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Clough et al: Combined center of rotation of angulation‐based leveling osteotomy and tibial tuberosity transposition: An ex vivo mechanical study
Veterinary Surgery 3, 2022

🔍 Key Findings

  • Combined CBLO-TTT did not reduce load to failure compared to CBLO or TTT alone (P = .81 and P = .12, respectively).
  • CBLO-TTT maintains construct strength without significant compromise compared to individual procedures.
  • Most common failure mode in CBLO-TTT was displacement of the tibial crest segment with k-wire pullout and tension band untwisting.
  • No fulcrum effect was seen in CBLO-TTT, unlike TPLO-TTT combinations, likely due to preservation of buttress effect.
  • Patellar ligament avulsion occurred in both CBLO and CBLO-TTT, but not as a clinical concern — possibly artifact from cadaver model.
  • Load-to-failure testing was static and unidirectional, not accounting for cyclic fatigue or in vivo healing.
  • Plate size and saw blade variation were based on clinical realism, introducing potential variability but not affecting outcomes.
  • Study suggests feasibility of simultaneous surgical correction of CCL rupture and MPL using CBLO-TTT in dogs.

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← Articles

Clough et al: Combined center of rotation of angulation‐based leveling osteotomy and tibial tuberosity transposition: An ex vivo mechanical study
Veterinary Surgery 3, 2022

🔍 Key Findings

  • Combined CBLO-TTT did not reduce load to failure compared to CBLO or TTT alone (P = .81 and P = .12, respectively).
  • CBLO-TTT maintains construct strength without significant compromise compared to individual procedures.
  • Most common failure mode in CBLO-TTT was displacement of the tibial crest segment with k-wire pullout and tension band untwisting.
  • No fulcrum effect was seen in CBLO-TTT, unlike TPLO-TTT combinations, likely due to preservation of buttress effect.
  • Patellar ligament avulsion occurred in both CBLO and CBLO-TTT, but not as a clinical concern — possibly artifact from cadaver model.
  • Load-to-failure testing was static and unidirectional, not accounting for cyclic fatigue or in vivo healing.
  • Plate size and saw blade variation were based on clinical realism, introducing potential variability but not affecting outcomes.
  • Study suggests feasibility of simultaneous surgical correction of CCL rupture and MPL using CBLO-TTT in dogs.

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Multiple Choice Questions on this study

In Clough 2022 et al., on CBLO-TTT construct testing, why might the CBLO-TTT not suffer the same load-to-failure weakness seen in TPLO-TTT constructs?

A. It uses two bone plates instead of one.
B. It eliminates the need for a TTT.
C. It preserves the distal femoral growth plate.
D. It maintains the buttress effect between tibial crest and plateau.
E. It fuses the tibial crest entirely.

Answer: It maintains the buttress effect between tibial crest and plateau.

Explanation: The cranial rotation of the proximal segment in CBLO preserves contact and support that is lost in TPLO-TTT.
In Clough 2022 et al., on CBLO-TTT construct testing, which outcome best describes the load-to-failure comparison between CBLO-TTT and CBLO alone?

A. CBLO-TTT failed at significantly lower loads than CBLO.
B. CBLO-TTT failed at significantly higher loads than CBLO.
C. CBLO-TTT and CBLO had similar load-to-failure values.
D. CBLO-TTT showed catastrophic failure in all limbs.
E. CBLO-TTT was not biomechanically tested.

Answer: CBLO-TTT and CBLO had similar load-to-failure values.

Explanation: The study showed no significant difference in mean failure loads between CBLO-TTT and CBLO (P = .81).
In Clough 2022 et al., on CBLO-TTT construct testing, what is the clinical implication of combining CBLO and TTT?

A. It significantly increases surgical time.
B. It cannot be performed in growing dogs.
C. It weakens the tibial plateau structure.
D. It offers a viable option for concurrent MPL and CCL treatment.
E. It replaces the need for trochleoplasty.

Answer: It offers a viable option for concurrent MPL and CCL treatment.

Explanation: The study supports the feasibility of combined CBLO-TTT to address both stifle instability and patellar luxation.
In Clough 2022 et al., on CBLO-TTT construct testing, what was the most common mode of failure in the CBLO-TTT specimens?

A. Tibial plateau fracture
B. Tibial diaphyseal spiral fracture
C. Displacement of the tibial crest with untwisting of tension band
D. Plate bending and breakage
E. Avulsion of the patellar ligament insertion

Answer: Displacement of the tibial crest with untwisting of tension band

Explanation: This mode occurred in most CBLO-TTT specimens, indicating a weakness at the tension band/k-wire interface.
In Clough 2022 et al., on CBLO-TTT construct testing, what key limitation affects clinical translation of this study?

A. Lack of radiographs for analysis
B. Small breed dogs only used
C. Use of cadavers with frozen tissue
D. CBLO plate always failed first
E. High intraoperative infection rate

Answer: Use of cadavers with frozen tissue

Explanation: The freezing process may alter soft tissue strength and failure mechanics, especially at the patellar ligament insertion.

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