Advances in the Canine Cranial Cruciate Ligament, 2nd edition

(^28) Tibial Tuberosity Advancement
Randy J. Boudrieau
Introduction
Advancement of tibial tuberosity was first
described by Maquet, where the premise of
the procedure was that an increase in the
efficiency of the quadriceps mechanism would
subsequently decrease retropatellar pressure,
thus alleviating pain associated with the
patellofemoral joint in humans (Maquet 1976).
Other possible effects on the biomechanics of
the tibiofemoral joint included evidence that a
variable tibiofemoral shear force was present
in the knee joint, which was directed either
anteriorly or posteriorly depending upon
the angle of knee joint extension or flexion
and patellar tendon angle (PTA), respectively
(Nisell 1985), and that the magnitude and
direction of the tibiofemoral shear force was
determined by the PTA (Nisell et al. 1986)
(Figure 28.1). An increase in translational knee
joint instability has been demonstrated by a
number of biomechanical studies in humans
as a result of variations in tibial plateau slope
(Giffinet al. 2004), axial loading (Liet al. 1998),
and knee flexion angle (Nisellet al. 1989). A
three-dimensional (3D) nonlinear finite ele-
ment model of the human knee evaluating the
Maquet procedure found it to be effective in
decreasing the femorotibial contact forces in
stifle joint extension, in addition to decreasing
retropatellar pressure (Shirazi-Adl & Mesfar
2007). Similarly, changes in tibiofemoral shear
forces were observed depending on the knee
flexion angle, which placed either more or less
stress on the anterior and posterior cruciate
ligaments depending on the amount of tibial
tuberosity advancement (Shirazi-Adl & Mesfar
2007). A relationship between tibial tuberosity
advancement, knee joint flexion/extension,
tibiofemoral shear force, retropatellar pressure,
femorotibial contact forces, and patellar tendon
force has been suggested and supported by a
variety of experimental studies (Maquet 1976;
Nakamuraet al. 1985; Nisell 1985; Nisellet al.
1986; Nisellet al. 1989; Liet al. 1998; Giffinet al.
2004; Shirazi-Adl & Mesfar 2007).
Stifle biomechanics
Based on data published by Maquet and Nisell,
Montavon and Tepic proposed that a similar sit-
uation existed in the dog, and tibial tuberosity
advancement (TTA) would similarly neutral-
ize cranial tibiofemoral shear force in a cranial
cruciate ligament (CrCL)-deficient stifle joint in
the dog (Maquet 1976; Nisellet al. 1986; Mon-
tavonet al. 2002; Tepicet al. 2002). A PTA of 90◦
Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.
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