Growth dynamics of the canine proximal tibial physis

Objective: To determine growth of the proximal tibial physis in the Labrador Retriever, a breed of dog at risk for rupture of the cranial cruciate ligament (CCL). Animals: Male Labrador Retriever dogs (n=6). Methods: Tantalum markers (0.5 mm diameter) were implanted in the right proximal tibial epiphysis and metaphysis of each dog at 16 weeks of age. Lateral and craniocaudal radiographic projections of the tibia were made monthly and longitudinal growth was assessed from radiographs; a growth curve was generated from the data. Data from dogs that had undergone proximal tibial epiphysiodesis (PTE) was compared with the growth curve to demonstrate if the growth curve accurately predicted changes in the growth associated with this procedure. Results: Growth rate of individual dogs decreased slowly and non‐linearly over the 1st year of age. Growth from the proximal tibial physis is described. Conclusions: Growth of individual dogs described here follows the model of saltation and stasis. The growth curve generated predicted the change in tibial plateau angle (TPA) for two Labrador Retrievers that had PTE (±1°).     

Comparison of tibial plateau angles in dogs with unilateral versus bilateral cranial cruciate ligament rupture: 150 cases (2000-2006)

OBJECTIVE: To compare tibial plateau angle (TPA) in dogs with unilateral versus bilateral cranial cruciate ligament (CCL) rupture, to compare right versus left TPA in dogs with bilateral CCL rupture, and to determine whether TPA can be used to predict whether a dog with unilateral CCL rupture would subsequently rupture the contralateral CCL. DESIGN: Retrospective case series. ANIMALS: 150 dogs with unilateral (n=58) or bilateral (92) CCL rupture. PROCEDURES: Medical records were reviewed and TPA was recorded. Dogs with unilateral CCL rupture that were not known to have ruptured the contralateral ligament were followed up for a minimum of 2 years. RESULTS: Dogs with unilateral CCL rupture were significantly older (median, 7.0 years) than dogs with bilateral CCL rupture (median, 4.5 years). Median TPA for dogs with unilateral CCL rupture (26 degrees) was not significantly different from median TPA for dogs with bilateral rupture (27 degrees in both the right and left limbs), and right and left TPAs were not significantly different in dogs with bilateral CCL rupture. There was no correlation between TPA and the time interval between diagnosis of the initial and subsequent CCL ruptures in dogs with bilateral CCL rupture. CONCLUSION AND CLINICAL RELEVANCE: Results suggested that TPA in the range studied (mostly<35 degrees) was not a useful predictor of contralateral CCL rupture among dogs with unilateral CCL rupture, although age may be a risk factor for development of bilateral CCL rupture. The incidence of bilateral CCL rupture may be higher than previously reported.     

Multivariate analysis of morphometric characteristics to evaluate risk factors for cranial cruciate ligament deficiency in Labrador retrievers

Objectives: To determine the combination of conformation characteristics of the pelvic limbs of Labrador Retrievers that best discriminates between limb at risk to develop cranial cruciate ligament (CCL) disease and limbs at low risk using radiographs, computerized tomography (CT) images, and dual‐energy X‐ray absorptiometry (DEXA). Study Design: Cross‐sectional clinical study. Animals: Twelve clinically normal and 9 unilaterally CCL‐deficient Labrador Retrievers. Methods: The pelvic limbs of normal dogs were considered as non‐predisposed to CCL disease and the contralateral limbs of CCL‐deficient dogs as predisposed. Conformation variables, obtained from femur and tibial radiographs, pelvic limb CT images and DEXA studies, of predisposed pelvic limbs were compared with the conformation variables from pelvic limbs of the low‐risk group. An ROC curve analysis was used to assess the discriminating properties of conformation variables for several combinations. Results: We determined that a combination of tibial plateau angle (TPA) and femoral anteversion angle (FAA) measured on radiographs was optimal for discriminating predisposed and non‐predisposed limbs for CCL disease in Labrador Retrievers. Conclusions: Assessing predisposition to CCL disease with a combination of conformational measurements is better than using univariate parameters. In the future, TPA and FAA may be used to screen dogs suspected of being susceptible to CCL disease.     

