New FONT technique targets two canine stifle problems at once
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A new Journal of Small Animal Practice study describes the Fulkerson-based oblique novel technique, or FONT, as a single osteotomy approach intended to treat two stifle problems at once in dogs: cranial cruciate ligament disease and medial patellar luxation. According to the paper’s abstract, the technique advances and lateralizes the tibial tuberosity through an oblique cut, with the goal of addressing instability and patellar maltracking in the same procedure. The work was evaluated in computational modeling and cadaveric analysis, so this is an early-stage, preclinical report rather than a clinical outcomes study in live canine patients. (pubmed.ncbi.nlm.nih.gov)
Why it matters: Concurrent cranial cruciate ligament rupture and medial patellar luxation can be difficult to manage, especially in small-breed dogs, because surgeons often need to correct both tibial thrust and malalignment while limiting implant burden and osteotomy-related risk. Prior literature and reviews suggest there’s still no settled consensus on the best approach for these combined cases, and newer combined-procedure concepts are being explored to reduce the drawbacks of performing multiple corrective techniques separately. FONT is notable because it appears designed to merge advancement and lateralization into one tibial tuberosity osteotomy, which could be relevant for referral surgeons if later clinical studies show acceptable stability, healing, and complication rates. (pmc.ncbi.nlm.nih.gov)
What to watch: The next key question is whether FONT moves from cadaveric and modeling work into prospective clinical cases with follow-up on healing, implant performance, reluxation, and return to function. (pubmed.ncbi.nlm.nih.gov)
A newly indexed Journal of Small Animal Practice paper introduces the Fulkerson-based oblique novel technique, or FONT, for dogs with concurrent cranial cruciate ligament disease and medial patellar luxation, a combination that can make stifle surgery especially complex. The authors report that FONT uses an oblique tibial tuberosity osteotomy to both advance and lateralize the tibial tuberosity, aiming to address cruciate-related instability and patellar maltracking in one construct. At this stage, though, the evidence is preclinical: the study was evaluated with computational modeling and cadaveric analysis, not live-patient outcomes. (pubmed.ncbi.nlm.nih.gov)
That matters because these combined cases have been a persistent surgical challenge, particularly in small-breed dogs. Reviews of the literature describe concurrent medial patellar luxation and cranial cruciate ligament rupture as a common stifle pathology, while also noting that the best corrective strategy remains debated. Traditional management may combine soft-tissue procedures, tibial tuberosity transposition, trochlear recession, extracapsular stabilization, TPLO-based approaches, or other corrective osteotomies depending on conformation and case specifics. (pmc.ncbi.nlm.nih.gov)
The rationale behind FONT appears to build on earlier biomechanical thinking around tibial tuberosity position. Prior canine work has suggested that standard tibial tuberosity transposition can alter patellofemoral mechanics, while Fulkerson-style oblique osteotomy concepts from human knee surgery have been studied as a way to change tracking and contact pressures more favorably. In that context, FONT looks like an attempt to adapt an oblique, multiplanar tibial tuberosity move for dogs that need both advancement and lateralization. That’s an inference from the study abstract and prior biomechanics literature, but it fits the design described by the authors. (pubmed.ncbi.nlm.nih.gov)
The broader field is already testing other “single-event” or combined corrections for these dogs. Recent reports have examined modified TPLO constructs and simultaneous TPLO-tibial tuberosity transposition strategies for concurrent cranial cruciate ligament disease and medial patellar luxation, with the aim of restoring alignment while avoiding the fracture and instability risks that can come with multiple osteotomies. Those efforts underscore the same clinical pressure point FONT is trying to address: how to stabilize the stifle and correct extensor mechanism malalignment without creating a more fragile repair. (scholarworks.gnu.ac.kr)
Direct outside commentary on FONT itself was limited, which isn’t unusual for a newly published technical paper. But expert and reference sources are aligned on the underlying clinical significance. The American College of Veterinary Surgeons notes that patellar luxation surgery becomes more difficult when cranial cruciate ligament disease is also present, and Merck Veterinary Manual similarly frames surgical intervention as the standard path for clinically significant patellar luxation because conservative care doesn’t correct the anatomic abnormality. (acvs.org)
Why it matters: For veterinary professionals, FONT is less a practice-changing result today than a signal of where orthopedic innovation is heading. A technique that truly combines tibial tuberosity advancement and lateralization in one osteotomy could eventually offer a more streamlined option for selected dogs, especially where implant crowding, osteotomy interaction, or small-breed bone size complicate conventional planning. But until live-case data are available, clinicians should view FONT as a promising concept rather than a validated standard. Questions around fixation strength, healing, complication rates, patellar stability, meniscal outcomes, and long-term function still need answers. (pubmed.ncbi.nlm.nih.gov)
What to watch: The next milestone will be clinical follow-up studies, ideally prospective case series or comparative trials, showing whether FONT can deliver reliable union, low complication rates, and durable functional improvement in real canine patients with concurrent cranial cruciate ligament disease and medial patellar luxation. (pubmed.ncbi.nlm.nih.gov)