Zuckerman JS, Dyce J, Arruda AG, Kramer CM, Ben-Amotz R. Fibular osteotomy to facilitate proximal tibial rotation during tibial plateau leveling osteotomy.
Vet Surg 2018;
47:923-931. [PMID:
30239027 DOI:
10.1111/vsu.12945]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/23/2018] [Accepted: 06/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE
To identify factors that restrict proximal tibial rotation during tibial plateau leveling osteotomy (TPLO) and report on the outcome of concurrent fibular osteotomy (TPLO-FO).
STUDY DESIGN
Retrospective case-control study.
ANIMALS
Dogs undergoing TPLO-FO (n = 23) and dogs undergoing routine TPLO (n = 49).
METHODS
Medical records and radiographs of dogs that had undergone TPLO-FO were reviewed. Data that were collected included signalment, preoperative tibial plateau angle (TPA), mechanical medial proximal tibial angle (mMPTA), postoperative and recheck TPA and mMPTA, ratio of fibular width to tibial width (FW:TW), presence of tibiofibular synostosis, tibial osteotomy location, and use of additional implants.
RESULTS
The odds of exhibiting rotational constraints requiring FO during TPLO were 62-fold greater in dogs with tibiofibular synostosis than in dogs without synostosis. Dogs with FW:TW greater than 0.24 were 7.8-fold more likely to exhibit rotational constraints. After TPLO-FO, the postoperative increase in TPA was greater after single-plate fixation (mean, 5.4 ° ± 4.5 °) compared with fixation with 2 plates (mean, 1.4 ° ± 0.6 °).
CONCLUSION
Proximal tibiofibular synostosis and a relatively wide fibula restricted tibial plateau rotation. In these dogs, concurrent fibular osteotomy allowed adequate rotation. Adjunct plate fixation limited loss of rotation after TPLO-FO.
CLINICAL SIGNIFICANCE
Successful TPLO relies on adequate rotation of the proximal tibial segment. Fibular osteotomy and adjunct plate fixation are recommended to achieve and maintain adequate rotation of the osteotomized tibia in dogs with rotational constraints.
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