Fracture of the proximal tibial epiphysis and tuberosity in 10 dogs

Ten dogs were presented with fractures of the proximal tibial epiphysis and tuberosity. All dogs had a cranioproximal-caudodistal angulation of the tibial plateau. Six dogs had marked caudal displacement of the proximal tibial epiphysis, five of which had also sustained fractures of the proximal fibula. The estimated mean angle of inclination of the tibial plateau of affected limbs was 45.8 +/- 9.6 degrees, which was significantly greater (P<0.0005) than the estimated mean angle of the normal contralateral limb 26.2 +/- 6.6 degrees. The mean angle of inclination of the tibial plateau of dogs with fibular fractures (n=5) was not significantly different from dogs without fibular fractures (n=5) (P>0.25). Five dogs were treated conservatively and five were treated by three different methods of surgical repair. Surgically treated dogs had significantly greater preoperative tibial plateau angles (P<0.05). All dogs regained full limb usage, regardless of the method of treatment chosen.     

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°).     

Avulsion of the tibial tuberosity in a litter of greyhound puppies

Avulslon of the tibial tuberosity was dlagnosed In six of seven greyhound ilttermates aged flve and a half months. The puppies showed hindlimb lameness of varying severity. Radiological assessment of affected stifle joints revealed partial or complete avulsion of the tlblal tuberoslties. In four puppies the lesions were bliaterai. Euthanasia of the two most severely affected puppies performed; the changes observed on histopathological examination of their cranioproximal tibiae suggested that the underlying lesion was that of osteochondrosis. A heredltary predisposition In greyhounds to osteochondrosis of the physis between the apophysis and the cranioproximal tibia1 dlaphysis Is postulated.     

Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs

Objective— To evaluate factors that predispose to tibial tuberosity (TT) fracture after tibial plateau leveling osteotomy (TPLO) in dogs.
Study Design— Retrospective study.
Animals— Dogs (n=182) with cranial cruciate ligament (CCL) rupture undergoing 213 TPLO surgeries.
Methods— Medical records and radiographs of 2 groups of dogs that had TPLO surgery (2000–2001, 2004–2005) were evaluated to determine the effect of operative technique and surgeon experience on TT fracture.
Results— TT fracture was diagnosed in 8 dogs (9 TPLO, 4.2% of surgical procedures). Four fractures occurred after unilateral TPLO in 167 dogs (2.4%), 4 fractures occurred after simultaneous bilateral TPLO in 5 dogs (40%), and 1 fracture occurred after staged bilateral TPLO in 36 dogs (2.8%). Simultaneous bilateral TPLO resulted in a 12.4 times higher odds of TT fracture versus unilateral TPLO ( P =.046). The mean absolute thickness of the TT after TPLO was less in dogs sustaining TT fractures (7.2 ± 2.2 mm) than those that did not (10.8 ± 2.7 mm, P <.0001). The odds of fracture decreased by 37% when the absolute TT width postosteotomy increased by 1 mm ( P <.0001). An increase in tibial plateau angle at follow-up versus immediately postoperative was associated with TT fracture ( P =.025). Surgeon experience was not associated with TT fracture.
Conclusion— A combination of surgical decision-making and surgical technique play a role in the occurrence of TT fracture after TPLO. Simultaneous bilateral TPLO was associated with a high percentage of TT fracture.
Clinical Relevance— Careful planning of osteotomy positioning is advised while performing TPLO surgery.     

Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints

OBJECTIVE: To describe a modification of the tibial tuberosity advancement (TTA) procedure that required tuberosity advancement in excess of 12 mm for the stabilization of cranial cruciate ligament (CrCL) deficient stifle joints. METHODS: Four large breed dogs with CrCL deficient stifle joints (one bilateral) underwent a modified TTA of 15 or 16 mm in order to obtain a patellar tendon angle of 90 degrees to the tibial plateau slope or common tangent between femur and tibia in the extended limb position. The desired TTA was achieved by displacing a 12-mm cage distally; this displacement distance was calculated from two similar triangles formed within the planned osteotomy site. An allogenous cancellous bone block placed proximal to the cage provided buttress support; a corticocancellous allograft filled the remainder of the gap. Tibial tuberosity fixation was performed as previously described. RESULTS: Healing of the osteotomy defects with incorporation of the cancellous block was observed at a mean of 8.6 weeks postoperatively. Normal return of limb function was reported in all of the dogs except for one dog that underwent revision surgery four months postoperatively for a continued lameness. Technical errors at the time of the original surgical procedure in this dog resulted in insufficient tuberosity advancement; additional advancement was performed, which resolved the lameness. CLINICAL SIGNIFICANCE: Results in this series suggest that our modification of the TTA, in order to advance the tuberosity in excess of 12 mm, could be successfully obtained using the currently available implants.     

