Femorotibial kinematics in dogs treated with TPLO for cranial cruciate ligament insufficiency: An in vivo fluoroscopic analysis during walking

Authors: 
Tinga S, Kim SE, Banks SA, Jones SC, Park BH, Burtch M, Pozzi A, Lewis DD.
Vet Surg. 2019 Nov 28. doi: 10.1111/vsu.13356.

OBJECTIVE: To determine the ability of tibial plateau leveling osteotomy (TPLO) to address abnormal femorotibial kinematics caused by cranial cruciate ligament (CCL) rupture during walking in dogs.

STUDY DESIGN: Prospective, clinical.

ANIMALS: Sixteen dogs (20-40 kg) with unilateral complete CCL rupture.

METHODS: Lateral view fluoroscopy was performed during treadmill walking preoperatively and 6 months after TPLO. Digital three-dimensional (3D) models of the femora and tibiae were created from computed tomographic (CT) images. Gait cycles were analyzed by using a 3D-to-2D image registration process. Craniocaudal translation, internal/external rotation, and flexion/extension of the femorotibial joint were compared between preoperative and 6-month postoperative time points for the affected stifle and 6-month postoperative unaffected contralateral (control) stifles.

RESULTS: In the overall population, CCL rupture resulted in 10 ± 2.2 mm (mean ± SD) cranial tibial translation at midstance phase, which was converted to 2.1 ± 4.3 mm caudal tibial translation after TPLO. However, five of 16 TPLO-treated stifles had 4.1 ± 0.3 mm of cranial tibial subluxation during mid-to-late stance phase, whereas 10 of 16 TPLO-treated stifles had 4.3 ± 0.4 mm of caudal tibial subluxation throughout the gait cycle. Overall, postoperative axial rotational and flexion/extension patterns were not different from control, but stifles with caudal tibial subluxation had more external tibial rotation during mid-to-late stance phase compared with stifles with cranial tibial subluxation.

CONCLUSION: TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking.

CLINICAL SIGNIFICANCE: Tibial plateau leveling osteotomy reduces cranial tibial subluxation during walking, but persistent instability is common.