DOI QR코드

DOI QR Code

Radiographic Comparison of Cranial Tibial Wedge Osteotomy versus Tibial Plateau Leveling Osteotomy: A Cadaveric Study

  • Lee, Jiyoon (Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University) ;
  • Kim, Dongwook (Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University) ;
  • Oh, Hyejong (Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University) ;
  • Lee, Sungin (Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University) ;
  • Choi, Seok Hwa (Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University) ;
  • Kim, Gonhyung (Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University)
  • Received : 2022.03.17
  • Accepted : 2022.05.16
  • Published : 2022.06.30

Abstract

The present study was performed to compare cranial tibial wedge osteotomy (CTWO) and tibial plateau leveling osteotomy (TPLO) through radiographic evaluation. The experiment was conducted with five cadaver dogs [mean (± SD) weight, 32.9 ± 4.1 kg; mean (± SD) age, 6 ± 2 years; three males and two females] euthanized for reasons unrelated to this study. The cadaver dogs consisted of German Shepherd (n = 3), Belgian Malinois (n = 1), and mixed breed (n = 1). CTWO and TPLO were carried out by the standard surgical method. Radiographic evaluation was performed by comparing several factors, including the flexion and extension angles, the anatomical mechanical axis angle (AMA-angle), tibial length, patellar height measurement using the Labelle-Laurin method, mechanical medial proximal tibial angle (mMPTA), mechanical medial distal tibial angle (mMDTA), and frontal plane alignment (FPA). Both the CTWO and the TPLO groups showed significantly increased flexion angles after surgery. Only the CTWO group had significantly increased extension angle. Although both groups showed significant decreases in the AMA-angle, the mechanical axis moved cranially against the anatomical axis only in the CTWO group. The patellar height was significantly lowered in the CTWO group. No significant differences were found in mMPTA, mMDTA, or FPA. In conclusion, radiographic comparison revealed more changes in CTWO group than in TPLO group.

