Comparison of Two Preoperative Radiographic Methods for Assessing Tibial Tuberosity Advancement to Achieve a Postoperative Patella Tendon Angle of 90° in Dogs

Abstract

Previous studies have suggested that the preoperative methods used to plan tibial tuberosity advancement in dogs may result in under-advancement. Therefore, this cadaveric study compared the effectiveness of the common tangent method and the tibial-anatomy-based method for achieving a target patellar tendon angle (PTA) of 90° after the modified Maquet procedure. Twenty stifle joints of mesomorphic dogs were randomly assigned to the two measurement methods. Radiographs taken in the mediolateral projection were used to measure tibial tuberosity advancement, and the wedge size was selected accordingly. For each surgical procedure, a custom-made three-dimensional wedge matched to an OrthoFoam wedge was used as a spacer. Postoperative radiographs were used to measure the PTA and to evaluate the position of the wedge. The measured advancement was not significantly different between the two methods. For 60% of the cases, the advancement measured using the common tangent method was <5.3 mm and the wedge size was increased to match that of commercially available wedges. Consequently, there was a significant difference between the measurements and wedges selected between the two procedures. The postoperative PTA did not differ significantly between the two methods and was 90° ± 5° in 80% of the stifles. The position of the wedge relative to the osteotomy was not significantly different between the methods. In conclusion, the advancement determined using the tibial-anatomy-based method was generally consistent with the size of commercially available wedges, and the method yielded a mean postoperative PTA of 90°.

Keywords

• modified Maquet procedure
• tibial tuberosity advancement
• wedge selection
• cranial cruciate ligament failure
• dogs