Preoperative planning using computed tomography in tibial plateau levelling osteotomy: A comparison with conventional radiography

Abstract

Background: Tibial plateau levelling osteotomy (TPLO) is currently one of the most common surgical procedures for the correction of the stifle joint with a ruptured cranial cruciate ligament. TPLO is based on the preoperative tibial plateau angle (TPA); therefore, it is essential to optimise the consistency and repeatability of TPA measurements. Objectives: This study aims to compare computed tomography (CT) with conventional radiography in the preoperative planning of TPLO. Methods: This prospective study included six dogs (12 hindlimbs) and 13 canine cadaveric hindlimbs. In the six beagle dogs, TPAs were measured by three radiologists using digital radiographic and CT images to evaluate the intra- and inter-observer agreement. To evaluate the intra-observer agreement of the TPA before and after surgery, and the intended angle of the postoperative TPA according to the preoperative planning method, 13 cadaveric hindlimbs were evaluated thrice at random by a single radiologist. Results: The intra- and inter-observer intraclass correlation coefficients (ICCs) of the CT method were higher than those of the radiographic method in normal beagle dogs. The intra-observer ICC of the CT method before and after TPLO was generally higher than that of the radiographic method in the cadaver. However, no significant difference was noted in the evaluation of the intended postoperative TPA according to the preoperative planning method. Conclusions: The intra- and inter-observer ICCs allowed for easy identification of landmarks required to consistently determine the TPA in the preoperative planning of TPLO based on CT images.