Comparison of tibial plateau angle between clinically normal Greyhounds and Labrador Retrievers with and without rupture of the cranial cruciate ligament

OBJECTIVE: To compare tibial plateau angle (TPA) between Greyhounds without damage to the cranial cruciate ligaments and Labrador Retrievers with and without damage to the cranial cruciate ligaments. DESIGN: Clinical study. ANIMALS: 87 client-owned dogs and 15 research colony Greyhounds. PROCEDURE: Standing position, horizontal-beam radiography was performed on Greyhounds and unaffected Labrador Retrievers to determine standing TPA. Lateral radiography of the stifle joint was performed on all dogs to determine traditional TPA. Age and body weight were recorded for unaffected and affected Labrador Retrievers. RESULTS: Greyhounds had mean standing TPA of 1.56 degrees and mean traditional TPA of 22.50 degrees. Unaffected Labrador Retrievers had mean standing TPA of 3.52 degrees and traditional TPA of 27.97 degrees. Affected Labrador Retrievers had mean traditional TPA of 25.55 degrees. No significant difference was found in mean standing TPA between Greyhounds and unaffected Labrador Retrievers. Standing TPAs in Greyhounds and unaffected Labrador Retrievers were not significantly different from a plane drawn parallel to the ground. Significant differences in traditional TPAs were detected among all 3 groups. CONCLUSIONS AND CLINICAL RELEVANCE: Greyhounds had mean traditional TPA of 22.50 degrees; similar angles should be considered normal for dogs. Although affected Labrador Retrievers had mean traditional TPA that was significantly greater than that of Greyhounds, the steepest TPA was found in unaffected Labrador Retrievers. Because Greyhounds and unaffected Labrador Retrievers had similar standing TPAs, we conclude that although TPA may be associated with damage to the cruciate ligaments, many dogs with a steep TPA do not develop cruciate ligament disease.     

MORPHOMETRIC ASSESSMENT OF THE PROXIMAL PORTION OF THE TIBIA IN DOGS WITH AND WITHOUT CRANIAL CRUCIATE LIGAMENT RUPTURE

Based on the clinical observation that dogs with a steep tibial plateau slope had variable tibial morphology, we hypothesized that these dogs could be further characterized using measurements developed by examining computer generated models of specific proximal tibial malformations. A 3D tibial model was created from a normal canine tibia. The model was manipulated to reproduce two specific proximal tibial anomalies representing deformities originating from the tibial plateau or the proximal tibial shaft. Data from these models were used to create specific measurements that would characterize the shape of these anomalies. These measurements included the diaphyseal tibial axis (DTA)/proximal tibial axis (PTA) angle, which defined the orientation of the proximal portion of the shaft in relation to the tibial mid-shaft. These measurements were then made on radiographs of dogs with and without cranial cruciate ligament (CCL) rupture. Models with tibial plateau and proximal shaft deformities had a steep tibial plateau slope (TPS). Models with proximal shaft deformity had a markedly increased DTA/PTA angle. The model with a 10 degree proximal shaft deformity had a DTA/PTA angle of 11.23 degrees. Six dogs (9.0%) had a DTA/PTA angle larger than 11.23 degrees (range, 11.4-13.9 degrees). Dogs in this group had ruptured CCL and a steep TPS. Dogs with CCL rupture had higher TPS (mean, 31.8 +/- 4.1 degrees) and DTA/PTA angle (mean, 6.0 +/- 3.3 degrees) than dogs without CCL rupture (means, 23.6 +/- 3.4 degrees and 4.1 +/- 2.2 degrees, respectively). Dogs with proximal shaft deformity represented a distinct group, which could not be identified using the magnitude of the TPS alone. Characterizing more precisely the shape of the proximal portion of the tibia in dogs contributes to our understanding of the pathogenesis of steep TPS and may facilitate the optimization of the surgical management of dogs with CCL rupture.     

Tibial plateau angle in four common canine breeds with cranial cruciate ligament rupture, and its relationship to meniscal tears

