Tibial tuberosity advancement

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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.

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Dr. Slobodan Tepic later founded KYON, a leading provider of veterinary orthopaedic implants, in 1999. Kyon became the first veterinary orthopedic implant company offering this procedure to veterinarians.

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 interdylar notch of the tibia at one end and the caudal (posterior) side of the lateral femoral condyle at the other end. It also helps to prevent the stifle (knee) joint from over-extending or rotating.

Trauma to the equivalent ligament in humans is common, and damage most frequently occurs during some form of sporting activity (including football, rugby and golf). The nature of the injury is very different in dogs. Rather than the ligament suddenly breaking due to excessive trauma, it usually degenerates slowly over time, rather like a fraying rope. This important difference is the primary reason why the treatment options recommended for cruciate ligament injury in dogs are so different from the treatment options recommended for humans.

In the vast majority of dogs, the cranial cruciate ligament (CrCL) ruptures as a result of long-term degeneration, whereby the fibres within the ligament weaken over time. The precise cause of this is not known, but genetic factors are probably most important, with certain breeds being predisposed (including Labradors, Rottweilers, Boxers, West Highland White Terriers and Newfoundlands). Supporting evidence for a genetic cause was primarily obtained by assessment of family lines, coupled with the knowledge that many animals will rupture the CrCL in both knees, often relatively early in life. Other factors such as obesity, individual conformation, hormonal imbalance and certain inflammatory conditions of the joint may also play a role. 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. A microsaggital saw is used to cut the Tibial Tuberosity off then a special titanium cage is used to advance the tibial tuberosity. A titanium plate is used to hold the tibial tuberosity in position. [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.

Since KYON first developed the TTA procedure, they have pioneered a new less invasive version of the procedure known as TTA-II. This new TTA procedure delivers the same TTA outcomes with less trauma, fewer implants, a simplified technique and at a reduced cost.

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

In 2012 TTA RAPID was introduced by the German manufacturer RITA LEIBINGER Medical GmbH & Co. KG in cooperation with the University of Ghent, Belgium. The TTA RAPID implant is a biocompatible sponge-construction which combines a wedge-cage with a plate on the top. In this way there is only one implant needed for the whole TTA surgery. It is called "rapid" because the implantation is very quick, easy to learn and offers a high stability. The surgery is based on the Maquet-Hole-Technique. [4]

Alternative procedures

Related Research Articles

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<span class="mw-page-title-main">Tibia</span> Leg bone in vertebrates

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<span class="mw-page-title-main">Posterior cruciate ligament</span> One of four major ligaments of the knee

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<span class="mw-page-title-main">Anterior cruciate ligament</span> Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate is Latin for cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an "X". It is composed of strong, fibrous material and assists in controlling excessive motion by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most frequently injured ligament in the knee.

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<span class="mw-page-title-main">Patellar tendon</span> Tendon in the human knee

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<span class="mw-page-title-main">Unicompartmental knee arthroplasty</span>

Unicompartmental knee arthroplasty (UKA) is a surgical procedure used to relieve arthritis in one of the knee compartments in which the damaged parts of the knee are replaced. UKA surgery may reduce post-operative pain and have a shorter recovery period than a total knee replacement procedure, particularly in people over 75 years of age. Moreover, UKAs may require a smaller incision, less tissue damage, and faster recovery times.

The triple tibial osteotomy is a surgical procedure used to treat dogs that have completely or partially ruptured the cranial cruciate ligament in one or both of their stifles. The cranial cruciate ligament connects the femur with the tibia, which functions to stabilise the canine stifle joint from the forces put on it during exercise and weight bearing.

Tightrope CCL is a veterinary orthopedic surgical method developed to provide a minimally invasive procedure for extracapsular stabilization of the canine cranial cruciate ligament-deficient stifle joint. The cranial cruciate ligament (CrCL) stabilizes the dog knee much like the anterior cruciate ligament (ACL) does in humans.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

High tibial osteotomy is an orthopaedic surgical procedure which aims to correct a varus deformation with compartmental osteoarthritis. Since the inception of the procedure, advancements to technique, fixation devices, and a better understanding of patient selection has allowed HTO to become more popular in younger, more active patients hoping to combat arthritis. The idea behind the procedure is to realign the weight-bearing line of the knee. By realigning the knee, the force produced from weight-bearing is shifted from the arthritic, medial compartment to the healthy, lateral compartment. This decrease in force or load in the diseased part of the knee joint decreases knee pain and can delay the development or progression of osteoarthritis in the medial compartment.

Simitri Stable in Stride is a three part modular surgical implant used during surgery performed on dogs to stabilize the stifle joint (knee) after rupture of the cranial cruciate ligament (CrCL) which is analogous to the anterior cruciate ligament (ACL) in humans.

References

  1. ↑ Johnson JM, and Johnson AL: Cranial Cruciate 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. ↑ http://www.tta-rapid.com, Official Website

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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