Tibial osteotomies for cranial cruciate ligament insufficiency in dogs.

Abstract

OBJECTIVE: To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs. STUDY DESIGN: Literature review. METHODS: Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007). RESULTS: Reported tibial osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge osteotomy [CTWO], tibial plateau leveling osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular osteotomy, chevron wedge osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial osteotomy procedure. CONCLUSIONS: Currently available data does not allow accurate comparisons between different tibial osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal osteotomy technique, and whether these procedures are superior to other stabilization methods. CLINICAL RELEVANCE: Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial osteotomy techniques.