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.

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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 in dogs, and limits the tibia from sliding forward in relation to the [femur]]. It is attached to the cranial (anterior) side of the intercondylar of the tibia at one end and the caudal (posterior) side of the 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. Uncorreced 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 tendon 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.

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