Proximal Tibial Epiphysiodesis in a Growing Dog

 Background: It is believed that the inclined tibial plateau angle to be a major cause of cranial cruciate ligament (CCL) rupture, and the treatment of this disease is the tibial plateau leveling for decrease the cranial tibial thrust. However, there are breeds predisposed to rupture of the cranial cruciate ligament and in this patterns breed the tibial plateau is more in­clined due to the conformation of the limb. The aim of this communication was to evaluate the effectiveness of the locking screw and cauterizing the growth plate of the tibial plateau as a preventive method of cranial cruciate ligament rupture. Case: In a young dog, one stifle joint randomly chosen for placing a screw in order to block the tibial plateau growth line. There was placed a 3.5 mm x 20 mm cancellous bone screw in the dorsocranial surface of the tibial plateau of the left hindlimb. Two months after the first surgical intervention, the contralateral limb was cauterized in the tibial plateau growth line. Electrocauterization was performed with a spatula electrode set at 60 watts, performing ablation on the cra­nial third of the tibial plateau physis with access to the medial and lateral surfaces of the proximal tibia. The electrode was placed against the physis for 10 seconds at each site. Both members were followed radiographically to measure the tibial plateau angle and observed the angle reduction. After 30 and 60 days post-surgery, the tibial plateau angle in left hindlimb decreased to 11o and -4o, respectively. However, the decrease plateau tibial angle was intense and severe and the screw was removed of the bone. However, even with the proximal tibial physis still open, withdrawing the screw did not alter the tibial plateau angle, which remained at -4º until the animal reached adulthood. The right left hindlimb was used as a control until the dog was 6 months old, when the tibial plateau angle exhibited a 26°. With the electrocauterization technique the tibial plateau angle decreased to 18° and 16° at 30 and 60 days after surgery, respectively, remaining at this last value until the animal completed its growth. Discussion: In the animals with cranial cruciate ligament rupture is indicate same surgical procedures like tibial plateau leveling osteotomy. In these cases, the recommended tibial plateau angle is aproximattely 5o. This study sought to block the line of growth of the tibial plateau to be reached an angle of approximately 5o. Epiphysiodesis technique with screw was already described for treating CCL rupture in young dogs, and the tibial plateau slope was reduced in all dogs studied. The surgical technique used was effective in blocking the physis; however, we observed that the tibial plateau slope was excessively modified and the screw was removed. This fact is explained by the dog’s immaturity, since the plateau leveling occurs more intensively in very young dogs. In epiphysiodesis using the electrocauterization technique, the same surgical principle of juvenile pubic symphysiodesis for treating coxofemoral dysplasia was used. However, in the current pilot study, it was unable to achieve the desired tibial plateau slope with this technique, possibly due to performing the procedure at an age in which the proximal tibial physis would have limited functional capacity. In this study, there was a reduction in the angle of the tibial plateau in both the techniques. However, further studies should be conducted to in order to confirm the actual effectiveness of both techniques described in this report. Keywords: cranial cruciate ligament, locking screw, electrocauterization, stifle join

Treatment of Radius Curvus in a Young Dog with Association of Radial Physeal Stapling, Ulnar Ostectomy and Transarticular Dynamic External Fixator Techniques

