Disease of the CCL is among the most common orthopedic problems and the leading cause of degenerative joint disease of the canine stifle joint. Surgical stabilization is recommended for most affected dogs.1 Cranialto-caudal angulation of the tibial plateau relative to the functional axis (ie, TPS) influences stress on the CCL during locomotion.2 The craniad force placed on the CCL increases with an increasing TPS.3 Clinically, TPS appears larger in some dogs with CCL disease, but not in others, suggesting a link between increased craniad forces and subsequent CCL disease.4,5 In cruciate-deficient stifles, craniad forces lead to cranial proximal tibial translation in relation to the femoral condyles, representing cranial drawer or cranial tibial thrust.6 Several surgical procedures are used to decrease TPS in dogs with CCL disease, therefore decreasing cranial tibial thrust.7–9 These corrective modalities rely on acute, intraoperative sliding, rotational, or closing wedge osteotomies and plate fixation and include the TPLO8 and TWO.9 The TPLO was specifically created to decrease TPS in dogs with CCL disease. This leads to a substantial decrease in cranial tibial subluxation, even though complete elimination of subluxation requires a specific surgical technique and angle of correction.2,3,10,a The TWO was created to correct caudal deformities of the proximal portion of the tibia and, since, has also been used to decrease TPS as an alternative to TPLO that may be technically simpler and not require a specific bone plate. However, scant information is available regarding the geometric and mechanical attributes of these surgeries.11,12,b
Closing wedge osteotomies may be performed by creating planar,9,13 curviplanar (dome),14 or V-shaped (chevron) kerfs. In humans, CWOs are used for phalangeal, ulnar, femoral, or tibial osteotomy stabilization, potentially because of their perceived increased stability over conventional closing wedge osteotomies.15–20 In 1 report,21 CWO healed faster than other wedge osteotomies, but it did not have clear advantages over other surgical methods in a recent review.22
Hinged circular ESF is a form of fixation widely used in humans to perform progressive corrective osteotomies of the proximal portion of the tibia. It is used as a less invasive alternative to internal fixation.23 Hinged circular ESF has been used to treat angular limb deformities and, in our teaching hospital, to alter TPS of dogs with CCL disease using HHCEF to perform progressive corrective osteotomies.24 In recent years, hinged unilateral ESF use has increased in humans, being considered technically simpler and less invasive than HHCEF. Additionally, hinged unilateral ESF allows pin insertion parallel to articular surfaces with juxta-articular osteotomies without additional components.25,26 A hinged unilateral ESF frame (ie, WOLF) has recently been designed by 1 author (DJM) and other investigators for correction of juxta-articular bone deformities, potentially including progressive alteration of TPS.
The purpose of the study reported here was to compare the geometric and mechanical properties of the following 5 canine tibial plateau leveling methods: TPLO,8 TWO,9 CWO, HHCEF, and WOLF. Properties evaluated included application time, accuracy of TPS correction, presence and magnitude of rotational and angular deformities, and axial stiffness of bone-implant constructs. We hypothesized that ESF would lead to a more rapid application and a more accurate and stable TPS correction, compared with internal fixation methods. We hypothesized that CWO would result in greater axial stiffness of bone-implant constructs than other internal fixation methods. We also hypothesized that ESF frame stiffness would not be negatively influenced by frame reuse.
Cranial cruciate ligament
Tibial plateau slope
Tibial plateau leveling osteotomy
Tibial wedge osteotomy
Chevron wedge osteotomy
External skeletal fixation
Hinged hybrid circular external fixation
Wedge osteotomy linear fixation
Kowaleski MP, Apelt D, Mattoon JS, et al. Effect of tibial plateau leveling osteotomy position on cranial tibial subluxation (abstr), in Proceedings. 31st Conf Vet Orthop Soc 2004;39.
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CT Sytec SRi, General Electric Co, Fairfield, Conn.
Mimics, version 7.10, Materialise, Leuven, Belgium.
SLA-190, 3-D Systems, Valencia, Calif.
Geomagic Studio, version 6.0, Raindrop Geomagic, Research Triangle Park, NC.
V2003-2004, SolidWorks Corp, Concord, Mass.
Beuthanasia-D, Schering-Plough Animal Health, Summit, NJ.
Adobe Photoshop, version 5.0, Adobe Systems Inc, Mountain View, Calif.
Synthes Ltd, Paoli, Pa.
Sturtevant Richmont, Franklin Park, Ill.
Stryker II, Stryker Instruments Inc, Kalamazoo, Mich.
Jorgensen Laboratories Inc, Loveland, Colo.
Hofmann S.r.L., Monza, Italy.
SK External Skeletal Fixation System, IMEX Inc, Longview, Tex.
ATS 1605C, Applied Test Systems, Inc., Butler, Pa.
PROC GLM, SAS, version 8.02, SAS Institute Inc, Cary, NC.
JMP, version 22.214.171.124, SAS Institute Inc, Cary, NC.
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