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PTIO versus TPLO in ruptured cranial cruciate ligaments
Rupture of the cranial cruciate ligament is seen daily in small animal practice. Surgery is recommended, and various techniques are described. The TPLO (tibial plateau levelling osteotomy) has become very popular over the last years but requires special and expensive equipment. Now the newest surgical technique is proximal tibial intraarticular ostectomy (PTIO) which does not require special instruments. Is it comparable to TPLO? An important question - especially before buying the TPLO equipment...

This prospective clinical study was done to report a technique for surgical alteration of the slope of the tibial plateau by a proximal tibial intraarticular ostectomy (PTIO) after injury to the canine cranial cruciate ligament (CCL) and to determine the outcome. Dogs (n=52) with CCL injury in 60 stifle joints were included.

CCL injury was treated by lateral stifle arthrotomy, removal of CCL remnants, and appropriate meniscal surgery.

PTIO was performed to remove a wedge of bone from the proximal aspect of the tibia.

The ostectomy site was reduced and stabilized using a bone plate and screws applied to the medial surface of the tibia as well as a craniocaudal positional screw.

Dogs were evaluated at 6 weeks, 6, and 12 months by complication assessment, lameness scores, stifle range of motion (ROM), thigh circumference, radiographic assessment, degenerative joint disease (DJD) scores, and surgeon and owner evaluation of function.

RESULTS: Lameness scores improved by 6 and 12 months in all but 1 dog.
Thigh circumference and DJD were increased at 6 and 12 months.
Complications occurred in 20% of dogs with all but 1 occurring perioperatively or within 6 weeks; most common were injury to the long digital extensor tendon (4 dogs) and plate failure (3); 2 other dogs required surgery to treat complications.

Most owners (98%) reported that lameness had improved by 12 months; 90% were extremely or very satisfied with the procedure and 90% would have the same procedure performed on another dog.

CONCLUSION: PTIO to level the tibial plateau provided a satisfactory clinical outcome in dogs >20 kg with CCL injury and the complication rate was similar to tibial plateau levelling osteotomy (TPLO). Stifle osteoarthritis continued to progress radiographically.

PTIO represents an alternative to TPLO that does not require specialized surgical equipment.



Source: Jerram RM, Walker AM, Warman CG. (2005): Proximal tibial intraarticular ostectomy for treatment of canine cranial cruciate ligament injury. In: Vet Surg. 2005 May-Jun;34(3):196-205.




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