The Effect of the Triple Tibial Osteotomy Procedure on Cranial Tibial Subluxation and Internal Tibial Rotation: A Radiographic Cadaver Study

Cranial cruciate ligament (CCL) rupture is a common cause of pelvic limb lameness in the dog. There are a multitude of techniques to address the instability associated with CCL rupture however recently the proximal tibial osteotomy techniques whereby the anatomy of the proximal tibia is changed to create an environment where an intact CCL is not required for stability have become generally favoured by specialist surgeons and the scientific literature. The Triple Tibial Osteotomy (TTO) is one such of these techniques however relative to its contemporaries, the Tibial Plateau Levelling Osteotomy and the Tibial Tuberosity Advancement, there is scant literature published
on the technique.
A radiographic cadaver study was performed to assess the effect of the TTO procedure on the cranial tibial subluxation (CTS) and internal tibial rotation (ITR) that occurs in a cranial cruciate ligament (CCL) deficient stifle. The study confirmed and quantified that transection of the CCL induces excessive CTS and ITR. The study found that CTS and ITR persist in a high percentage of dogs after application of the TTO (60.8%). A lesser percentage of dogs had resolution of CTS which was accompanied by a reduction in ITR after application of the TTO (39.1%). Additionally, the study also sought to assess the accuracy of the wedge osteotomy which was found to be consistently larger by approximately 2 degrees than planned on both the medial and lateral aspect of the tibia. Despite this the post-operative patella tendon angle closely approximately the planned 90o.