Background: Radius curvus is a clinical manifestation of the premature closure of the distal ulnar physis and the most common physeal disease in dogs, representing 63% of all physeal injuries. There are few reports indicating the technique of stapling for treatment of radius curvus in squeletically immature dogs. The aim of this study is to report a case of radius curvus in a young dog successfully treated with a combination of 3 surgical tecniques: 1- Stapling the medial and cranial portions of the distal radial physis; 2- Oblique osteotomy of the proximal ulna and ostectomy of the distal ulna, and 3- Dynamic external skeletal fixation in the elbow joint.Case: A 5-month-old female dog was referred to the University Veterinary Hospital with a history of left thoracic limb deformity for 2 weeks. There was a history of possible traumatic event on the front limb, in addition to providing nutritional supplements daily. In the radiographic evaluation the changes were identified in the left thoracic limb: shortening of the ulna, procurvatum and medial angulation of the distal radius, increased joint space and articular incongruity of the elbow joint. The dog was subjected to surgical treatment by the combination of three main surgical techniques. For the stapling of the distal radial physis the surgical approach on the cranial-medial surface of the distal radius was made. Two surgical staples were positioned in the distal radial physis. Thereafter a caudal approach was made to the distal region of the ulnar diaphysis for the distal ostectomy of the ulna. A bone segment of 1 cm in length of the distal ulnar diaphysis was removed. Another caudal approach was made to the proximal region of the ulnar diaphysis and a proximal oblique osteotomy of the ulna was performed. For the dynamic external skeletal fixation in the elbow joint two Steinmann pins were inserted. The first pin was proximal to the supracondilar foramen of the humerus and the second pin was caudal to the trochlear notch of the ulna, both parallel to the joint surface. To create a dynamic system, the pin tips were connected with elastic rubber bands on the medial and lateral sides of the elbow joint. Clinical and radiographic revaluation were made at 15, 30 and 60 days after surgery. Total correction of the limb deviation was achieved at 60 days postoperative. Two years after the surgical procedure, the owner was contacted and reported that the dog was very well and with no change in the operated limb.Discussion: The most common cause of premature closure of the distal ulnar physis is trauma. Due to the proper conical shape of the distal ulnar physis, there is more predisposition to the compression of the germinative cells in traumatic events, leading to radius curvus disease. Another cause of the radius curvus is the nutritional disbalances. In the reported case the patient had both predisponent factors, although unilateral limb involvement suggested trauma with primary causative agent. The treatment included the interruption of the supplementation of the diet associated with surgical techniques. The stapling of the distal radial physis is usually indicated for mild angular valgus deviation. In the current case the technique was applied with success regardless of the higher grade of radial deviation. Generally, the ulnar ostectomy is preferred to the osteotomy, since it reduces the rate of ulnar osteosynthesis, ensuring that the restrictive effect of the ulna upon the radial growth does not restart. In the reported case the ulnar ostectomy was associated with ulnar osteotomy to achieve a more effective result. Furthermore, the proximal ulnar osteotomy is usually indicated when elbow subluxation is present. In the current case the joint congruence was improved with the use of the dynamic external skeletal fixator

Juvenile pubic symphysiodesis associated with pectineus myectomy for treatment of hip dysplasia in dog

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery.Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development.Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.Keywords: hip dysplasia, juvenile pubic symphysiodesis, hip joint, osteoarthritis, dog.Título: Sinfisiodese púbica juvenil associada à miectomia do pectíneopara tratamento de displasia coxofemoral em cãoDescritores: displasia coxofemoral, sinfisiodese púbica juvenil, coxofemoral, osteoartrite

FÍSTULA ABOMASO-UMBILICAL EM BEZERRO: RELATO DE CASO

Objetivou-se por meio deste relato a ocorrência de fístula abomaso-umbilical em bezerro Girolando, descrevendo a sintomatologia clínica e tratamento instituído. Um bezerro com quatro meses de idade e 80 kg, apresentou histórico de onfaloflebite e lesão eritematosa com edemaciação umbilical. À inspeção física, verificou-se gotejamento de secreção esbranquiçada com aspecto leitoso e presença de orifício na região umbilical. Verificou-se pela palpação digital a presença de tecido pregueado semelhante mucosa abomasal. Por meio desses achados, sugeriu-se o diagnóstico de fístula abomaso-umbilical e procedeu-se a correção cirúrgica da lesão fistulante. Após 15 dias do tratamento instituído, o animal recebeu alta médica. Dessa forma, pôde-se concluir que, apesar de rara, essa patologia foi de fácil diagnóstico clínico e a terapia foi capaz promover a completa recuperação do animal

Clinical comparison between two stabilization methods in distal tibial angular deviation corrected by the CORA method

