A novel tibial tuberosity advancement technique with cranial implant fixation (TTA CF): a pilot study in sheep

Abstract

BackgroundCranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals. An array of surgical techniques have been described to stabilize the stifle joint in dogs, including intraarticular stabilization, extraarticular stabilization, and tibial osteotomy techniques. Tibial plateau leveling osteotomy and tibial tuberosity advancement with a lot of modifications are the most common. In this study we report the possibility of fixing the novel titanium implant for tibial tuberosity advancement with two screws in a craniocaudal direction. The aim of our study was to improve the clinical benefit of the tibial tuberosity advancement surgical technique where an attempt was made to reduce the number of screws and obtain a strong implant fixation with minimal bone traumatization. This way of attachment allows to distribute the forces evenly on medial and lateral side of osteotomy gap.ResultsTibial tuberosity advancement with cranial implant fixation was performed in four sheep. Complete radiographic and clinical follow up was recorded. All four sheep had a complete osteotomy line healing at a mean of 10 weeks postoperative (range 8–12 weeks). None of the animals had osteotomy gap healing grades of poor. Minor complication included the minimally cracked Maquet hole on the postoperative radiographs, without displacement of the tibial crest which occurred in 2 sheep. Major complication grade 1, major complication grade 2 and catastrophic were not found.ConclusionsThe novel surgical technique for tibial tuberosity advancement with cranial implant fixation is technically comparable to the recent trend in tuberosity advancement techniques, where partial osteotomy of the cranial tibial tuberosity crest is performed. A cranial implant fixation allows to distribute the forces evenly on medial and lateral side of osteotomy gap, which may result in less number of major complications in dogs. A novel titanium implant decreases the tibial traumatisation by reducing the number of screws.

41 Cases of Treatment of Cranial Cruciate Ligament Rupture with Porous TTA: Three Years of Follow Up

“…This technique was introduced in 2002 in veterinary medicine by Montavon, Damur and Tepic [1]. From 2002, many authors described different techniques variations using different kinds of implants to obtain the cranial advancement of the tibial tuberosity [2,3,4,5].…”

Mechanical Testing of the New Cage for Tibial Tuberosity Advancement with the Cranial Implant Fixation (TTA CF) Technique—Ex Vivo Study on Sheep Model

“…Tibial bones (n = 10) were collected by disarticulation of the stifle and talocrural joints from adult Merino sheep weighing 45 kg (±5 kg) that were euthanized after a six-month follow-up period in an experimental in vivo TTA CF study [ 9 ]. All the animals underwent TTA CF surgery six months prior.…”

“…Tibial tuberosity advancement (TTA) and tibial plateau levelling osteotomy (TPLO), and their subsequent modifications are the most frequently used techniques for the dynamic stabilization of the stifle joint in dogs [ 4 , 5 , 6 , 7 , 8 ]. One of the recently described modifications of the TTA procedure was named TTA with cranial implant fixation (TTA CF) [ 9 , 10 ]. Conventional TTA and TTA CF are based on the theory that the angle between the patella tendon and the tibia plateau affects the formation of tibiofemoral shear forces during weight bearing [ 11 ].…”

“…The TTA Rapid was first reported in 2014 [ 8 ] and based on the Maquet procedure for treating patellofemoral osteoarthritis or chondromalacia of the patella [ 13 ]. TTA-2 [ 14 ] and TTA CF [ 9 , 10 ] are simplified modifications of TTA surgery that consists of the Maquet osteotomy, settled with a new design cage that excludes stress risers that are created by the fork, plate, and screws, hence fork and plate fixation are unnecessary [ 9 , 10 , 14 ]. Studies have confirmed the assumptions that the cage size, cage position relative to the tibial tuberosity, and the conformation of the tuberosity have an impact on the clinical outcomes and rate of complications after TTA [ 15 ].…”

“…Studies have confirmed the assumptions that the cage size, cage position relative to the tibial tuberosity, and the conformation of the tuberosity have an impact on the clinical outcomes and rate of complications after TTA [ 15 ]. During the TTA CF procedure, the only implants that were needed were a hollow titanium cage with porous surfaces and two 2.7 mm titanium self-taping screws that were positioned in a craniocaudal direction from the tibial crest [ 9 , 10 ].…”