Origin
Tuberosity Tibial Advancement (TTA) is a procedure developed in Zurich, Switzerland, in the early 2000s (Source 1). The biomechanics behind the success of this procedure in correcting knee joints with cranial cruciate ligament defects is a change in the patellar tendon angle that effectively neutralizes the tibiofemoral shear (tibial thrust) that occurs during weight-bearing.
Theory of the TTA surgical method
The advantage of TTA is a significantly less invasive osteotomy and the fact that the axis of the tibia, on which the weight rests, is not affected. The procedure involves a cranial tibial crest osteotomy, anterior advancement of the tibial crest with an advancement cage (which is called a tibial tuberosity cage). stabilizing wedge (serves) and the internal fixation of the ridge with a thin tension band plate secured with bone screws (Figure). To determine the appropriate cage and plate size, preoperative measurements are taken using X-rays of the lateral knee joint (with joint extension).
Procedure of the TPLO operation
The procedure before, during and after TTA surgery is essentially identical to that of the TPLO operation.
Duration of the healing process TTA
In our experience, the patient's experience in the immediate postoperative phase appears to be better than with other active and passive stabilization techniques such as TPLO and extracapsular lateral suture implantation. Dogs seem to feel more comfortable in the first few postoperative days, as evidenced by their ability to be exercised from the outset. This may also be because we consider this surgical method appropriate only for a relatively small group of dogs—primarily very small and therefore light breeds such as Chihuahuas.
Based on our experience and an indirect comparison of published results, the long-term outcome of the TPLO method appears to be similar. Patients quickly regain their strength and rapidly regenerate muscle mass.
Possible complications of TTA
Implant complications are rare, which is probably due to the less invasive procedure.
Among the serious complications These include: postoperative patellar dislocation, tibial fracture, implant loosening, as more screws are used here than in TPLO, and meniscus injury (if no original meniscectomy/meniscus decompression was performed).
Minor complications These include: infection/inflammation of the incision, seroma, and wound dehiscence.
TTA surgery in the video
References
1 PM Montavon, DM Damur, S Tepic. Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stylus. Proceedings of the 1st World Orthopedic Veterinary Congress; Munich Germany, September 2002, p. 152.