Tibial tuberosity advancement

Tibial Tuberosity Advancement (TTA) is an orthopedic procedure to repair deficient cranial cruciate ligaments in dogs. It has also been used in cats. This procedure was developed by Dr. Slobodan Tepic and Professor Pierre Montavon at the School of Veterinary Medicine, University of Zurich, in Zurich, Switzerland beginning in the late 1990s.

The cranial cruciate ligament (CrCL) in dogs, provides the same function as the anterior cruciate ligament in humans. It stabilizes the knee joint, called the stifle joint in quadrupeds, and limits the tibia from sliding forward in relation to the femur. It is attached to the cranial (anterior) medial side of the intercondylar notch of the tibia at one end and the caudal (posterior) side of the lateral femoral condyle at the other end. Damage to the CrCL is one of the most common injuries in dogs and can cause severe lameness. 20 to 40% of dogs with CrCL rupture of one limb subsequently have rupture of the other limb. Uncorrected CrCL deficiencies have been associated with meniscal damage and degenerative joint diseases such as osteoarthritis.[1]

TTA is a surgical procedure designed to correct CrCL deficient stifles. The objective of the TTA is to advance the tibial tuberosity, which changes the angle of the patellar ligament to neutralize the tibiofemoral shear force during weight bearing.[2] By neutralizing the shear forces in the stifle caused by a ruptured or weakened CrCL, the joint becomes more stable without compromising joint congruency.

TTA appears to be a less invasive procedure than some other techniques for stabilizing the deficient cranial cruciate ligament such as TPLO (Tibial Plateau Leveling Osteotomy) and TWO (Tibial Wedge Osteotomy), as TTA does not disrupt the primary loading axis of the tibia.

Recently, TR BioSurgical has developed a bioscaffold to be used for veterinary osteotomies as a substitute for autologous cancellous bone grafting. [3]

References

  1. ^ Johnson JM, and Johnson AL: Cranial Crkuciate Ligament Rupture Pathogenesis, Diagnosis, and Post operative Rehabilitation. Vet Cl of N America: Small Animal Practice 23:4, July 1993
  2. ^ Apelt D, Kowaleski MP, Boudrieau RJ: Effect of Tibial Tuberosity Advancement on Cranial Tibial Subluxation in Canine Cranial Cruciate-Deficient Stifle Joints: An In Vitro Experimental Study. Vet Surg 36:170-177, 2007
  3. ^ Pullen CM, Kellerman JW, Woods CW: TR Matrix BioScaffold: A New Substitute for Autologous Bone Graft in Tibial Tuberosity Advancement. Internal Report-Tr BioSurgical Clinical Trial; Dec. 2008

4. Boudrieau RJ: Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement? Vet Surg 38:1-22, 2009

5. Kim SE, Pozzi A, Banks SA, et al: Effect of Tibial Tuberosity Advancement on Femorotibial Contact Mechanics and Stifle Kinematics. Vet Surg 38:33-39, 2009

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