FONT study explores one-cut option for cruciate disease and MPL
Bottom line
Dogs with concurrent cranial cruciate ligament disease and medial patellar luxation may eventually have another combined surgical option, according to a March 18, 2026 study in the Journal of Small Animal Practice describing the Fulkerson-based oblique novel technique, or FONT. The approach uses an oblique tibial tuberosity osteotomy with a standard tibial tuberosity advancement cage to try to achieve both cranial advancement and lateralization of the tibial tuberosity in one move, rather than pairing separate procedures. In a computational model and ex vivo cadaver study of 14 pelvic limbs, the authors found the technique could produce simultaneous advancement and lateralization, with a 30-degree osteotomy theoretically yielding 50.0% lateralization and 86.7% advancement. But the freehand cuts were imperfect in practice: the mean achieved angle was 32.27 degrees, and measured lateral translation was consistently greater than intended while cranial translation was lower than intended across cage sizes. (onlinelibrary.wiley.com)
Why it matters: Concurrent cruciate disease and medial patellar luxation remain a familiar surgical challenge, especially in small-breed dogs, and current options often combine TPLO, CTWO, TTA, or tibial tuberosity transposition-based strategies depending on anatomy and surgeon preference. Reviews and prior reports show simultaneous treatment is already feasible, but they also underscore the technical complexity and the need to balance stifle stabilization with extensor mechanism realignment. FONT is notable because it aims to simplify that problem into a single oblique osteotomy using existing TTA hardware, but the new paper is still preclinical, and its own findings suggest accuracy may depend on improved instrumentation such as cutting guides before clinical adoption can be judged. (pmc.ncbi.nlm.nih.gov)
What to watch: The next meaningful step will be clinical outcome data in live canine patients, especially complication rates, implant performance, reluxation control, and whether guided cuts can make the technique reproducible enough for referral practice. (onlinelibrary.wiley.com)
Key facts
- Study type
- Computational model and ex vivo cadaver study
- Journal
- Journal of Small Animal Practice
- Publication date
- March 18, 2026
- Technique
- Fulkerson-based oblique novel technique (FONT)
- Target conditions
- Concurrent cranial cruciate ligament disease and medial patellar luxation
- Sample size
- 14 pelvic limbs
- Key finding
- A 30-degree osteotomy theoretically yielded 50.0% lateralization and 86.7% advancement
- Main limitation
- Freehand cuts were imperfect; mean achieved angle was 32.27 degrees, with lateral translation greater than intended and cranial translation lower than intended
A new cadaveric and computational study in the Journal of Small Animal Practice puts an early spotlight on FONT, short for Fulkerson-based oblique novel technique, as a possible way to address two difficult stifle problems at once in dogs: cranial cruciate ligament disease and medial patellar luxation. Published March 18, 2026, the paper describes an oblique tibial tuberosity osteotomy designed to let surgeons both advance and lateralize the tibial tuberosity using a standard tibial tuberosity advancement cage. (onlinelibrary.wiley.com)
The clinical need is real. Concurrent medial patellar luxation and cranial cruciate ligament rupture has been well described in dogs, particularly in smaller breeds, and the literature already includes several one-stage strategies, including TPLO plus tibial tuberosity transposition, modified TPLO variants, and tibial tuberosity transposition-advancement techniques. A recent review notes that surgeons have been trying to solve both instability and quadriceps malalignment in the same operation for years, while a 2026 Animals paper compared TPLO + TTT with CTWO + TTT in this population, underscoring that combined correction remains an active area of orthopedic refinement. (pmc.ncbi.nlm.nih.gov)
Against that backdrop, the FONT study is best read as a proof-of-concept. The investigators used trigonometric modeling, 3D computer simulation, and ex vivo testing in 14 mixed-breed dog cadaver limbs weighing 15.8 to 25.3 kg. They modeled osteotomy angles of 0, 25, 30, and 35 degrees, then performed freehand oblique osteotomies targeting 30 degrees and compared pre- and postoperative CT measurements. (onlinelibrary.wiley.com)
The geometry is the key finding. In the model, increasing the obliquity increased lateralization while reducing the proportion of pure cranial advancement: 0 degrees produced 0% lateralization and 100% advancement, 25 degrees produced 42.3% lateralization and 90.7% advancement, 30 degrees produced 50.0% lateralization and 86.7% advancement, and 35 degrees produced 57.3% lateralization and 82.0% advancement. That supports the authors’ central idea that a single oblique cut can produce two corrective vectors at once. (onlinelibrary.wiley.com)
Still, the practical limitations were just as important as the concept itself. The mean osteotomy angle actually achieved was 32.27 degrees, significantly different from the 30-degree target, and for all tested cage sizes, from 3 mm to 12 mm, lateral translation exceeded the target while cranial translation fell short. The authors concluded that while simultaneous advancement and lateralization is achievable, freehand execution showed limited accuracy, and they specifically suggested cutting guides could improve consistency. (onlinelibrary.wiley.com)
That caution fits with the broader orthopedic literature. Earlier reports on combined procedures, including tibial tuberosity transposition-advancement and TPLO-TTT approaches, have shown that single-stage correction can work, but complication management, implant choice, and case selection remain central. Continuing education guidance for practitioners also frames concurrent MPL and cruciate disease as a technically demanding problem with multiple accepted surgical pathways rather than a settled standard of care. No independent expert reaction specific to FONT was readily available in public sources, so the clearest industry perspective comes from that wider body of work: innovation is welcome, but reproducibility and clinical outcomes will decide whether a new technique sticks. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary professionals, FONT is interesting less because it changes practice today and more because it may point toward a more streamlined future approach. If a single oblique osteotomy using familiar TTA-style hardware can reliably address both tibial thrust and extensor mechanism malalignment, it could reduce procedural complexity in selected cases. But this study does not establish safety, healing, functional outcome, or complication rates in live patients. It also raises a practical warning: if freehand cuts drift even a few degrees, the balance between intended advancement and lateralization changes, which could affect patellar tracking, implant loading, or cruciate stabilization. (onlinelibrary.wiley.com)
What to watch: Watch for prospective clinical case series, guided-instrument or jig development, and any head-to-head comparisons with established combined procedures such as TPLO + TTT, modified TPLO, or TTTA. Until then, FONT looks like a promising biomechanical idea, not yet a practice-changing standard. (onlinelibrary.wiley.com)