Extended long-term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog

Vet Surg. 2020 Jan;49(1):146-154. doi: 10.1111/vsu.13277. Epub 2019 Jul 9.


Objective: To report extended long-term outcomes of dogs with cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement (TTA).

Study design: Retrospective clinical cohort study.

Animals: Client-owned dogs with ≥3 years follow-up (118 dogs, 166 stifles).

Methods: Records from June 2012 to May 2015 were reviewed. Follow-up examination and radiography were performed in dogs meeting the inclusion criteria. Measures of outcomes included a radiographic osteoarthritis score (preoperative, 8 weeks postoperative, and ≥3 years postoperative), the Canine Brief Pain Inventory, and the Canine Orthopedic Index.

Results: Ninety-four dogs treated with TPLO (133 stifles) and 24 dogs treated with TTA (33 stifles) met the inclusion criteria. All dogs underwent meniscal release or partial medial meniscectomy. Osteoarthritis score progressed more after TTA (P = .003) and in dogs with bilateral surgery (P = .022). Long-term outcomes that were better after TPLO compared with TTA included average pain in the last 7 days (P = .007), interference with walking (P = .010), morning stiffness (P = .004), jumping (P = .003) and climbing (P = .040), limping during mild activities (P = .001), and overall quality of life (P = .045).

Conclusion: Osteoarthritis progressed more after TTA and in dogs with bilateral stifle surgery. Dogs treated with TPLO subjectively seemed to have less pain and fewer mobility issues.

Clinical significance: Tibial plateau leveling osteotomy provides a better long-term radiographic and functional outcome than TTA.

MeSH terms

  • Animals
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Injuries / veterinary*
  • Cohort Studies
  • Dog Diseases / surgery*
  • Dogs
  • Female
  • Male
  • Osteotomy / methods
  • Osteotomy / veterinary*
  • Patellar Ligament / surgery*
  • Retrospective Studies
  • Rupture / surgery
  • Rupture / veterinary*
  • Stifle / surgery
  • Tibia / surgery*