title: Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle.
abstract: OBJECTIVE
  To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO).
  
  
  METHODS
  Retrospective clinical study.
  
  
  METHODS
  Fifteen client-owned dogs (18 stifle joints).
  
  
  METHODS
  Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview.
  
  
  RESULTS
  Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status.
  
  
  CONCLUSIONS
  Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone.
  
  
  CONCLUSIONS
  TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA.
authors.forename: Miriam B
authors.initials: MB
authors.lastname: Talaat
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kowaleski
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Boudrieau
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D004285:Dogs; D005260:Female; D017102:Fracture Healing; D007794:Lameness, Animal / Q000453:epidemiology; D008297:Male; D010027:Osteotomy / Q000379:methods / Q000662:veterinary*; D011183:Postoperative Complications / Q000453:epidemiology / Q000662:veterinary; D012189:Retrospective Studies; D013264:Stifle / Q000293:injuries / Q000601:surgery*; D013977:Tibia / Q000293:injuries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome