title: Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Surgical technique, radiographic and clinical outcomes.
abstract: OBJECTIVE
  To report surgical technique, morphometric effects and clinical outcomes for tibial tuberosity transposition-advancement (TTTA), sulcoplasty and para-patellar fascial imbrication for management of concomitant medial patellar luxation (MPL) and cranial cruciate ligament (CCL) disease in 32 dogs.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A previous technique for tibial tuberosity advancement was modified to incorporate lateral and distal tibial tuberosity transposition. Preoperative, immediate, and six to eight week postoperative radiographs were reviewed with morphometry of a range of tibial and stifle anatomic parameters. Findings of sequential clinical examinations to six to 20 months postoperatively were recorded.
  
  
  RESULTS
  Thirty-nine stifles were treated by surgery. Medial patellar luxation grade ranged from II to IV/IV. The CCL rupture was complete in 17/39 stifles, and incomplete in 22/39. Complications occurred in 11/39 stifles including MPL recurrence (n=4). Resolution of subjectively-assessed lameness occurred in 29/39 stifles at the six to eight week assessment. Resolution of lameness was eventually documented in 35/39 stifles (4/39 lost to follow-up), and was maintained at the six to 20 month reassessment where available. The TTTA induced relative patella baja in 31/39 stifles. Magnitude of actual tibial tuberosity advancement was lower than that predicted by cage size.
  
  
  CONCLUSIONS
  Tibial tuberosity transposition-advancement is a potential treatment modality for concomitant CCL disease and MPL in the dog, but refinement of planning is required, while biomechanical and kinematic effects remain unknown.
authors.affiliation: Fitzpatrick Referrals, Halfway Lane, Eashing, Surrey, GU7 2QQ, United Kingdom. r.yeadon@vet.gla.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Yeadon
authors.forename: N
authors.initials: N
authors.lastname: Fitzpatrick
authors.forename: M P
authors.initials: MP
authors.lastname: Kowaleski
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D004283:Dog Diseases / Q000601:surgery; D004285:Dogs / Q000293:injuries*; D006614:Hindlimb / Q000473:pathology*; D008022:Ligaments / Q000293:injuries*; D019637:Orthopedic Procedures / Q000379:methods / Q000662:veterinary*; D031222:Patellar Dislocation / Q000601:surgery / Q000662:veterinary*