High tibial osteotomy shows durable outcomes in canine CrCLD

A retrospective observational study found that canines undergoing high tibial osteotomy (HTO) for cranial cruciate ligament disease (CrCLD) without routine stifle exploration had long-term owner-reported outcomes similar to dogs that later required arthrotomy and meniscectomy for persistent late lameness.¹

The findings, published online in the Journal of the American Veterinary Medical Association, add to an ongoing clinical question in canine stifle surgery: whether routine meniscal evaluation and intervention are necessary at the time of tibial plateau leveling osteotomy (TPLO) or cranial closing wedge ostectomy (CCWO), particularly when some meniscal lesions may not be clinically important.

Study design and surgical approach

The investigators reviewed records from a private small animal surgical referral practice in the United Kingdom and included 191 dogs representing 236 stifles treated with HTO without concurrent stifle exploration. Procedures included TPLO in 55 stifles (23.3%) and CCWO in 181 stifles (76.7%).¹

Dogs with arthrotomy at the time of stabilization, previous stifle surgery, clinically significant concurrent orthopedic disease, or loss to short-term follow-up were excluded. No antirotational sutures were used because medial rotational instability was not identified intraoperatively.¹

Short-term follow-up occurred at a median of 46 days postoperatively. Long-term owner-reported outcome data were collected remotely with the Liverpool Osteoarthritis in Dogs (LOAD) and Canine Orthopedic Index (COI) instruments at a median of 996 days postoperatively in 128 dogs representing 158 stifles. Late lameness, defined as acute lameness after the expected postoperative return to function, occurred in 15.7% of 236 stifles at a median of 141 days after surgery.¹

The investigators used a meniscal-sparing management strategy for these cases. Dogs were reevaluated to identify complications requiring intervention, such as implant failure or surgical site infection. If no surgically actionable cause was identified, suspected meniscal injury was managed nonsurgically for up to 4 weeks with NSAIDs and no exercise restriction.¹

Lameness resolved with this nonsurgical approach in 24 of the 37 affected stifles. The remaining 13 stifles underwent arthrotomy and meniscectomy after lameness failed to respond. In those 13 stifles, surgeons identified 10 bucket handle tears and 3 complex medial meniscal tears; 12 were treated with partial medial meniscectomy and 1 with total medial meniscectomy.¹

No negative arthrotomies occurred. The overall late meniscal injury rate requiring surgical treatment was 5.5% of 236 stifles.¹

Owner-reported long-term outcome scores were not significantly different between dogs that underwent late meniscectomy and dogs that never underwent stifle exploration. After adjustment for age at surgery and time from surgery to outcome assessment, LOAD scores were similar between dogs undergoing meniscectomy (median, 13; IQR, 5.25-23) and those without stifle exploration or meniscectomy (median, 14; IQR, 6.25-21; P = .681). COI scores also did not differ significantly between the meniscectomy group (median, 10; IQR, 1.75-22.75) and the nonexplored group (median, 12; IQR, 3-24; P = .507).¹

Overall, 76.6% of 128 dogs with long-term follow-up returned to full exercise. Median long-term LOAD and COI scores for the cohort were 14 of 48 and 12 of 64, respectively.¹

The investigators concluded that long-term functional outcome after HTO with a meniscal-sparing approach was not different from outcome after HTO followed by later meniscectomy. They also noted that some late meniscal injuries may resolve clinically with nonsurgical management.¹

The median preoperative tibial plateau angle (TPA) was 25.5°, and the median postoperative TPA was 4.8°. Postoperative TPA was higher in stifles that developed late lameness than in those that did not: 5.5° vs 4.5°, respectively.¹

Each 1° increase in postoperative TPA was associated with increased odds of late lameness (unadjusted OR, 1.296; 95% CI, 1.091-1.541; P = .003) and increased odds of late meniscal injury requiring surgery (unadjusted OR, 1.395; 95% CI, 1.100-1.768; P = .006). Preoperative TPA was not associated with late lameness or late meniscal injury requiring intervention.¹

Although the median difference between groups was small, the authors suggested the finding may reinforce the importance of accurate planning and execution when targeting postoperative tibial plateau leveling.¹

Complications and clinical context

At short-term follow-up, outcomes were recorded as acceptable in 201 stifles (85.2%), full in 33 stifles (14.0%), and unacceptable in 2 stifles (0.8%). No dogs had persistent postoperative lameness after HTO without arthrotomy to assess the meniscus, and no postoperative medial rotational instability was recorded.¹

Complications occurred in 43 stifles (18.2%). Minor complications occurred in 17 stifles (7.2%), major I complications in 21 stifles (8.9%), and major II complications in 9 stifles (3.8%). The overall surgical site infection rate was 10.6%.¹

The study builds on earlier work questioning whether meniscal evaluation is always required during TPLO. In a prior owner-assessed series of 130 dogs treated with TPLO without meniscal evaluation, investigators reported a low incidence of late postoperative lameness and only 1 dog with persistent lameness that did not improve with nonsurgical management.² Experimental work has also shown that medial meniscal surgery can alter stifle contact mechanics, supporting caution around unnecessary meniscal intervention.³

Implications for practice

For surgeons and referring veterinarians, the study supports a more selective approach to meniscal intervention in dogs undergoing HTO for CrCLD. The data suggest that omitting routine arthrotomy did not compromise long-term owner-reported function in this cohort, and many cases of late lameness improved without meniscectomy.¹

The findings do not eliminate the need for meniscal surgery. In this series, dogs with persistent late lameness unresponsive to nonsurgical management all had medial meniscal lesions identified at arthrotomy, and no negative arthrotomies were reported.¹ Practically, this supports close postoperative reassessment and a staged approach: rule out major complications, manage selected late lameness cases conservatively, and reserve arthrotomy or arthroscopy for nonresponsive cases.

The clinical takeaway is measured but relevant: routine meniscal exploration at the time of HTO may not be necessary for every dog, and some suspected late meniscal injuries may be managed successfully without immediate surgery.

References

1. Treharne R, Low D, Rutherford S. Long-term outcome of high tibial osteotomy for canine cranial cruciate ligament disease without stifle exploration: an observational study of 236 stifles. J Am Vet Med Assoc. 2026;264(6). doi:10.2460/javma.25.11.0736
2. Bureau S. Owner assessment of the outcome of tibial plateau leveling osteotomy without meniscal evaluation for treatment of naturally occurring cranial cruciate ligament rupture: 130 cases (2009 to 2013). J Small Anim Pract. 2017;58(8):468-475. doi:10.1111/jsap.12691
3. Pozzi A, Litsky AS, Field J, Apelt D, Meadows C, Johnson KA. Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau leveling osteotomy in dogs. Vet Comp Orthop Traumatol. 2008;21(1):8-14. doi:10.3415/VCOT-06-12-0099