Vet360 Vet360 Vol 05 Issue 03 - Page 9

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 Advanstar Communications inc. All rights reserved Issue 03 | JULY 2018 | 9