OBJECTIVES: To compare tibial plateau angle (TPA) among Labrador Retrievers, Rottweilers, Boxers, and German Shepherd Dogs that had undergone tibial plateau leveling osteotomies (TPLO) for cranial cruciate ligament disease, and to determine if higher TPAs are associated with increased risk for concurrent meniscal injury. METHODS: This was a retrospective study including 275 client-owned dogs of one of the four aforementioned breeds that received TPLO radiographs between 1999 and 2005 prior to undergoing the TPLO procedure. The TPA measured by the original surgeon was compared among four breeds and analyzed with respect to presence or absence of meniscal injury diagnosed via arthroscopy or arthrotomy at the time of surgery. RESULTS: Labrador Retrievers, Rottweilers, Boxers, and German Shepherd Dogs had mean TPAs of 25.9 degrees , 26.2 degrees , 25.9 degrees , and 28.2 degrees , respectively. The TPA of German Shepherd Dogs was significantly higher than that of the other breeds of dogs examined. TPA higher than the mean for dogs in this study did not significantly increase the risk for concurrent meniscal injury. CLINICAL SIGNIFICANCE: German Shepherd Dogs with cranial cruciate ligament disease had a significantly higher TPA compared to the other breeds examined. Higher TPA did not increase the likelihood of meniscal tears in this study. However, several variables that were not assessed, including the degree of cranial cruciate ligament integrity at the time of surgery and the time between original CrCL deficiency and surgical assessment, could have affected this analysis.     

Sequential measurements of the tibial plateau angle in large-breed, growing dogs

OBJECTIVES: To determine the earliest age that canine tibial plateau angles (TPAs) can be reliably measured and determine whether TPAs change during long bone growth. ANIMALS: 10 Labrador Retrievers and 20 Labrador Retriever-hound crossbreeds. PROCEDURE: Stifle joints were radiographed every 2 months from 8 weeks of age to radiographic closure of the tibial physes. Four examiners radiographically evaluated TPA, physeal closure status (ie, complete or incomplete) of the proximal and distal tibial physis, and whether anatomic TPA measurement landmarks were sufficiently visible (LSV) or insufficiently visible (LIV) for accurate measuring. Linear regression analysis was performed to detect change in TPAs over time. Mean ages with 95% confidence intervals (CIs) were determined for dogs with radiographs classified as LIV and LSV. RESULTS: TPAs did not change from 90 days of age to physeal closure. Mean age for dogs with radiographs classified as LIV was 70.2 days (95% CI, 68.12 to 72.28 days), with no dog with LIV radiographs over 81 days of age. Mean age for dogs with radiographs classified as LSV was 85.5 days (CI, 76.73 to 94.27 days). CONCLUSIONS AND CLINICAL RELEVANCE: TPAs in Labrador Retrievers and Labrador Retriever-hound crossbreeds can be measured accurately after 90 days of age, and earlier attempts to measure result in falsely low TPA measurements. Measuring TPAs in growing dogs may allow earlier detection of premature physeal closures. As more is learned about the role of theTPA in cranial cruciate ligament injury, early treatment may be possible for growing dogs with cruciate ligament injuries and excessive tibial slope.     

Age, Tibial Plateau Angle, Sex, and Weight as Risk Factors for Contralateral Rupture of the Cranial Cruciate Ligament in Labradors

Objective— To compare rates of contralateral cranial cruciate ligament rupture (CCLR) in Labradors based on age and weight at initial rupture, sex, and tibial plateau angle (TPA) and to determine whether Labradors that rupture their initial cranial cruciate ligament (CCL) at an earlier age (<4 years) are more likely to rupture their contralateral side within a certain period of time. Study Design— Case series. Animals— Labradors (n=94) that had tibial plateau leveling osteotomy (TPLO). Methods— Two groups: no contralateral rupture (NR) and contralateral rupture (CR) were compared for significant (P<.05) differences in percentage of subsequent cruciate tears using a Wilcoxon's rank‐sum tests for continuous variables and Fisher's exact test for sex. Adjusted odds ratios for likelihood of subsequent cruciate tears (yes/no) were estimated using logistic regression. Associations of these characteristics with time to subsequent rupture were assessed using Kaplan–Meier survival analysis estimation. Predictors of presentation with bilateral ruptures (BR) versus single rupture were also evaluated using Wilcoxon's rank‐sum tests and a generalized Fisher's exact test. Results— Subsequent CCLR occurred in 45 dogs (48%), and BR on admission were identified in 10 dogs (10.6%). Comparing NR and CR dogs, there were no significant differences between age or weight at initial rupture, sex or TPA; however there were associations toward longer time to CR for dogs older than the median age and female dogs (intact and spayed). There were no significant differences in age, sex, weight, or TPA of dogs with bilateral CCL ruptures compared with initial unilateral ruptures; however, there was a trend toward dogs presenting at an older age and with lower TPA's in the BR group. Among the 84 NR/CR dogs, the median time to rupture of the contralateral CCL was 5.5 months (95% CI 5.2–5.7). Conclusions— Age and weight at initial rupture, sex, and TPA does not affect likelihood or rate of contralateral CCL rupture or presentation with bilateral CCL ruptures. Clinical Relevance— Approximately 50% of Labradors will rupture the contralateral CCL within 5.5 months of the initial rupture but age, weight, sex, and TPA cannot be used as predictive features.     

Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia

Objective— To describe a method for radiographic measurement of proximal and distal mechanical joint angles of the canine tibia. Normal ranges were established for a population of dogs, and specifically, Labrador retrievers, with cranial cruciate ligament rupture.
Study Design— Retrospective study.
Sample Population— Tibiae (n=105) of dogs evaluated for cranial cruciate ligament rupture; 70 tibiae were from Labrador retrievers, 35 tibiae were from other breeds.
Methods— Anatomic landmarks were established and craniocaudal radiographs were used to measure the mechanical medial proximal (mMPTA) and distal (mMDTA) tibial angles in the frontal plane.
Results— Means (±SD) for all tibiae were mMPTA, 93.30±1.78°, and mMDTA, 95.99±2.70°. For Labrador retrievers, means were mMPTA, 93.38±1.81°, and mMDTA 96.34±2.51°. No significant differences were detected between Labrador Retrievers and non-Labrador retrievers with respect to mMPTA (power=0.5) or mMDTA (power=0.342). Labrador Retrievers were significantly younger than non-Labradors ( P =.003).
Conclusion— A method for measurement of the mechanical joint angles of the canine tibia in the frontal plane was established and reference ranges for a population of dogs and Labrador Retrievers with cranial cruciate ligament rupture are reported.
Clinical Relevance— The established method of measurement and references ranges can be used to aid in diagnosis, determining indications, and surgical planning for angular limb deformities of the tibia, especially when affected bilaterally. The methodology and reference values may also be used for postoperative critique.     

Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries

OBJECTIVE: To measure and compare tibial plateau angles (TPA) of dogs with cranial cruciate ligament (CrCL) injuries and dogs without CrCL injuries. DESIGN: Prospective study. ANIMALS: 87 dogs. PROCEDURE: Stifle joints were measured from lateral radiographic views to determine TPA in 3 groups: group-1 dogs had CrCL injuries, group-1a dogs, a subgroup of group 1, had 1 unaffected stifle joint, and group-2 dogs had no CrCL injuries. Age, sex, breed, body weight, limb injured, and TPA were recorded for each dog. RESULTS: 56 stifle joints were measured in group-1 dogs; mean TPA was 23.76 degrees , and mean age and weight were 5.7 years and 37.91 kg (83.4 lb), respectively. Fourteen stifle joints were measured in group-1a dogs; mean TPA was 24.71 degrees , and mean age and weight were 5.6 years and 38.06 kg (83.8 lb), respectively. Sixty stifle joints were measured in group-2 dogs; mean TPA was 18.10 degrees , and mean age and weight of these dogs were 4.83 years and 35.85 kg (79 lb), respectively. The most common breeds included Labrador Retriever, Golden Retriever, and Rottweiler. The TPA of dogs in group 1 and group 1a were significantly greater than the TPA of dogs in group 2. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs with CrCL injuries have a significantly greater TPA than dogs without CrCL injury. With further investigation, a normal TPA can be determined. In the future, TPA measurements may be used to screen dogs suspected of being susceptible to CrCL injury.     

Relationship between age and tibial plateau angle in dogs with cranial cruciate rupture

The pathogenesis of cranial cruciate ligament (CCL) rupture remains controversial, and its relationship to tibial plateau angle is unknown. In this study, the tibial plateau angle was measured in 200 large-breed dogs diagnosed with CCL rupture. Correlation analyses were performed to determine whether the age at the time of CCL rupture and the tibial plateau angle were related. While these two values were inversely correlated, the relationship was not strong enough to explain the frequency of CCL rupture in young, large-breed dogs. There was no statistically significant correlation between age at the time of CCL rupture and tibial plateau angle.     

In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig

OBJECTIVE: To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: In vitro experimental study. ANIMALS: Large-breed canine cadavers (n=20). METHODS: TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. RESULTS: Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (P<.005) from the tibial plateau. Median deviations were -4.0 degrees (group 1), 11.8 degrees (group 2), 11.2 degrees (group 3), and 0.2 degrees (group 4). Group 1 was not significantly different from group 4. CONCLUSIONS: A jig is not essential for osteotomy orientation, tibial plateau rotation, or fragment reduction. Comparable results were achieved performing a vertical osteotomy with the tibia slightly internally rotated (10 degrees -15 degrees) and parallel to the table surface. CLINICAL RELEVANCE: TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost.     

