Tibial tuberosity advancement
Encyclopedia
Tibial Tuberosity Advancement (TTA) is an orthopedic procedure to repair deficient cranial cruciate ligament
s 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.
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
. 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.
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
s 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
University of Zurich
The University of Zurich , located in the city of Zurich, is the largest university in Switzerland, with over 25,000 students. It was founded in 1833 from the existing colleges of theology, law, medicine and a new faculty of philosophy....
, in Zurich
Zürich
Zurich is the largest city in Switzerland and the capital of the canton of Zurich. It is located in central Switzerland at the northwestern tip of Lake Zurich...
, Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
beginning in the late 1990s.
The cranial cruciate ligament (CrCL) in dogs, provides the same function as the anterior cruciate ligament
Anterior cruciate ligament
The anterior cruciate ligament is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle , based on its anatomical position, it is referred to as the cranial cruciate ligament.The ACL originates from deep within the notch of the distal femur...
in humans. It stabilizes the knee joint, called the stifle joint
Stifle joint
The stifle joint is a complex joint in the hind limbs of quadruped mammals such as the sheep, horse or dog. It is the equivalent joint to the human knee...
in quadrupeds, and limits the tibia
Tibia
The tibia , shinbone, or shankbone is the larger and stronger of the two bones in the leg below the knee in vertebrates , and connects the knee with the ankle bones....
from sliding forward in relation to the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
. 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.
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
Weight bearing
In orthopedics, weight-bearing is the amount of weight a patient puts on the leg on which surgery has been performed. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.After...
. 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
Tibial plateau leveling osteotomy
TPLO, or tibial-plateau-leveling osteotomy, is a surgery performed on dogs to stabilize the stifle joint after ruptures of the cranial cruciate ligament . Normally, the CrCL prevents backward–forward movement of the joint...
) 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.