Background: Angular deformity is characterized by the deviation of part of the bone that can occur in three different planes, frontal, sagittal and transverse. Trauma on physeal plates is the most common cause of angular deviations of the limbs in dogs. Currently the CORA (Center of Rotation of Angulation) methodology is the best way to evaluate and surgically correct these deformities. The objective of this study is to describe the surgical procedures performed to treat the uniapical valgus deviation affecting both tibial bones in a dog, comparing the outcomes of hybrid external skeletal fixator used in the right pelvic limb in relation to the locking plate used in the left pelvic limb.Case: A 10-month old Border Collie dog was attended at the University Veterinary Hospital with history of lameness and deviation of both pelvic limbs. In the orthopedic examination, it was possible to identify bilateral valgus deviation in the region of the tibio-tarsal joints and moderate lameness, with absence of pain or joint crepitation. Radiographic examination showed that the deformity was only uniapical in the frontal plane, affecting both tibial bones of the dog. Signs of osteoarthrosis were not observed and the preoperative examinations were within the normal limits for the species. The deformities were corrected in two surgical times starting with the procedure in the right tibia, which appeared to be clinically worse. Due to the fact that it was a bilateral affection and there was not a healthy pelvic limb to obtain the normal angles values of this dog, for planning according to the CORA methodology, the values of the tibial mechanical angles for dogs of similar size were taken from the literature. For surgical correction of the right tibia, a closed wedge osteotomy was performed following the second rule of Paley, with bone stabilization using type IB hybrid external skeletal fixator (ESF). The radiographic follow-up was done every 30 days postoperatively, however at 60 days the dog presented with severe lameness and the ESF had to be removed due to the breaking of one of the wires that composed the ring of the hybrid system. The limb continued to be treated by external bandages and total bone healing occurred at 210 days after surgery. Only after the complete recovery of the right limb, the left pelvic limb was operated and was also corrected by closed wedge osteotomy from the second Paley's rule. However, the bone stabilization was achieved with the use of a T-shaped locking plate. Radiographic follow-up was performed every 30 days postoperatively and at 60 days the osteotomy gap was already consolidated and the dog showed good weight bearing in the pelvic limbs without signs of lameness or pain.Discussion: Currently, it is indicated that bone deformities in small animals should be corrected using the CORA methodology. The hybrid ESF is one of the most commonly used fixation systems for bone stabilization after corrective osteotomies due to great versatility, however, the reported complication rates are relatively high. The locking plates with special shapes, such as the "T" plate used in this study, provide the stable fixation of osteotomies with limited bone stock, as they allow the introduction of larger number of screws per area. Thus, this latter type of implant becomes advantageous for the correction of bone deformities close to the joints. It is concluded that CORA methodology is really effective in the planning of corrective surgeries of angular deviations in dogs. In this case report, the resulting tibial angles after the surgical corrections were within the normal range for healthy dogs of similar size. However, the use of locking plate provided better results with early bone healing and fewer complications than the type IB hybrid ESF

Hydrocolloid Membrane Dressing in Shearing Injuries in the Distal Part of the Pelvic Limbs in Dogs

Background: Shearing wounds on the limbs of dogs usually affect the regions distally from the radiocarpal joint at the thoracic limb and from the tibiotarsal joint at the pelvic limb. The tissue coverage and re-epithelialization of the injured region are important factors that should be considered in the definitive surgical treatment. The hydrocolloid membrane promotes selective autolytic debridement and accelerates the formation of granulation tissue and epithelialization. The present study aims to describe the treatment with hydrocolloid membrane dressing of three cases of shearing wounds with concomitant orthopedic injuries in the pelvic limbs of dogs.Case: Three dogs with pelvic limb injuries after vehicular trauma were selected for treatment. Two patients had shearing lesions on the medial aspect of the pelvic limb with exposure of the tibia and fibula, the talus and the tibiotarsal joint, associated with bone loss on the medial surface of the limb and rupture of the medial collateral ligament of the tarsus. Another patient had a shearing wound on the dorsal surface of the distal region of the pelvic limb, with injury of the digital extensor tendons and bone exposure of the second and third metatarsals. Initially, the surgical debridement of the lesion was performed and during the first five days after trauma the wound was cleansed with chlorhexidine solution and topical application of crystallized sugar daily. In this initial period a dry adherent dressing was used on the lesions, without bandages for immobilization of the pelvic limb. In all dogs, the hydrocolloid membrane was applied from the sixth day after initial wound management. Immediately after the application of the hydrocolloid membrane, temporary immobilization of the affected pelvic limb with a padded Robert Jones bandage was performed. The first changes of the hydrocolloid membranes were performed after five days of their use. Subsequently, the membranes changes became more spaced and were performed within a period between 7 to 10 days. After wound repair, in one of the dogs with a shearing injury in the medial surface of the pelvic limb, the rupture of the medial collateral ligament was surgically treated with the use of anchor screws and nylon thread for the ligament reconstruction. The other dog presented with lesion in the medial surface of the pelvic limb and collateral ligament rupture was not submitted to late orthopedic surgical treatment. The latter was clinically managed and developed valgus deviation of the affected pelvic limb, but with functional use of the limb. The dog with a shearing lesion on the dorsal surface of the pelvic limb and injury to the extensor tendons was managed conservatively with use of orthosis and, after 45 days of initial trauma, the dog showed a functional lameness and absence of pain in the affected limb.Discussion: In all animals, the hydrocolloid membrane was applied on the wound from the sixth day after the initial lesion treatment. As the wound was healing the hydrocolloid dressing was changed in a more spaced period and this management allowed the proper tissue healing without complications. The wound treatment with dressing was aided by the application of temporary limb immobilization with padded bandage, until a late orthopedic procedure was performed or a final clinical resolution occurred. In general, the shearing wounds healed in a period ranging from 28 to 38 days. In conclusion, the use of the hydrocolloid membrane dressing associated with limb immobilization was an effective method for treatment of patients with shearing wounds, allowing proper healing of the affected tissues and good recovery of the limb function. The hydrocolloid membrane has the main benefits to allow the spaced changes of the dressings and the ability to stimulate the rapid healing of the wound

