230 Surgical Treatment
CTS-IdI d d
d****
****CTS-T CTS-O CTS-CPFigure 28.3 Lateral radiographic images of cranial tibial subluxation (CTS) in a loaded stifle joint within an
experimental limb press model. Left to right: before cranial cruciate ligament (CrCL) transection (CTS-I); after CrCL
transection (CTS-T); post-tibial tuberosity advancement after maximal tibial tuberosity advancement (CTS-O); and at
critical point tibial tuberosity advancement (CTS-CP). The critical point for the tibial tuberosity advancement distance in
this model was defined as the position one revolution before stifle joint instability occurred. The CTS was defined as ‘d’
in each figure: CTS-T/CTS-O/CTS-CP=d–dI,wheredI(arrow) is the horizontal distance between the tibial marker (∗)
and the vertical passing through the femoral marker (dotted line) in the intact CrCL (the intact CrCL was the reference
position), and d is the same horizontal distance (arrows) for each respective position (CTS-T, CTS-O, and CTS-CP). In this
specimen, CTS-T was positive, CTS-O was negative, and CTS-CP was slightly negative. Source: Apeltet al.2007.
Reproduced with permission from John Wiley & Sons, Inc.
Normal CrCL-Deficient TTA-TreatedMPaFigure 28.4 Axial view of bone models depicting three-dimensional poses of normal, cranial cruciate-deficient
(CrCL-Deficient), and tibial tuberosity advancement (TTA-Treated) stifles, with corresponding contact maps
representative of each testing condition. The tibia (light gray) is cranially displaced and internally rotated relative to the
femur (dark gray) after CrCL transection; the femorotibial poses of normal and TTA-treated stifles are similar. CrCL
transection resulted in a caudal shift, a reduced area and an increased pressure of femorotibial contact; TTA contact
patterns are similar to normal. Left=lateral; top=cranial. CrCL, cranial cruciate ligament; TTA, tibial tuberosity
advancement. Source: Kimet al. 2009. Reproduced with permission from John Wiley & Sons, Inc.