Keywords

References

  1. Anagnostakos K, Lorbach O, Reiter S, Kohn D. Comparison of five patellar height measurement methods in 90° knee flexion. Int Orthop 2011; 35: 1791-1797. https://doi.org/10.1007/s00264-011-1236-4
  2. Apelt D, Pozzi A, Marcellin-Little DJ, Kowaleski MP. Effect of cranial tibial closing wedge angle on tibial subluxation: an ex vivo study. Vet Surg 2010; 39: 454-459. https://doi.org/10.1111/j.1532-950X.2010.00670.x
  3. Bailey CJ, Smith BA, Black AP. Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs. Vet Comp Orthop Traumatol 2007; 20: 169-174. https://doi.org/10.1160/vcot-06-02-0012
  4. Campbell KA, Payne JT, Doornink MT, Haggerty J. Outcome of tibial closing wedge osteotomy in 55 cranial cruciate ligament-deficient stifles of small dogs (<15 kg). Vet Surg 2016; 45: 1056-1062. https://doi.org/10.1111/vsu.12558
  5. Carpenter DH Jr, Cooper RC. Mini review of canine stifle joint anatomy. Anat Histol Embryol 2000; 29: 321-329. https://doi.org/10.1046/j.1439-0264.2000.00289.x
  6. Choi IH, Chung CY, Cho TJ, Park SS. Correction of genu recurvatum by the Ilizarov method. J Bone Joint Surg Br 1999; 81: 769-774. https://doi.org/10.1302/0301-620X.81B5.0810769
  7. Chonko DJ, Lombardi AV Jr, Berend KR. Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 2004; 12: 231-238.
  8. Conzemius MG, Evans RB, Besancon MF, Gordon WJ, Horstman CL, Hoefle WD, et al. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc 2005; 226: 232-236. https://doi.org/10.2460/javma.2005.226.232
  9. Cooper A, Alghamdi GA, Alghamdi MA, Altowaijri A, Richardson S. The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in hemiparetic stroke patients. Physiother Res Int 2012; 17: 150-156. https://doi.org/10.1002/pri.528
  10. Corr SA, Brown C. A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures. Vet Comp Orthop Traumatol 2007; 20: 312-319. https://doi.org/10.1160/VCOT-07-02-0013
  11. Dan MJ, McMahon J, Parr WCH, Broe D, Lucas P, Cross M, et al. Evaluation of intrinsic biomechanical risk factors in patellar tendinopathy: a retrospective radiographic case-control series. Orthop J Sports Med 2018; 6: 2325967118816038.
  12. Dismukes DI, Tomlinson JL, Fox DB, Cook JL, Song KJ. Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. Vet Surg 2007; 36: 699-704. https://doi.org/10.1111/j.1532-950X.2007.00323.x
  13. Duerr FM, Martin KW, Rishniw M, Palmer RH, Selmic LE. Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians. Vet Comp Orthop Traumatol 2014; 27: 478-483. https://doi.org/10.3415/VCOT-14-03-0047
  14. Fuller MC, Kapatkin AS, Bruecker KA, Holsworth IG, Kass PH, Hayashi K. Comparison of the tibial mechanical joint orientation angles in dogs with cranial cruciate ligament rupture. Can Vet J 2014; 55: 757-764.
  15. Guenego L, Payot M, Charru P, Verwaerde P. Comparison of tibial anatomical-mechanical axis angle between predisposed dogs and dogs at low risk for cranial cruciate ligament rupture. Vet J 2017; 225: 35-41. https://doi.org/10.1016/j.tvjl.2017.04.011
  16. Guenego L, Vezzoni A, Vezzoni L. Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than 30° and clinically normal Labradors retrievers. BMC Vet Res 2021; 17: 368. https://doi.org/10.1186/s12917-021-03094-3
  17. Hette K, Rahal SC, Volpi RS, Pereira-Junior OC, Mamprim MJ, Colombi da Silva V. Radiographic measurement of tibial joint angles in sheep. Vet Comp Orthop Traumatol 2009; 22: 204-209. https://doi.org/10.3415/VCOT-08-07-0065
  18. Jandi AS, Schulman AJ. Incidence of motion loss of the stifle joint in dogs with naturally occurring cranial cruciate ligament rupture surgically treated with tibial plateau leveling osteotomy: longitudinal clinical study of 412 cases. Vet Surg 2007; 36: 114-121. https://doi.org/10.1111/j.1532-950X.2006.00226.x
  19. Johnson AL, Probst CW, DeCamp CE, Rosenstein DS, Hauptman JG, Kern TL. Vertical position of the patella in the stifle joint of clinically normal large-breed dogs. Am J Vet Res 2002; 63: 42-46. https://doi.org/10.2460/AJVR.2002.63.42
  20. Kaufer H. Mechanical function of the patella. J Bone Joint Surg Am 1971; 53: 1551-1560. https://doi.org/10.2106/00004623-197153080-00007
  21. Kim SE, Pozzi A, Kowaleski MP, Lewis DD. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125. https://doi.org/10.1111/j.1532-950X.2007.00361.x
  22. Kim TW, Lee S, Yoon JR, Han HS, Lee MC. Proximal tibial anterior open-wedge oblique osteotomy: a novel technique to correct genu recurvatum. Knee 2017; 24: 345-353. https://doi.org/10.1016/j.knee.2016.10.008
  23. Kowaleski MP, McCarthy RJ. Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope. Vet Comp Orthop Traumatol 2004; 17: 30-34. https://doi.org/10.1055/s-0038-1632797
  24. Krotscheck U, Nelson SA, Todhunter RJ, Stone M, Zhang Z. Long term functional outcome of tibial tuberosity advancement vs. tibial plateau leveling osteotomy and extracapsular repair in a heterogeneous population of dogs. Vet Surg 2016; 45: 261-268. https://doi.org/10.1111/vsu.12445
  25. Kuan S, Smith B, Black A. Tibial wedge ostectomy: complications of 300 surgical procedures. Aust Vet J 2009; 87: 438-444. https://doi.org/10.1111/j.1751-0813.2009.00482.x
  26. Lavernia C, D'Apuzzo M, Rossi MD, Lee D. Accuracy of knee range of motion assessment after total knee arthroplasty. J Arthroplasty 2008; 23(6 Suppl 1): 85-91. https://doi.org/10.1016/j.arth.2008.05.019
  27. Lee JY, Kim G, Kim JH, Choi SH. Kinematic gait analysis of the hind limb after tibial plateau levelling osteotomy and cranial tibial wedge osteotomy in ten dogs. J Vet Med A Physiol Pathol Clin Med 2007; 54: 579-584. https://doi.org/10.1111/j.1439-0442.2007.01003.x
  28. Lee JY, Kim JH, Lee WG, Han TS, Cho K, Han HJ, et al. Scintigraphic evaluation of TPLO and CTWO in canine osteoarthritis. In Vivo 2007; 21: 855-859.
  29. Manohar Babu KV, Fassier F, Rendon JS, Saran N, Hamdy RC. Correction of proximal tibial recurvatum using the Ilizarov technique. J Pediatr Orthop 2012; 32: 35-41. https://doi.org/10.1097/BPO.0b013e31823b15e2
  30. Marzo JM, Bowen MK, Warren RF, Wickiewicz TL, Altchek DW. Intraarticular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction. Arthroscopy 1992; 8: 10-18. https://doi.org/10.1016/0749-8063(92)90129-Y
  31. Morris E, Lipowitz AJ. Comparison of tibial plateau angles in dogs with and without cranial cruciate ligament injuries. J Am Vet Med Assoc 2001; 218: 363-366. https://doi.org/10.2460/javma.2001.218.363
  32. Oxley B, Gemmill TJ, Renwick AR, Clements DN, McKee WM. Comparison of complication rates and clinical outcome between tibial plateau leveling osteotomy and a modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 739-750. https://doi.org/10.1111/j.1532-950X.2013.12033.x
  33. Phillips CL, Silver DA, Schranz PJ, Mandalia V. The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 2010; 92: 1045-1053.
  34. Pozzi A, Dunbar NJ, Kim SE. Effect of tibial plateau leveling osteotomy on patellofemoral alignment: a study using canine cadavers. Vet J 2013; 198: 98-102. https://doi.org/10.1016/j.tvjl.2013.06.029
  35. Slocum B, Devine T. Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. J Am Vet Med Assoc 1984; 184: 564-569.
  36. Tinga S, Kim SE, Banks SA, Jones SC, Park BH, Pozzi A, et al. Femorotibial kinematics in dogs with cranial cruciate ligament insufficiency: a three-dimensional in-vivo fluoroscopic analysis during walking. BMC Vet Res 2018; 14: 85. https://doi.org/10.1186/s12917-018-1395-2
  37. Vaienti E, Scita G, Ceccarelli F, Pogliacomi F. Understanding the human knee and its relationship to total knee replacement. Acta Biomed 2017; 88(2S): 6-16.
  38. Wallace AM, Addison ES, Smith BA, Radke H, Hobbs SJ. Modification of the cranial closing wedge ostectomy technique for the treatment of canine cruciate disease. Description and comparison with standard technique. Vet Comp Orthop Traumatol 2011; 24: 457-462. https://doi.org/10.3415/VCOT-10-11-0159