The effect of tibial plateau angle on ground reaction forces 4-17 months after tibial plateau leveling osteotomy in Labrador Retrievers

OBJECTIVE: To assess the relationship between postoperative tibial plateau angle (TPA) and ground reaction forces (GRFs) in Labrador Retrievers at least 4-months after tibial plateau leveling osteotomy (TPLO) surgery. STUDY DESIGN: A retrospective longitudinal study. ANIMALS: Thirty-two Labrador Retrievers with unilateral cranial cruciate ligament disease that had TPLO and concurrent meniscal surgery. METHODS: TPA and GRFs were measured pre- and > or = 4 months postoperatively. Preoperative GRFs, preoperative TPA, duration of injury, postoperative TPA and degree of rotation were each compared with postoperative GRFs using correlation analysis. Dogs were also grouped by postoperative TPA and compared using 1-way analysis of variance (ANOVA). Postoperative function was compared with meniscal release/meniscectomy, patient age, sex, body weight and follow-up time using ANOVA. RESULTS: No significant relationship was found between preoperative GRFs, preoperative TPA, duration of injury, postoperative TPA, degree of rotation, or meniscal release/meniscectomy and postoperative function. Mean preoperative GRFs for all dogs were 28.8 +/- 9.5 for peak vertical force (PVF) and 9.3 +/- 3.1 for peak vertical impulse (VI). Mean postoperative GRFs for all dogs were 40.4 +/- 5.0 for PVF and 14.1 +/- 1.9 for VI. CONCLUSIONS: No statistically significant relationship was found between postoperative TPA and GRFs after TPLO > or = 4 months after surgery, where the postoperative angle was between 0 and 14 degrees. No significant relationship was found between the preoperative TPA and postoperative function. CLINICAL RELEVANCE: Limb function in Labrador Retrievers was not affected by postoperative TPA and re-operation for cases with a postoperative TPA between 0 and 14 degrees is not recommended.     

Risk factors for fibular fracture after TPLO

Objective: To determine (1) risk factors for fibular fracture after tibial plateau leveling osteotomy (TPLO) and (2) if a single postoperative radiographic measurement or measurement ratio of the proximal tibial fragment can be used as a predictor for fibular fracture. Study Design: Multivariate retrospective clinical study. Animals: Dogs (n=326) with cranial cruciate ligament rupture that had TPLO (n=355). Methods: Medical records (January 2004–November 2007) and radiographs of dogs that had TPLO were reviewed. TPLO plate type, distance between tibial plateau and proximal screw, proximodistal tibial plateau fragment length, tibial plateau width, the presence of a fibular drill hole filled with a screw or not, and fibular fractures were recorded. Results: The odds of having a fibular fracture were 10 times greater in dogs with a fibular drill hole than in dogs without a drill hole. The odds of having a fibular fracture were 1.46 times greater for every 4.5 kg increase in body weight. Tibial plateau angle (TPA) at the time of reevaluation was larger than the postoperative TPA and TPA increase was larger in dogs with fibular drill holes than without (P<.01) and in dogs with fibular fractures than without (P<.01). Conclusion: An unfilled fibular drill hole and increased body weight are risk factors for fibular fracture.     

Use of the proximal portion of the tibia for measurement of the tibial plateau angle in dogs

OBJECTIVE: To determine whether the canine tibial plateau angle (TPA) can be accurately measured from lateral radiographic views of the stifle joint that include only the proximal portion of the tibia. SAMPLE POPULATION: 282 lateral radiographic views of the stifle joint from 128 dogs. PROCEDURE: 236 radiographs were obtained from 102 dogs with no stifle joint disease, and 46 were obtained from 26 dogs with cranial cruciate ligament rupture. Radiographs were digitized. Tibial plateau angles were determined by measuring the angle between the intersection of the tibial plateau slope line and perpendiculars to 4 tibial axes. The gold standard TPA was based on a reference axis that used the entire length of the tibia and was determined by the line connecting the midpoint of the tibial intercondylar eminence and the center of the talus. Tibial plateau angle1, TPA2, and TPA3 were based on tibial axes that were determined by use of only the proximal portion of the tibia. RESULTS: TPA determined on the basis of the shortest proximal reference axis (TPA1) was not accurate. However, as the length of the reference axis increased, reliability of the TPAs obtained from proximal reference axes improved, and their correlations with the gold standard TPA increased (r = 0.78, 0.86, and 0.92 for TPA1, TPA2, and TPA3, respectively). Equations obtained by regression analysis allowed estimation of the gold standard TPA with some degree of accuracy. CONCLUSIONS AND CLINICAL RELEVANCE: Use of a proximal reference axis to calculate TPA may be an alternative to a calculation based on the full-length axis.     

