Tibial Tuberosity Advancement (TTA) Torn ACL surgery | Cantonvets.com
Tibial Tuberosity Advancement (TTA)

Tibial Tuberosity Advancement (TTA)

What is Tibial Tuberosity Advancement (TTA)?
 This technique was developed as an alternate way to eliminate cranial tibial thrust in dogs with cranial cruciate ligament rupture.
·         Tibial osteotomy procedures (TTA) approach the stifle instability seen with cranial cruciate ligament rupture from a different perspective. Instead of attempting to recreate the damaged or torn cranial cruciate ligament, osteotomy techniques change the geometry of the stifle joint in an attempt to eliminate the shear forces (cranial tibial thrust) seen between the femur and tibia during ambulation. It is important to note that these techniques do not eliminate static cranial drawer movement found on recumbent orthopedic examination.
·         The goal of the tibial tuberosity advancement is to move the insertion of the patellar tendon cranially so that the patella tendon and the articular surface of the tibia (tibial plateau) are at 90 degrees. This change in geometry of the joint is theorized to neutralize the femorotibial shear force (thrust).
·         While not as technically demanding as the TPLO, the TTA still requires training and comfort with advanced orthopedic equipment.
·         Recent reports have presented some concerning data regarding complication rates and late meniscal tears following TTA. Most complications were related to technical issues in the application of the surgical technique and case selection.
Case selection for TTA procedure is more limited than for other cranial cruciate surgical techniques.
·         Dogs with a low patellar tendon insertion point,
·         A tibial plateau angle greater than 30 degrees, and or
·         An angular limb deformity are poor candidates for the procedure.
 TTA can be used in dogs with concurrent medial patellar luxation as the tension plate applied to the tuberosity can be bent more to produce lateral transposition of the tuberosity.
Tibial Tuberosity Advancement (TTA) Surgical Technique.
·         Following surgical examination of the stifle joint and treatment of meniscal injury, if present, an approach is made to the proximal medial aspect of the stifle.
·         With the TTA, considerable preplanning is done with preoperative tibial radiographs to determine the tibial plateau angle and the amount of tibial advancement necessary for each individual patient.
·         If a patient has a tibial plateau angle (TPA) greater than 30 degrees then a TTA should not be considered.
·         with the TTA, a medial approach is made to the proximal tibia. The aponeurosis of the gracilis and semitendinosus along with the caudal belly of the sartorius are lifted off the cranial medial aspect of the tibial crest.
·         Tibial tuberosity advancement (TTA) involves an osteotomy of the non-weight-bearing portion of the tibia.
·         The proximal attachment points for the TTA tension plate are predrilled in the tibial crest. A sagittal saw is used to free the crest from the shaft of the tibia.
·         A cage, of predetermined size, is placed at the proximal end of the osteotomy site. The distal end is placed against the tibia and the crest is fixed in place with a tension plate.
·         Bone graft is placed in the osteotomy void. Cranial tibial thrust should be eliminated at this time as evidenced by the elimination of indirect drawer motion.
Postoperative Care and Assessment. The limb is not splinted postoperatively. Only very restricted exercise is allowed for the first 8 weeks, followed by a gradual increase of activity over the following 4 weeks.
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