case_images: PMC11113046_01
case_images: Preoperative right stifle radiographs. (a) Mediolateral view revealing proximal displacement of the tibia towards the femur and infrapatellar pad sign. (b) Posteroanterior view revealing proximal displacement of the tibia towards the femur. Yellow arrows in (a) and (b) point to the popliteal sesamoid bone, which was displaced caudodistally. Cranially to it, a small bone fragment could be identified. The blue arrow in (a) points to the suspected joint effusion and/or oedema of the fat pad
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case_images: fig1-20551169241247439
case_images: Orthogonal radiographs confirmed cranioproximal displacement of the tibia with respect to the femur and effacement of the infrapatellar fat pad shadow, consistent with joint effusion and/or oedema of the fat pad, caudodistal displacement of the popliteal sesamoid bone and a small bone fragment located cranially to it, whose origin was uncertain (Figure 1).
case_images: Intraoperative assessment of the stifle joint. Yellow arrow pointing to the cranial cruciate ligament's (CrCL) origin in the cranial intercondyloid area of the tibia. Note that the remnants of the CrCL were removed. The blue arrow indicates the complete rupture of the caudal cruciate ligament
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case_images: PMC11113046_01_10.1177_20551169241247439-fig2.jpg
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case_images: Cartilage erosion of the medial aspect of the femoral condyle, complete rupture of both CrCL and CaCL, as well as marked disruption of the caudal poles of both menisci were identified intraoperatively (Figure 2).
case_images: Orthogonal stifle diagrams show the medial and lateral augmentation sutures placement. (a) Medial aspect of the stifle diagram, showing the relationship between the tibial plateau levelling osteotomy (TPLO) plate and the medial augmentation suture. (b) Anteroposterior stifle diagram. The blue line represents the lateral augmentation suture, which was inserted through the TPLO plate's suture hole, through a predrilled tibial tunnel, and then secured to a distal lateral femoral condylar interference screw. The red line represents the medial augmentation suture, anchored with three interference screws. One femoral screw in the caudodistal area of its medial condyle and two tibial screws in its medial aspect: one proximocaudally and the other cranially to the second most distal TPLO pate screw. Note that the TPLO plate screws have been removed to allow a better visualisation of the suture placements
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case_images: PMC11113046_01_10.1177_20551169241247439-fig3.jpg
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case_images: The osteotomy was stabilised with a 2 mm locking TPLO plate (Arthrex), and the K-wire was removed (Figure 3). The tibial plateau angle (TPA) was rotated from 23  to 6 . Therefore, the remaining suture from the femoral interference screw was brought to the cranial aspect of the proximomedial tibia (cranial to the second most distal TPLO plate screw) and fixed with a 2.5 mm size interference screw (Figure 3).
case_images: Immediate postoperative orthogonal stifle radiographs: (a) mediolateral view; and (b) posteroanterior view. The blue arrows indicate the position of the lateral augmentation suture femoral interference screw. The yellow arrows point to the position of the medial augmentation suture femoral interference screw
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case_images: The TPA was reduced to 6  (Figure 4).
case_images: Orthogonal stifle radiographs 12 weeks postoperatively: (a) mediolateral view; and (b) posteroanterior view. The yellow arrows point to the presence of periosteal reaction, indicative of bone healing
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case_images: The previously identified mild tibial caudal subluxation persisted radiographically (Figure 5).