types of tibial tuberosity transposition fixation techniques: (a) pin and figure-8 tension band wire (Pin-TBW), (b) locking plate with pin and a tension band wire (Plate-Pin-TBW) and (c) locking plate with a pin (Plate-Pin). Methods Six pairs of raccoon dog cadaveric tibiae were tested in Phase I Pin-TBW versus Plate-Pin-TBW and seven pairs in Phase II Plate-Pin-TBW versus Plate-Pin. One limb of each pair was randomly assigned to one of two groups for each phase. A tensile force was applied to the patellar ligament until construct failure. Results Pin-TBW (342N ± 54.7N) failed at a lower load than Plate-Pin-TBW (469N ± 77.3N), p = 0.00748, with all Pin-TBW failing by fracture and the majority of Plate-Pin-TBW failing by rupture of patellar ligament. Pin-TBW group Phase I, normalized with Plate-Pin-TBW Phase I, failed at a lower load than Plate-Pin group Phase II, normalized with Plate-Pin-TBW Phase II, p = 0.00467. There was no significant difference in mean load at failure, stiffness or mode at failure between the groups in the Phase II study. Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative live dog or cat, these results demonstrate lower construct strength of the Pin-TBW construct compared with the Plate-Pin construct in the raccoon dog cadaver model.

Section: Discussionmentioning

confidence: 42%

Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study

Eskelinen¹,

Suhonen²,

Virolainen³

et al. 2021

“…Factors that increase the odds of tibial tuberosity fracture after TPLO include antirotational pin placement distal to the patellar ligament insertion, tuberosities with the narrowest point below the patellar ligament insertion and BSSTPLO. 20 Of the fractures in this report, the dog with bilateral tibial tuberosity fractures had antirotational pin placement distal to the patellar ligament bilaterally, and the unilateral tibial tuberosity fracture occurred on a limb with a tuberosity with the narrowest point below the patellar ligament insertion. Therefore, both dogs had an additional factor that increased the odds of tibial tuberosity fracture, not just undergoing BSSTPLO.…”

Section: Discussionmentioning

confidence: 88%

Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study

Cappelle¹,

Barnhart²

2019

Objective The aim of this study was to compare complications between dogs with bilateral cranial cruciate ligament disease treated with single-session bilateral tibial plateau levelling osteotomies (BSSTPLO) versus staged bilateral TPLO (STPLO) procedures stabilized with locking plates. Study Design Medical records of client-owned dogs treated with BSSTPLO or STPLO stabilized with locking plates between March 2017 and July 2018 at two associated institutions were reviewed. Patient data and complications from 37 dogs with BSSTPLO and 18 with STPLO were compared between groups. Major complications were defined as any complication that required further surgical or medical treatment whereas minor complications did not. Results Incidence for major complications for BSSTPLO and STPLO was 7/37 and 6/18 respectively. Incidence for minor complications for BSSTPLO and STPLO was 3/37 and 2/18 respectively. No significant differences in minor or major complication rates existed between study groups (p = 0.2). Mean body weight was significantly higher in the STPLO group (p = 0.001); however, no correlation between weight or BCS and complication rate existed within either group. Increasing age was the only significant risk factor for major complications (p = 0.01) in either group. Conclusion Our findings support the claim that BSSTPLO and STPLO performed with locking implants have similar complication rates. The decision to perform BSSTPLO or STPLO in dogs with bilateral cranial cruciate ligament disease should be based on other considerations rather than just complication rates.

“…Similar conservative treatment was described by Moles and colleagues in three patients that developed postoperative tibial tuberosity fracture following triple tibial osteotomy surgery. 3 Postoperative tibial tuberosity fracture has also been described in tibia plateau levelling osteotomy 11,12 and in some tibia tuberosity advancement 13,14 procedures, conservative management was normally associated with a good outcome; however, the authors recommend that severe lameness at presentation or a major displacement of the tibia tuberosity may warrant a surgical intervention. 8,[11][12][13][14][15][16][17][18] Although none of our cases needed revision surgery, there is always the risk that the tibial tuberosity fracture due to its displacement with its consequences and the possibility of needing revision surgery could lead to an unfavourable outcome.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Risk Factors and Outcome of Postoperative Tibial Tuberosity Fractures in Dogs Undergoing Triple Tibial Osteotomy Surgery

Puerta

Rossanese

Emmerson

2019

Objective The aim of this study was to report the prevalence and to identify the risk factors associated with postoperative tibial tuberosity fracture following a triple tibial osteotomy. This article also evaluates the outcome of these patients treated conservatively. Materials and Methods Medical records of 100 dogs (113 limbs) that underwent triple tibial osteotomy procedure were evaluated. Information obtained included signalment, preoperative, immediate postoperative and 6-week postoperative radiographic findings, intraoperative and postoperative complications. Long-term outcome was assessed using an owner questionnaire. Results Postoperative tibial tuberosity fracture was identified in 25/113 stifles. The only variable associated with the presence or absence of postoperative tibial tuberosity fracture within 6 weeks of surgery was postoperative cortical hinge width (CHW) or an indexed value of CHW to tibial width (TW). Using either a cut-off value of CHW of ≥ 5.5 mm or a cut-off value of CHW/TW of ≥ 0.21, only 1/27 stifle in our study developed tibial tuberosity fracture. Long-term owner evaluation of outcome was considered excellent or good in 65/70 stifles. Conclusion A narrow CHW at the distal cortical attachment of the tibial crest had a strong association with the development of postoperative tibial tuberosity fracture. No other patient or surgical variables were associated with tibial tuberosity fracture. Patients that developed tibial tuberosity fracture and were conservatively managed did not have a worse clinical outcome than patients that did not develop tibial tuberosity fracture.