Cutting-Edge Procedure at CASE

February 13, 2018

CORA Based Leveling Osteotomy

CORA Based Leveling Osteotomy (CBLO) is a tibial plateau leveling procedure—developed by Don Hulse, DVM, DACVS, DECVS—that combines the advantages of Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) for dogs with cranial cruciate tears. The osteotomy is centered on the anatomic CORA of the proximal tibia, achieving alignment of the proximal anatomic axis and distal anatomic axis of the tibia.

Surgeons have recognized that the TPLO was a good procedure for its time but it does have its shortcomings, many of which are addressed below and improved upon with the CBLO.

Advantages of the CBLO Procedure:
  • Extra-articular osteotomy; ease of osteotomy
  • Ample target for rigid fixation in giant breeds
  • Ample target for fixation in small/toy breeds
  • Compression of osteotomy leads to stability, early clinical function, and healing within 6 weeks vs 8 weeks with TPLO
  • Excellent alignment; no cases of pivot shift
  • No balcony effect/secondary translation
  • Near normal articular cartilage on second look arthroscopy (95 cases) as compared to similar studies with TPLO and extracapsular repairs
  • Slope reduction in early partial tears protects the ACL vs extracapsular repairs
  • Facilitates leveling in juvenile dogs with open growth plates
  • Facilitates procedure in dogs with excessive tibial plateau angles (>34 degrees)
  • Facilitates correction with concurrent patella luxation
  • Facilitates correction in cases with compromised tibial crest
  • Facilitates application of intra-articular auto/allografts
  • Excellent passive anterior/posterior stability (cranial drawer)

Performed at CASE by Trent Stephens, PharmD, DVM, MS, DACVS

A Tennessee native, Dr. Trent Stephens, DVM, PharmD, MS, DACVS, started his education with a Bachelor of Science degrees in biology and chemistry at Western Kentucky in 1999 and a Doctor of Pharmacy at Stanford University in 2003. He finalized his education with a Doctor of Veterinary Medicine at Auburn University in 2007 and a Master’s Degree in Biomedical Sciences at Auburn University in 2011.