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Cranial Closing Wedge Osteotomy (CCWO)

Information about the procedure for referring vets.

The cranial closing wedge ostectomy (CCWO) was the original tibial plateau levelling osteotomy (TPLO) technique described by Slocum and Slocum in the 1980’s.

The surgery eliminates tibial thrust by reducing the angle of the tibial plateau and making the cranial cruciate ligament redundant.

How is the technique performed?

Following a medial mini-arthrotomy to allow assessment of cruciate and menisci the proximal medial tibia is exposed. A premeasured wedge of bone is removed, and orthopaedic wire is passed through two holes placed in the cranial tibia and twisted to allow gradual closure and compression of the ostectomy. Finally a TPLO ‘locking’ type plate, is placed across the osteotomy to provide stabilisation.

Which patients may be suitable for this technique?

The surgeon assessing the patient's radiographs will take a few factors into account in deciding what might be the best approach. CCWO is usually considered in patients with:

-Steep tibial plateau angle (TPA). An angle over 28 degrees is considered steep and this anatomy makes other techniques such as TTA less suitable.

-Tibial crest is poorly developed. All dogs have variations in the anatomy of the proximal tibia and some breeds in particular have a relatively underdeveloped tibial crest. These patients are less suitable candidates for TTA and so may be considered for CCWO.

- Older patients. CCWO provides direct apposition of bone. TTA surgery leaves an osteotomy gap that needs to be filled by new bone formation. This may take an excessively long time in geriatric dogs, making CCWO a more appropriate procedure.

Don’t forget!

Techniques such as CCWO and TTA provide dynamic stabilisation and therefore DO NOT ELIMINATE CRANIAL DRAW. They provide dynamic stability during weight bearing and eliminate tibial thrust.