In vitro evaluation of five canine tibial plateau leveling methods

Objective - To compare application time, accuracy of tibial plateau slope (TPS) correction, presence and magnitude of rotational and angular deformities, and mechanical properties of 5 canine tibial plateau leveling methods. Sample population - 27 canine tibial replicas created by rapid prototyping methods. Procedure - The application time, accuracy of TPS correction, presence and magnitude of rotational and angular deformation, and construct axial stiffness of 3 internal fixation methods (tibial plateau leveling osteotomy, tibial wedge osteotomy, and chevron wedge osteotomy [CWO]) and 2 external skeletal fixation (ESF) methods (hinged hybrid circular external fixation and wedge osteotomy linear fixation [WOLF]) were assessed. Results - Mean bone model axial stiffness did not differ among methods. Mean application time was more rapid for WOLF than for other methods. Mean TPSs did not differ from our 5° target and were lower for ESF methods, compared with internal fixation methods. Mean postoperative rotational malalignment did not differ from our target or among groups. Mean postoperative medio-lateral angulation did not differ from our target, except for CWO. Internal fixation methods lead to axially stiffer constructs than ESF methods. Reuse of ESF frames did not lead to a decrease in axial stiffness. Conclusions and clinical relevance - The 5 tibial plateau leveling methods had acceptable geometric and mechanical properties. External skeletal fixation methods were more accurate as a result of precise data available for determining the exact magnitude of correction required to achieve a 5° TPS.