Reverse TPLO for asymmetrical ‐premature closure of the proximal tibial physis in a dog

A 4 · 5‐month‐old, 13 · 8 kg, female neutered mixed breed dog was presented for evaluation of acute non‐weight bearing right pelvic limb lameness. Radiographs revealed a tibial tuberosity avulsion fracture for which open reduction/internal fixation was performed. Asymmetrical premature closure of the cranial aspect of the proximal tibial physis ensued with a tibial plateau angle of ?12°. Abnormal stifle biomechanics resulted in lameness and caudal cruciate ligament fraying. Tibial plateau ‐levelling osteotomy was performed in standard fashion with the exception that the proximal tibial ‐fragment was rotated cranioproximally to increase the tibial plateau angle from ?12° to +5° (reverse tibial ‐plateau levelling osteotomy). Normal healing and resolution of lameness followed and the dog remained ‐clinically healthy 2 years postoperatively. This case report demonstrates that any change in proximal tibial anatomy, whether traumatic, iatrogenic or with therapeutic intent, can cause altered stifle biomechanics and should not be underestimated. Surgical management through corrective ‐osteotomy can be used to restore adequate function.     

Management of laterally displaced proximal tibial physeal fractures in three dogs

Fractures of the proximal tibial physis are uncommon in dogs, and are rarely associated with marked instability and lateral displacement of the proximal tibial epiphysis. Three dogs with proximal tibial physeal fractures demonstrating marked instability and lateral displacement were treated with two different principles of fixation. Healing of the physeal fracture was achieved with rigid internal fixation in one case, and with adaptational osteosynthesis supplemented with a temporary transarticular external skeletal fixator in two cases. Duration of surgery and technical difficulty was reduced using a modified adaptational osteosynthesis approach, suggesting that surgical treatment of these uncommon and challenging fractures may be more appropriately achieved by this technique.     

Extended proximal trochleoplasty for the correction of bidirectional patellar luxation in seven Pomeranian dogs

Seven Pomeranians with bidirectional patellar luxation (BPL) were prospectively studied regarding aetiology and results of a new surgical technique. Radiographic evaluation of the ratio between patellar ligament length and patellar bone length revealed no differences between Pomeranians with bidirectional patellar luxation and healthy stifle joints. Functional rather than anatomic patella alta might be associated with bidirectional patellar luxation in Pomeranians. The surgical outcome of extended proximal trochleoplasty was good‐to‐excellent in 87·5% of the stifles and all dogs achieved functional recovery. There was only minimal radiographic progression of osteophyte formation at 48 weeks after surgery. To the authors’ knowledge, this is the first report on bidirectional patellar luxation in small breed dogs and its successful surgical treatment.     

Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease

OBJECTIVE: To assess functional outcome in dogs with cranial cruciate ligament (CrCL) disease after tibial tuberosity advancement (TTA) using force plate gait analysis, and to evaluate parameters potentially influencing outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Consecutive clinical patients (n = 37) with CrCL-deficient stifles (n = 40). METHODS: The stifle joints were examined arthroscopically prior to TTA. Meniscal release was not performed if the medial meniscus was intact. Open medial arthrotomy and partial meniscectomy were performed in the presence of meniscal tears. Vertical ground reaction forces were measured preoperatively and at follow-up examinations four to 16 months postoperatively (mean: 5.9 months). The ground reaction forces of a group of 65 healthy dogs were used for the comparison. The potential effects of clinical parameters on functional outcome were evaluated statistically. RESULTS: Complete CrCL rupture was identified in 28 joints, and partial CrCL rupture in 12 joints. The medial meniscus was damaged in 21 stifles. Vertical ground reaction forces were significantly higher at follow-up (P < 0.01), but remained significantly lower than those of control dogs (P < 0.01). Complications were identified in 25% of joints, and the dogs with complications had significantly lower peak vertical forces at follow-up than the dogs without complications (P = 0.04). Other clinical parameters did not influence outcome. CONCLUSIONS: Tibial tuberosity advancement significantly improved limb function in dogs with CrCL disease, but did not result in complete return to function. Complications adversely affected functional outcome. CLINICAL SIGNIFICANCE: A return to a function of approximately 90% of normal can be expected in dogs with CrCL disease undergoing TTA.     

Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs

Eight dogs presented with chronic hindlimb lameness associated with cranial cruciate ligament rupture. Seven were small terriers. A caudal deformity of the proximal tibial shaft, originating at the proximal tibial physis, and an excessive caudal slope of the tibial plateau were present bilaterally in all dogs. The deformity was thought to be responsible for the cranial cruciate ligament failure and poor response to conservative management. Tibial plateau angles were in excess of 26 degrees in all dogs. The lameness was bilateral in three dogs. There was complete cranial cruciate ligament rupture in seven stifles and partial rupture in four. There were no meniscal injuries. Surgical correction resulted in a significant improvement (P<0.0001) in all dogs, with a mean follow-up of 12 months (range three to 24 months). There were no complications.     

Conservative management of 17 horses with nonarticular fractures of the tibial tuberosity

REASONS FOR PERFORMING STUDY: Fractures of the tibial tuberosity (FTT) are caused by direct trauma, and are the second most commonly reported injury in event horses with stifle trauma. Conservative management of horses with FTT has been advocated, but results and prognosis for this method of therapy are unknown. OBJECTIVES: To report and review the findings of a retrospective study of 17 horses admitted to a veterinary teaching hospital from 1986-2001 with nonarticular FTT that received conservative management. METHODS: Subject details, aetiology of the accident, limb affected, degree of lameness at time of admission, size and degree of displacement of the fracture fragment, complications such as comminution of the fracture fragment or damage to soft tissue structures within the affected stifle, and treatment recommendations were obtained from medical records. Owners and trainers were contacted regarding the horse's return to athletic use. The follow-up period consisted of 11-154 months. RESULTS: Two horses were reportedly sound, but unable to return to competition for unrelated reasons. Of the horses that completed the rehabilitation period, 12/15 (80%) returned to athletic use at the same level as before the injury. Three horses were diagnosed with damage to soft tissue supporting structures of the affected stifle and could not return to their former level of competition. CONCLUSIONS: Concurrent soft tissue damage, diagnosed at the time of the initial injury, was statistically significant in precluding horses from returning to athletic careers. All other variables were found to have no effect upon outcome. POTENTIAL CLINICAL RELEVANCE: This retrospective study suggests that the conservative management of nonarticular FTT is a viable treatment modality in managing athletic equine patients presenting with these fractures.     

Treatment of fractures of the tibial tuberosity in the dog.

Of 27 dogs with fractures of the tibial tuberosity, 24 were treated by various methods of open reduction. Follow-up examination was obtained in 21 cases, and it was found that all but one fracture healed in 8 weeks. Tension band wiring and single interfragmentary screws were most commonly used; healing was similar in both groups.     

Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy

OBJECTIVE: To investigate radiographic changes of the tibial tuberosity after tibial plateau leveling osteotomy (TPLO) surgery and identify clinical findings and risk factors associated with such changes. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Hundred and eighty-six client-owned dogs (219 stifles) that had TPLO surgery. METHODS: Patient data retrieved included radiographic changes of the tibial tuberosity during re-examination, age, body weight, whether unilateral or single-session bilateral surgery had been performed, location of the anti-rotational pin, approximate tibial tuberosity area, and approximate average tibial tuberosity width. RESULTS: Fracture with resulting caudal displacement of the proximal tibial tuberosity (1.4%; 3 of 219) occurred less frequently than non-displaced tibial tuberosity fractures (7.3%; 16 of 219). Age, weight, average tibial tuberosity width, location of the anti-rotational pin, and single session bilateral surgery were identified as risks factors for non-displaced fracture. Weight divided by the square of the average tibial tuberosity width may be a stronger risk factor than either weight or average tibial tuberosity width alone. CONCLUSIONS: Dogs undergoing single session bilateral TPLO surgery are at greater risk for developing non-displaced tibial tuberosity fractures. The non-displaced tibial tuberosity fracture does not appear to adversely affect outcome or lead to tibial tuberosity avulsion. Significant risk factors for fracture of the proximal tibial tuberosity with caudal displacement were not identified. CLINICAL RELEVANCE: Factors including age, weight, tibial tuberosity thickness, and conditions that may enhance strain on the tibial tuberosity, such as single-session bilateral procedures, may increase risk of fracture.