Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review

Abstract

Summary Objective: The optimal surgical technique for treatment of cranial cruciate ligament rupture in canine has been scientifically discussed for decades. Despite the continuous debate, proximal tibial osteotomies such as tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) are increasingly common. The objective of this review was to systematically evaluate the literature reporting outcome and complications associated with TPLO and TTA. Materials and methods: A systematic search of literature databases identified articles published from August 2004 to February 2016 describing evaluations of short- or longterm outcomes as well as complications following TPLO or TTA. Results: Ninety-one studies were included in this review and assigned to one out of four evidence levels. Of those, 89 studies provided the lowest evidence level and only two were assigned to the third-best evidence level. A comparison of subjective gait analyses could not detect differences in the decrease of lameness between TPLO and TTA, while objective gait analysis supports the superiority of TPLO. Fewer patients treated with TPLO were diagnosed with postoperative joint instability and TPLO had a lower percent increase of osteoarthritis (OA) after surgery. Owner satisfaction was high for both techniques. For TPLO and TTA the average total, minor, major and catastrophic complication rates were 15.9 % and 20.8 %, 7.9 % and 11.6 %, 5.2 % and 13.2 % as well as 0.8 % and 5.6 %, respectively. Conclusion and clinical significance: The assessed literature supports the hypothesis that TPLO is associated with lower complication rates, an improved clinical-functional outcome and less increase of OA compared to TTA. The results are indicative for a long-term restoration of normal limb function after TPLO. However, the strength of available evidence and the comparability of each study’s results were poor and more comparative studies are needed to draw strong conclusions towards the superiority of the TPLO over the TTA.

Short-term outcomes and complications of 65 cases of porous TTA with flange: a prospective clinical study in dogs

“…The significant improvement of FSL observed in our study was similar to that of previous studies [ 28 , 36 – 39 ].…”

Surgical Treatments for Canine Anterior Cruciate Ligament Rupture: Assessing Functional Recovery Through Multibody Comparative Analysis

“…The pattern of the patellar ligament force is similar to that of the quadriceps force, since these quantities are closely related, so the higher patellar forces are produced by the CBLO procedure. On that note, it should be reminded that higher patellar ligament forces mean higher ligament stresses which, in turn, may lead to ligament thickening or desmitis (Mattern et al, 2006; Milovancev and Schaefer, 2009; Beer et al, 2018).…”

“…Overall, the basic concept behind TPLO surgery is converting tangential forces acting on the tibial plateau into a compressive reaction force, normal to the plateau itself (Slocum and Slocum, 1993). However, an excessive compressive force could lead to degenerative complications, such as osteoarthritis and meniscal injuries (Beer et al, 2018). From articular compressive forces computed during squat simulations, it is evident how the ACL-deficient stifle undergoes a lower compressive articular force, compared to the physiological stifle, and this is in accordance with Kim et al (2009).…”

“…The ACL insufficiency is an important orthopedic issue which can occur after acute trauma or, more commonly, it can arise from chronic pathological biomechanical stress and constitutes one of the main causes of lameness in dogs (Wilke et al, 2005; Kim et al, 2008; Raske et al, 2013). Furthermore, in the long term, the resulting stifle instability leads to progressive osteoarthritis and severe meniscal injuries (Pozzi et al, 2006; Boundrieau, 2009; Beer et al, 2018). From a biomechanical point of view, the intra-articular forces acting on the tibial plateau under weight-bearing conditions can be resolved into a compressive force, perpendicular to the plateau, and an anterior-posterior (AP) directed force (tangential force), parallel to the plateau (Slocum and Slocum, 1993).…”

A Retrospective Study Using the String of Pearls Tibial Plateau Levelling Osteotomy Locking Plate for the Treatment of Cranial Cruciate Ligament Disease

“…In our study, the total complication rate was 24.7% (95% CI: 18.2-31.2%), higher than the historical rate for TPLO procedures (15.9%) and marginally greater than recent TPLO studies utilizing locking plates (12.5-23.7%). [9][10][11]25,26 Major complication rates in these locking plate studies were 0 to 6.1%, marginally less than our study of 6.5% (95% CI: 2.8-10.2%). Complication rates in this study may have been influenced by primary construct instability with loose screws, a fractured antirotational pin and a migrating pin noted.…”