Correction of pivot shift phenomenon following tibial plateau leveling osteotomy using lateral fabellotibial suture in a toy-breed dog with cranial cruciate ligament rupture.

Abstract

BACKGROUND: Cranial cruciate ligament rupture (CCLR) is a leading cause of lameness in dogs, often requiring surgical stabilization. Tibial plateau leveling osteotomy (TPLO) is a widely used procedure; however, postoperative instability, including the pivot shift phenomenon, can occur. This case highlights the need for additional stabilization techniques when TPLO alone is insufficient. CASE DESCRIPTION: A 5-kg toy poodle presented with right hind limb CCLR. The tibial plateau angle (TPA) was 25°, and no injury was observed in the medial meniscus. TPLO was performed; however, postoperative instability due to the pivot shift phenomenon was observed. To restore joint stability, a lateral fabellotibial suture (LFTS) was placed. Eight weeks later, lameness developed in the left hind limb, and orthopedic examination confirmed CCLR with a TPA of 25° and an intact medial meniscus. LFTS was applied to the left stifle joint due to recurrent instability following TPLO. Postoperatively, stifle joint stability was regained in both hind limbs. CONCLUSION: While TPLO is an effective treatment for CCLR, some cases may require additional stabilization. This case suggests that LFTS can be a valuable adjunct for managing postoperative instability in small-breed dogs, improving surgical outcomes when the pivot shift phenomenon occurs.