Observer variability of tibial plateau slope measurement in 40 dogs with cranial cruciate ligament-deficient stifle joints

OBJECTIVE: To determine (1) the inter- and intraobserver variability in measurement of tibial plateau angle (TPA), (2) whether this inter- and intraobserver variability is related to the characteristics of the dog (age, size, and amount of degenerative joint disease [DJD]) and the experience level of the observer, and (3) the extent of any relationship between interobserver variability of TPA and the variability of the observers' selection of the specific cranial and caudal points along the tibial plateau. STUDY DESIGN: Examination of tibial radiographs of 40 dogs clinically affected with a cranial cruciate ligament (CrCL)-deficient stifle joint. METHODS: Eleven different observers, divided into 3 groups based on their level of experience with the tibial plateau leveling osteotomy (TPLO) technique, measured the TPA on all 40 radiographs on 5 different occasions. The degree of DJD present in the stifle joint was independently graded as an overall measure and then again as it specifically related to the cranial and caudal points along the tibial plateau. The total observed variabilities of the TPA were assessed with reference to interobserver differences, intraobserver differences, and among the groups of observers with respect to the different dog characteristics. Finally, the specific points selected on the radiographs were reexamined to determine whether any variability was present in cranial and caudal point selection. RESULTS: The interobserver standard deviation of the TPA measurements for each dog was 0.8 degrees, and the intraobserver standard deviation was 1.5 degrees. The TPA measurements obtained by the 11 observers differed significantly from each other (P <.001); however, there was no significant difference of TPA among the different groups of observers (P =.67). There was no significant correlation observed between either the inter- or intraobserver variability and the dog characteristics. Specific point data and their relationship to the various variables of dog characteristics and inter- and intraobserver TPA variability revealed significant correlations only to the amount of DJD present at the caudal point (P =.001). CONCLUSIONS: Interobserver variation, but no significant group variation, was present. Overall DJD did not appear to be related to the variability in TPA angle measurement. Most of the interobserver variability was attributable to variability in horizontal point selection at both the cranial and caudal points and vertical point selection at the caudal point. It appears that degenerative changes that specifically obscure the points on the tibial plateau, especially at the caudal point, are responsible for most of the interobserver variation. CLINICAL RELEVANCE: The desired postoperative TPA of 5 degrees is dependent on a precise initial measure of TPA preoperatively. This study indicates that there is statistically significant interobserver variability with measurement of TPA, which, therefore, can result in a similar amount of variability with the final tibial plateau slope obtained postoperatively.     

Biomechanics of tibial plateau leveling of the canine cruciate-deficient stifle joint: a theoretical model

OBJECTIVE: To evaluate the effect of tibial plateau leveling on the biomechanics of the canine stifle. STUDY DESIGN: Analysis of a 3-dimensional (3-D) anatomically accurate theoretical model of the canine stifle. METHODS: A 3-D, 3-segment mathematical model of the normal canine stifle was modified to simulate the effect of rotation of the tibial plateau during tibial plateau leveling osteotomy (TPLO). The model examined the normal stifle, the stifle with a tibial plateau angle (TPA) of 0 degrees, and the stifle with a TPA of 5 degrees. Analysis of the models at 10 consecutive equally spaced positions during the stance phase yielded data such as ligament forces and joint reaction forces at each position. RESULTS: Rotation of the tibial plateau to a TPA of 0 degrees almost eliminates forces in the cranial cruciate ligament (CCL) throughout the stance phase. Rotation to a TPA of 5 degrees did not, however, substantially decrease the load in the CCL. Both procedures increased the load in the caudal cruciate ligament (CaCL). CONCLUSIONS: Cranial tibial thrust (CTT) is converted into caudal tibial thrust when the TPA is 0 degrees ; however, rotating the plateau to a TPA of 5 degrees does not eliminate the CTT. CLINICAL RELEVANCE: The TPLO procedure performed as currently recommended (rotating the tibial plateau to a TPA of 5 degrees) may not eliminate the CTT, but only reduce it. Both TPLO procedures evaluated here were found to increase the load in the CaCL.     

