Closing Cranial Wedge Ostectomy and Triple Tibial Osteotomy 251(A)(B)Figure 29.6 Treatment of combined cruciate ligament rupture and medial patella luxation. Immediate postoperative
radiographs of the proximal tibia after a triple tibial osteotomy (TTO) combined with lateral translation of the tibial
tuberosity fragment to re-align the quadriceps mechanism and position the patella in line with the trochlear groove. The
wedge ostectomy is stabilized with a pre-contoured TPLO plate. The tibial tuberosity position was maintained with two
K-wires and two tension band wires were placed to counter the pull of the quadriceps mechanism.
this is minimally displaced, and the patient is
not lame, conservative management is usually
successful. However, if it is unstable or the
patient is lame, then surgical stabilization with
a K-wire and tension band wire is indicated.
In a review of 121 TTO procedures, fracture
of the distal attachment of the tibial tuberos-
ity fragment was observed in nine tibias, three
of which were managed surgically (Moleset al.
2009).
Other complications reported are similar to
those evident in other osteotomy procedures
(surgical site infection, late meniscal tears)
(Bruceet al. 2007; Moleset al. 2009; Renwicket al.
2009).
Outcome
When the tuberosity fragment is stable, healing
is usually adequate at 6–8 weeks after surgery.
Union between the cranio-proximal corner of
the plateau fragment and the tuberosity frag-
ment likely protects the osteotomy.
Subjective assessments of outcome by own-
ers indicated a good return to normal function
in the majority of cases (Bruceet al. 2007; Moles
et al. 2009; Renwicket al. 2009). No studies using
objective measures have been performed. Given
that the endpoint of the surgery is based on
similar principles to the TTA, similar outcomes
would be expected.