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Guénégo et al: Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) to Treat Cranial Cruciate Ligament Deficient Stifle in 204 Dogs Over 50 Kg
Veterinary and Comparative Orthopaedics and Traumatology 3, 2025

🔍 Key Findings

  • AMA-based CCWO realigned the anatomical and mechanical axes in 82% of dogs >50 kg, with postoperative AMA angle of 0° in most cases.
  • Surgical site infection (SSI) rate was only 0.5%, markedly lower than TPLO-reported rates in similar populations (up to 37.5%).
  • All osteotomies achieved Grade 4 healing by 8 weeks, with no implant failures.
  • AMA-based planning based on preoperative AMA and TPA allowed for better correction of proximal tibial angulation compared to TPLO in large dogs.
  • Use of a double locking plate (DLP) fixation and Robert Jones bandage (RJB) contributed to improved mechanical stability and infection prevention.
  • Dogs with AMA angle >3.4° (hyper-CCAPT) were 38% of the cohort, supporting AMA as a critical metric in planning.
  • Postoperative alignment of the AA and MA was more consistently achieved when preoperative AMA was >2.4°, confirming suitability of AMA-based CCWO for severe angulation.
  • Most infections in TPLOs occur within 15 days, but RJB plus antibiotics in this study appeared protective, suggesting benefit for early-phase SSI prevention.

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Guénégo et al: Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) to Treat Cranial Cruciate Ligament Deficient Stifle in 204 Dogs Over 50 Kg
Veterinary and Comparative Orthopaedics and Traumatology 3, 2025

🔍 Key Findings

  • AMA-based CCWO realigned the anatomical and mechanical axes in 82% of dogs >50 kg, with postoperative AMA angle of 0° in most cases.
  • Surgical site infection (SSI) rate was only 0.5%, markedly lower than TPLO-reported rates in similar populations (up to 37.5%).
  • All osteotomies achieved Grade 4 healing by 8 weeks, with no implant failures.
  • AMA-based planning based on preoperative AMA and TPA allowed for better correction of proximal tibial angulation compared to TPLO in large dogs.
  • Use of a double locking plate (DLP) fixation and Robert Jones bandage (RJB) contributed to improved mechanical stability and infection prevention.
  • Dogs with AMA angle >3.4° (hyper-CCAPT) were 38% of the cohort, supporting AMA as a critical metric in planning.
  • Postoperative alignment of the AA and MA was more consistently achieved when preoperative AMA was >2.4°, confirming suitability of AMA-based CCWO for severe angulation.
  • Most infections in TPLOs occur within 15 days, but RJB plus antibiotics in this study appeared protective, suggesting benefit for early-phase SSI prevention.

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Multiple Choice Questions on this study

In Guénégo 2025 et al., on AMA-based CCWO, which subgroup had the most consistent axis alignment postoperatively?

A. Dogs with TPA < 25°
B. Dogs with no miniarthrotomy
C. Dogs with AMA > 2.4°
D. Dogs with AMA < 2.4°
E. Dogs with patellar ligament thickening

Answer: Dogs with AMA > 2.4°

Explanation: Realignment of AA and MA was achieved more consistently in dogs with higher pre-op AMA.
In Guénégo 2025 et al., on AMA-based CCWO, what proportion of dogs had contralateral CCLR after initial AMA-based CCWO?

A. 20%
B. 38%
C. 66%
D. 10%
E. 50%

Answer: 66%

Explanation: 66% of dogs developed contralateral CCLR during the study period.
In Guénégo 2025 et al., on AMA-based CCWO, which combination was key to minimizing SSIs in AMA-based CCWO?

A. Double plating alone
B. Rigid external fixation only
C. Robert Jones bandage and antibiotics
D. TPLA and cerclage wire
E. Caudal closing wedge technique

Answer: Robert Jones bandage and antibiotics

Explanation: Use of RJB and postop antibiotics was associated with a low SSI rate.
In Guénégo 2025 et al., on AMA-based CCWO, what was the surgical site infection (SSI) rate observed?

A. 9.1%
B. 5.5%
C. 0.5%
D. 21.3%
E. None reported

Answer: 0.5%

Explanation: Only one SSI occurred in 204 dogs, giving a 0.5% infection rate.
In Guénégo 2025 et al., on AMA-based CCWO, what was the postoperative AMA angle achieved in most dogs?

A. 0°
B. >2.4°
C. –1°
D. <3.4°
E. Unchanged from pre-op

Answer: 0°

Explanation: The AMA angle was reduced to 0° in most dogs, achieving axis alignment.

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