# Simultaneous Modified Tibial Plateau Leveling Osteotomy and Tibial Tuberosity Transposition for Grade IV Medial Patellar Luxation and Cranial Cruciate Ligament Disease in Small-Breed Dogs

## TL;DR

This study shows that a combined surgical technique is effective for treating severe knee issues in small dogs.

## Contribution

A new combined surgical approach for Grade IV MPL and CCLD in small-breed dogs is proposed and evaluated.

## Key findings

- No major complications were observed in nine cases after the combined surgery.
- Postoperative gait recovery and radiographic outcomes were favorable.
- Owner satisfaction and lameness improvement were reported six months post-surgery.

## Abstract

Medial patellar luxation (MPL) and cranial cruciate ligament disease (CCLD) are common causes of hindlimb lameness in dogs. Severe MPL is frequently observed with CCLD in small and toy breeds, rendering surgical correction difficult. Here, we evaluated the feasibility of a combined surgical approach termed modified tibial plateau leveling osteotomy and tibial tuberosity transposition (mTPLO-TTT) for these conditions. We assessed nine cases (seven dogs) postoperatively (at 6–14 weeks). We followed the long-term results through telephone interviews with the owners six months after surgery or later. No major complications were observed, and the postoperative gait recovery and radiographic outcomes were favorable. Owner satisfaction was excellent. Therefore, simultaneous mTPLO-TTT is an effective surgical option for managing severe MPL and CCLD in dogs.

This study explored the complications and prognosis of modified tibial plateau leveling osteotomy with tibial tuberosity transposition (mTPLO-TTT) for simultaneously correcting high-grade medial patellar luxation (MPL) and cranial cruciate ligament disease (CCLD) in small-breed dogs. This retrospective study evaluated patient data, lameness scores, radiographic outcomes, and complications over a median follow-up period of 10 weeks. Additionally, an owner interview was conducted 6 months postoperatively. Nine stifles from seven dogs were included in this study. All cases showed satisfactory patellar alignment and stability after surgery, with no major complications or reluxations. The lameness scores improved, and radiographic assessments confirmed implant stability and appropriate bone healing. Owner-reported outcomes at 6 months were also favorable. These findings suggest that simultaneous mTPLO-TTT is an effective surgical option for small-breed dogs with concurrent CCLD and Grade IV MPL.