© Schattauer 2014 Vet Comp Orthop Traumatol 2/2014 148 Clinical Communication Tibial tuberosity fracture as a complication of tibial tuberosity advancement I. Calvo 1 ; J. Aisa 2 ; D. Chase 3 ; P. Garcia-Fernandez 4 ; F. San Roman 4 ; D. Bennett 1 1 Glasgow University Veterinary School, Division of Small Animal Sciences, Glasgow, Scotland, UK; 2 University College Dublin, Small Animal Surgery, Dublin, Ireland; 3 Pride Veterinary Centre, Derby, UK; 4 Facultad de Veterinaria, Universidad Complutense de Madrid, Departamento de Medicina y Ciurugia Animal, Madrid, Spain Keywords TTA, tibial tuberosity, fracture, dog, stifle Summary Objectives: To retrospectively compare two clinical subsets of dogs suffering tibial tube- rosity (TT) fracture (incidental finding or sudden onset severe lameness) as a compli- cation of tibial tuberosity advancement (TTA) and to report the surgical management and outcome of TT fracture as a complication of TTA. Material and methods: The medical records of 10 dogs with eleven TT fractures or crest fractures after TTA were reviewed. The out- come and complications were determined from clinical and radiographic follow-up ex- aminations. Limb function was evaluated be- tween six and 12 weeks postoperatively. Owners were contacted by phone for long- term follow-up at least six months after the last examination. Results: Four dogs required surgical stabili- zation and six dogs had conservative man- agement. In the surgical group, every case experienced a sudden non-weight-bearing lameness after the initial TTA surgery. In three of the four cases an attempt was made to stabilize the TT and crest fracture while maintaining the TT advancement. Postoper- ative complications were encountered in three of the four surgically treated cases. Functional outcome was considered excel- lent in seven cases and good in the other three. Clinical significance: Tibial tuberosity frac- ture is a complication of TTA that seems to have a favourable prognosis, although it can result in significant morbidity and in some cases revision surgery may be required. Correspondence to: Mr Ignacio Calvo, Ldo Vet, CertSAS, Dipl ECVS, MRCVS Lecturer & Head Small Animal Orthopaedic Surgery University of Glasgow School of Veterinary Medicine, Small Animal Hospital Bearsden Road, Bearsden G61 1QH Glasgow, Scotland United Kingdom Phone: +44 141 3305 848 Fax: +44 141 3303 663 E-mail: ignacio.calvo@glasgow.ac.uk Vet Comp Orthop Traumatol 2014; 27: 148–154 doi:10.3415/VCOT-13-06-0071 Received: June 6, 2013 Accepted: November 26, 2013 Pre-published online: January 20, 2014 Introduction Rupture of the cranial cruciate ligament is one of the most common orthopaedic problems observed in the canine stifle joint (1). Restoration of function is achieved sur- gically by neutralizing the tibio-femoral shear forces in a cranial cruciate ligament- deficient stifle using either a static or dy- namic surgical procedure (2). Dynamic stabilization is achieved by neutralizing the cranial tibial thrust. Historically this has been achieved by a tibial plateau levelling osteotomy, in which a radial osteotomy of the proximal tibia is performed, and ro- tation of the tibial plateau allows a reduc- tion of the tibial plateau angle (2). Tibial tuberosity advancement was pro- posed in 2002 as an alternative to tibial pla- teau levelling osteotomy (3). Tibial tube- rosity advancement achieves dynamic stifle stabilization by advancing the tibial tube- rosity, thereby altering the direction of the patellar tendon force vector. This results in either a neutral or caudally directed tibio- femoral shear force during the weight- bearing phase of the gait cycle (4). Tibial tuberosity advancement has be- come popular over recent years. By compari- son with tibial plateau levelling osteotomy, it is claimed that, tibial tuberosity advance- ment is less invasive and less technically de- manding, with a reduced major compli- cation rate (5, 6). However, some reports in the current literature suggest that the compli- cation rates are similar for the tibial tuberos- ity advancement and tibial plateau levelling osteotomy procedures (1, 2, 6–11). Fracture of the tibial tuberosity is con- sidered one of the more serious compli- cations following tibial plateau levelling os- teotomy, because of increased patient mor- bidity and client expense; the reported inci- dence is three to nine percent (12). Tibial tuberosity fractures have also been re- ported after tibial tuberosity advancement, with an incidence ranging from one to four percent (1, 2, 6). Risk factors for tibial tube- rosity fracture have been reported for both tibial plateau levelling osteotomy and tibial tuberosity advancement (12-14). The majority of the tibial tuberosity fractures previously reported were inciden- tal avulsion fractures detected on routine radiographic follow-up (1, 2, 7, 8). Al- though we acknowledge that this is the For personal or educational use only. No other uses without permission. All rights reserved. Downloaded from www.vcot-online.com on 2018-05-12 | ID: 1000333563 | IP: 54.70.40.11