Tibial Tuberosity Advancement, or TTA Surgery
Tibial Tuberosity Advancement, or TTA, is one of the newest and most advanced surgical options for canine cranial cruciate ligament, or ACL ruptures. This procedure is known as a biomechanical repair that neutralizes cranial tibial thrust, also known as cranial drawer. The TTA surgery may have similar outcomes to the TPLO. TTA’s have been used in over 100,000 cases by more than 1,000 surgeons.
TTA Surgery Has the Following Steps:
- Special measurements are made on preoperative radiographs to determine the degree of advancement of the tibial tuberosity to prevent tibial thrust.
- An osteotomy (cutting of the bone) is made to remove the tibial tuberosity from the tibia.
- A TTA plate and TTA cage, both made of titanium, are used to advance the tibial tuberosity and to secure it in place until the bone is healed.
- A bone graft or synthetic bone graft is placed in the osteotomy site which helps the osteotomy site heal into bone.
Advantages and Possible Complications With the TTA Technique
There are both advantages and disadvantages to choosing the TTA technique to repair a ruptured cranial cruciate ligament. Here are some of the common advantages and disadvantages: To date, the decision between a TPLO and TTA is based purely on the opinion of the surgeon and their personal experience. No published data supports one technique being superior to the other.
Advantages of TTA
- Shear forces on the knee joint are neutralized, causing the joint to become more stable, without compromising joint congruency.
- The TTA surgery is less invasive and is a simplified surgical procedure compared to some other popular cranial cruciate ligament surgery techniques.
- Long term prognosis after surgery is good with reports of significant improvement in 85-90% of patients.
Possible Complications Following TTA Surgery
- Complications may occur, although these do not often lead to a need for a second surgery.
- Infection of the incision site or opening of the incision has been known to occur. These complications are typically caused by allowing the pet to lick at the incision, or allowing it to become wet or dirty following surgery and not following appropriate homecare.
- Implant failure, malunion, nonunion, or post-operative fracture are possible with any orthopedic surgery. By providing sound surgical technique and appropriate homecare until completely healed lowers the risk substantially.
- Studies show that post meniscal tears develop approximately 10-15% of the time following TTA surgery. If this occurs, typically additional surgery is required. The incidence of post meniscal tears is approximately the same as compared to the TPLO.