Relationship of tibial plateau slope to limb function in dogs treated with a lateral suture technique for stabilization of cranial cruciate ligament deficient stifles

OBJECTIVE: To evaluate the effect of a lateral suture technique (LST) on tibial plateau angle (TPA) measurement and to compare TPA with functional outcome in dogs treated for cranial cruciate ligament (CrCL) rupture with LST. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Dogs (n=34) with unilateral CrCL instability. METHODS: All dogs had lameness examination, survey stifle radiographs, and force plate analysis before and at 6, 12, 24, and 48 weeks after surgery. Radiographic osteoarthritis (OA) scores and lameness scores were assigned using previously reported methods. Preoperative radiographs were performed in all dogs, and postoperative serial radiographs were performed in 6 dogs for measurement of TPA. Differences in TPA measurements were evaluated with a random effects repeated measures model. The significance of LST on TPA measurement was established in 6 dogs and the effect of TPA on vertical impulse, peak vertical force, progression of radiographic scores, and lameness score were analyzed by general linear models in all dogs. Differences were considered significant if P<.05. RESULTS: Significant differences were not noted between pre- and serial postoperative measurements of TPA. A significant correlation was not established between TPA and postoperative vertical impulse, peak vertical force, lameness score, or radiographic OA scores. CONCLUSIONS: TPA values were unchanged after LST and TPA does not affect outcome measures in dogs treated with LST. CLINICAL RELEVANCE: TPA has no predictive value on clinical outcome in dogs treated with LST for stabilization of CrCL deficient stifles.     

Digital measurement of radiographic tibial plateau angle. A comparison to measurement on printed digital images.

Pre-operative digital radiographs from 50 dogs undergoing a tibial plateau leveling osteotomy were evaluated. Tibial plateau angles were measured directly on printed films and measured on digital images using two different commercial DICOM viewers. The radiographs were scored for osteoarthritis and positioning. Using pooled results, the mean TPA from the digital images employing Web1000 (26.47 degrees +/- 3.90) was significantly higher then the mean TPA using film radiographs (25.41 degrees +/- 3.51), or IQ-View Pro (25.48 degrees +/- 3.89). There was not a significant difference between mean TPA using radiographs or IQ-view. Digital TPA measurement using built-in angle calipers in the clinical setting is a valid technique compared to measurements from film radiographs, and produces reproducible results. However, before changing to digital measurements, the chosen software programme should be validated against measurements using film radiographs to determine the magnitude of differences.     

Evaluation of Intra‐ and Interobserver Variability and Repeatability of Tibial Plateau Angle Measurements with Digital Radiography Using a Novel Digital Radiographic Program

Objective— To compare the intra‐ and interobserver variability occurring when observers with differing experience levels measure tibial plateau angles (TPAs) with a novel digital radiographic projection program (tibial plateau leveling osteotomy [TPLO] planning program), the Kodak Picture Archiving and Communications System (PACS), and standard sized printed films (SF). Study Design— Cross‐sectional study. Sample Population— Dogs (n=36) with cranial cruciate ligament (CCL) rupture that had a TPLO. Methods— Six observers, divided into 3 equal groups based on experience level, measured TPA on 36 digitally captured radiographic images of tibiae of dogs clinically affected with CCL rupture. Each observer used 3 methods of measuring TPA and repeated the measurements 3 times with each method. The intra‐ and interobserver variability was compared using the coefficient of variation. Results— Averaged over all replications and images, there was no significant difference (P>.05) in the average variability occurring with each method for all but 1 observer. There was no effect of experience level on measurement variability; however, interobserver variability was significantly less with measurements made with the PACS and TPLO planning program compared with measurements made from SF (P<.05). Conclusions— Repeated measurements of TPA made using digital images and computer‐based measurement programs were significantly less variable between observers than those made from images printed on standard radiographic films. Clinical Relevance— Digital radiography and computer‐based measurement programs are effective for determining the TPA, allowing less variability in measurements compared with SF. The ability to manipulate the image may allow better identification of anatomic landmarks.