Tibial tuberosity: advancement

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Sections available in full article Introduction, Uses, Technical problems, Alternative techniques, Decision taking, Requirements, Personnel, Materials required, Procedure, Aftercare, Immediate Aftercare, Long term Aftercare, Sequelae, Complications, Prognosis, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Mr Rob Pettitt BVSc CertSAS MRCVS
Mr Warrick Bruce BVSc(Dist) MVM DSAS(ortho) MACVSc
Synonyms TTA

Introduction

  • A surgical procedure aimed at stabilizing a cranial cruciate ligament (CrCL) deficient stifle by advancing the tibial tuberosity sufficiently to achieve a 90° patella tendon tibial plateau angle when the stifle is extended. This will negate the cranial thrust on the stifle.
    This technique should not be attempted by veterinarians without appropriate specialist training.

Uses

  • To neutralize instability in CrCL-deficient stifle joint Stifle: cranial cruciate ligament disease in active dogs.

Advantages

  • According to proponents, TTA will provide quick recovery and a good to excellent outcome for dogs of all sizes with cruciate ligament disease.

Disadvantages

  • Limited independent verification of technique by surgeons in academia or practice.
  • Numerous techniques for repair of CrCL injury have been publicly described during the past 50 years; uniform success rates of 80-90% have been published for many of these procedures. Initial reports for TTA are similar.
  • Technically challenging procedure with steep initial learning curve.
  • Complications can be more severe than for lateral tibiofabella suture techniques.

Requirements

Materials required

Ideal equipment

  • Routine for joint surgery.
  • Specific TTA instrumentation.

Other requirements

  • Sterile equipment:
    • Oscillating saw.
    • Drill.
    • TTA plates and cages.
    • Screws.

Sequelae

Complications

  • Post-operative meniscal injury Stifle: meniscus lesions.
  • Implant failure.
  • Osteomyelitis Osteomyelitis.

Prognosis

  • Good - excellent.

Reasons for treatment failure

  • Technical errors in surgery.
  • Premature, excessive limb usage.

Sources

Publications

  • Recent references to PubMed.
  • Boudrieau R J (2009) Tibial plateau leveling osteotomy or tibial tuberosity advancement? Vet Surg 38 (1), 1-22 PubMed.
  • Voss K, Damur D M et al(2008) Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Veterinary And Comparative Orthopaedics And Traumatology 21 (3), 243-249 PubMed.
  • Lafaver S, Miller N S et al(2007) Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: Surgical technique, early results, and complications in 101 dogs. Vet Surg 36 (6), 573-586 PubMed.

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