effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study

• Published in: Veterinary surgery Vol. 34; no. 4; pp. 332 - 336
• Main Authors: Kowaleski, M.P, Apelt, D, Mattoon, J.S, Litsky, A.S
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Science Inc 01.07.2005; Blackwell Publishing Ltd
• Subjects: Analysis of Variance; Animals; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; biomechanics; Body Weight - physiology; Cadaver; Comparative studies; cranial cruciate ligament; dislocations (injuries); dog; Dogs; Dogs - injuries; Dogs - surgery; forces; in vitro studies; Legs; ligaments; Osteotomy - methods; Osteotomy - veterinary; postmortem; Postoperative Complications - veterinary; quantitative analysis; spatial distribution; Statistics, Nonparametric; stifle; Stifle - injuries; Stifle - surgery; Surgery; tibia; Tibia - injuries; Tibia - surgery; tibial long axis shift; tibial plateau angle; tibial plateau leveling osteotomy (TPLO); Treatment Outcome
• ISSN: 0161-3499; 1532-950X
• DOI: 10.1111/j.1532-950X.2005.00051.x

Objectives— To compare centered versus distal tibial plateau leveling osteotomy (TPLO) position on cranial tibial subluxation, postoperative tibial plateau angle (TPA), and tibial long axis shift (TLAS). Study Design— In vitro biomechanical evaluation. Animals— Six pairs of canine cadaveric hind limbs. Methods— One limb of each pair was randomly assigned to the distal (TPLO‐D) or centered (TPLO‐C) osteotomy group. Cranial tibial subluxation (CTS) under load was quantified sequentially under 3 conditions: intact, after cranial cruciate ligament transection, and after TPLO; a corrected CTS value was also calculated. Postoperative TPA and TLAS were measured. Comparisons were made using 1‐way repeated measures ANOVA with a Tukey's multiple comparison post hoc test for CTS, and a Wilcoxon's sign rank test for TPA and TLAS. Significance was set at P<.05. Results— TPLO‐C had a significantly lower mean CTS than TPLO‐D (P<.01). Corrected CTS was also significantly lower in TPLO‐C than in TPLO‐D (P<.001). Postoperative TPA and TLAS were less in TPLO‐C than in TPLO‐D (P=.0312). Conclusion— Our results confirm that distal centering of the TPLO leads to craniodistal translation of the tibial plateau, TLAS, and a postoperative TPA that is greater than expected. This geometric effect has the biomechanical effect expected of inadequate tibial plateau leveling, namely incomplete neutralization of cranial tibial thrust. Clinical Relevance— The centered osteotomy position is geometrically more precise, and biomechanically more effective than the distal position.