Figure 3: Left Stifle, lateral view. Immediate postoperative TTA. Figure 4: Left Stifle, lateral view. Six weeks post-CBLO.
to the premeasured tibiofemoral contact point when
the limb is in near full extension. This will in turn result
in neutralisation of the tibiofemoral shear force in a
CCL-deficient stifle joint. The implant system consists
of a cage and a bone plate that acts as a tension band.
The cage is inserted within the proximal portion of the
osteotomy and is size-specific to the intended cranial
advancement of the tibial tuberosity fragment. The
plate is then secured proximally to the medial aspect
of the advanced tibial tuberosity fragment and distally
to the tibial diaphysis acting as a tension band. The
patient is then limited in activity over the next six to
eight weeks while the osteotomy gap fills in and heals.
Case selection is important with this technique, as
specific tibial tuberosity conformations and excessive
TPAs (> 30 degrees) may result in less favorable
outcomes. includes the fact that it can be performed in juvenile
patients, as the osteotomy and plate placement do
not affect the proximal tibial physis and tibial tuberosity
apophysis. Further advantages include an increase in
fracture contact area for more load sharing, increased
proximal fragment bone stock for additional implant
placement and ease of adding on ancillary stabilising
procedures.
The CBLO (Figure 4) procedure is the most recently
described procedure and is similar to the TPLO in
that it is a dome osteotomy technique that attempts
to level the TPA. The location of the osteotomy is
based on the CORA of the tibia and attempts to place
the axis of correction (ACA) in line with the CORA to
limit tibial translation, thus limiting a caudal shift in
joint forces that have been described with the TPLO
procedure. An additional advantage over the TPLO
While each osteotomy procedure may have its own
subset of complications specific to each individual
technique, all procedures pose similar risks and
complications of implant infection and/or failure. At
the end of the day the procedure or procedures that
are recommended are often determined based on the
age, size, body condition of the patient, concomitant
morbidities, the comfort level of the surgeon with the
described techniques, the expectation of the owner
and the pet owner’s ability to financially suppor t the
recommended procedure.
References available online
Article reprinted with permission of DVM360 – June 12,
2018. DVM360 MAGAZINE is a copyrighted publication of
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Issue 03 | JULY 2018 | 9