Autogenous Osteochondral Graft Associated with IGF-1 in Induced Articular Cartilage Lesion in Rabbits

Background: Articular cartilage has a limited capacity for regeneration and of the various treatments proposed, none have reached appropriate therapeutic effectiveness. This study aimed to evaluate autogenous osteochondral grafts in intact or macerated format, in association with or without insulin-like growth factor type-1 (IGF-1) in the repair of osteochondral defects induced in the femoral trochlear groove of rabbits.Materials, Methods & Results: Seventeen healthy White New Zealand rabbits were selected for this study. The rabbits were female, six months old, and had an average body weight of 4.5 kg. All 34 stifle joints were subjected to autogenous osteochondral grafting in the femoral trochlear groove. The joints were divided into four groups designated as intact osteochondral graft with IGF-1 (INT + IGF), intact osteochondral graft with physiological solution (INT + FIS), macerated osteochondral graft with IGF-1 (MAC + IGF), and macerated osteochondral graft with physiological solution (MAC + FIS). Serial evaluations were performed by orthopedic and radiographic examination. After 6 and 12 weeks postoperatively, the grafted area was subjected to macroscopic, histological, and immunohistochemical analyses. Although no statistically significant differences were found between the groups in relation to clinical, macroscopic, histological, and immunohistochemical aspects, a tendency of IGF-1 to promote tissue repair was evident. In the radiographic evaluation, the articular surface and the recipient site in both groups with IGF-1 showed significantly more effective filling (P ≤ 0.05). Regardless of the group, collagen type 2 production, as assessed by immunohistochemistry, was found to be appropriate on the grafted articular surface.Discussion: In extensive cartilage lesions, the use of intact osteochondral grafts may be infeasible due to donor site morbidity. An alternative is the use of macerated osteochondral grafts, which cover a larger area and act as a support and cellular source in the repair process. Growth factors have been evaluated in association with grafted tissues to aid tissue repair, and IGF-1 is currently prominent. In the radiographic analysis of the present study, when comparing sites subjected to osteochondral grafting, presence of the whole graft evidenced adequate local filling in all groups. However, graft integration was apparently rapid and effective in the INT + IGF and MAC + IGF groups from the sixth and ninth weeks of the procedure, respectively. In the macroscopic evaluation at the twelfth week, graft integration with the original cartilaginous tissue was more evident, especially in both groups treated with IGF-1. It is likely that the property of IGF-1 to increase chondrogenesis in the cartilage repair of articular lesions in vivo may have contributed to these results in radiographic and macroscopic examinations. Histological examination showed no significant difference between groups in the same period of time; however, it was observed that addition of IGF-1 promoted a more evident tissue reaction and cellular activation, potentiating the process of reabsorption and repair in the grafted tissue. Immunohistochemical analysis showed similar immunoreactivity for collagen type 2 in all groups as early as the sixth week. However, a small portion of these tissues cannot be considered true hyaline cartilage due to the absence of some typical features. In summary, addition of IGF-1 to the autogenous osteochondral graft seemed to stimulate reabsorption and replacement processes in the grafted tissue. The grafts showed adequate ability to repair articular cartilage, displaying formation of collagen type 2 similar to that in the original tissue

Femoral Fracture Repair in a Ferret (Mustela putorius furo)

Background: Ferrets (Mustela putorius furo) are increasingly popular as pets. They require similar medical and surgical care as small animals, and orthopedic lesions are more and more common. Fracture diagnosis is based on history, orthopedic exam, and diagnostic imaging. The preferred treatment for femur fractures is surgery, which has a favorable outcome in the majority of cases. However, surgical fracture repair in ferrets can be challenging due to the small size of the bones. The objective of thispaper is to report the surgical repair of a femoral fracture in a ferret using an external skeletal fxation system type IA connected to an intramedullary pin (tie-in confguration).Case: An adult ferret was referred to the veterinary hospital after being stepped on. The ferret was diagnosed with an oblique diaphyseal fracture of the left femur and surgery was recommended. Open fracture reduction was performed with a 1 mm in tramedullary pin (Kirschner wire) placed in a retrograde direction into the proximal bone segment. After fracture reduction, the intramedullary pin was inserted into the distal bone segment. The external skeletal fxator type IA was created by the insertionof a 1.5 mm Schanz pin into the distal diaphysis and another, also 1.5 mm, inserted into the proximal metaphysis, both percuta neously. The three pins were connected externally to an aluminum bar with the aid of three staples to form a tie-in system. Rest and restriction of activity were recommended during the frst month after surgery. The ferret recovered well and, at 120 days, orthopedic and radiographic exams showed complete fracture healing. The implant was removed and no functional changesrelated to ambulation were observed.Discussion: The orthopedic knowledge applied to ferrets commonly originates in procedures performed on cats and dogs. Overall,the main objective when dealing with fractures is to stabilize the broken bone to allow early ambulation. Due to the location and type of fracture, an external immobilization was contraindicated in this case. A plate was considered, but the small diameter of the femur and the consequent risk of iatrogenic fractures made this option not feasible. Therefore, the external skeletal fxator in a tie-in confguration was selected. This method permitted control of the forces acting on the fracture site and had the advantage of low cost and ease of application and removal. Nevertheless, the vast musculature that covers the femur could hinder the use ofthe external pins and lead to discomfort. The method has been reported with some changes in ferrets, though with inconclusive results due to lack of follow-up. In the present report, a less rigid method, type I, was used since types II and III have a biplanar confguration and were thus inadequate due to the possible contact between the fxator and the abdominal or inguinal region. The precautions taken during placement of the implant were the same as in cats and dogs since their anatomy follows the same pattern. The implant was rigid, light, and effective, allowing early weight-bearing on the affected limb without discomfort to the patient. As such, the external fxator type IA connected to the intramedullary pin in a tie-in confguration was an effective method for the treatment of the oblique diaphyseal femoral fracture in this ferret. Although it is not the recommended method for this type of fracture in cats and dogs, there were no complications in the ferret, with complete fracture healing and return tofunction of the affected limb. Since there has yet to be a consensus on the recommended procedures in these animals, reports of this nature are important due to the growing number of ferret patients in veterinary practice.Keywords: ferret, osteosynthesis, bone fxation, repair of fractures

Technique of Tibial Tuberosity Transposition and Advancement (TTTA) With Use of TTA-Maquet Cage-Only in Dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinary technique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibial tuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition and advancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatment of a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in the left pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests, and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographs of the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurements were taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and a titanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity with the aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and the cage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tapping cortical screws. At the moment of the cage attachment to the tibial tuberosity, orthopedic washers of 2 mm wide were placed between the cranial ears of the cage and the tibial tuberosity, thus promoting a lateral transposition of the tibial tuberosity. The patient was maintained in the early postoperative period with Robert Jones bandage, and with antibiotic, analgesic and anti-inflammatory drugs. On the second day after the procedure partial limb support with presence of mild lameness was observed. At three months postoperatively, the animal had no claudication and MPL was corrected. The radiographic examination showed the proper process of bone repair at the osteotomy site. In the clinical evaluation performed at one year after surgery the patient was in good condition without lameness and with proper limb support and muscular gain.Discussion: The studies that evaluated the association of tibial tuberosity transposition and tibial tuberosity advancement techniques (TTTA) for the simultaneous treatment of MPL and CCL rupture demonstrated that this is a viable and effective procedure. In this report, the accomplishment of tibial osteotomy based on the Maquet hole and the advancement of the tibial tuberosity with the TTA-Maquet cage-only allowed the dynamic stabilization of the CCL deficient stifle and the early use of the affected limb. In addition, the TTTA technique proved to be effective for the correction of grade 3 of MPL in a large dog, allowing adequate recovery of the limb function without complications during a one year evaluation period