Tibial Tuberosity Advancement 237(A) (B)Figure 28.9 Craniomedial
view of the proximal tibia after
tibial tuberosity transposition
(TTA) performed routinely (A)
and after simultaneous lateral
transposition (B) with the
advancement for a medial
patellar luxation treatment. Note
that the caudal cage ‘ear’ has
been recessed slightly into the
caudal tibial bone fragment. This
is done by bending this ‘ear’ at
∼ 45 ◦without removing a large
amount of bone. The plate also
is contoured such that it meets
the tuberosity more laterally.
Alternatively, or additionally, the
cranial cage ‘ear’ may be
elevated off of the tuberosity
bone by placing one to two
small metal washers under this
‘ear.’
the width of the gap, this must be done
judiciously because a large stress riser is cre-
ated above the cage, which could result in frac-
ture of the tibial tuberosity at that level (Burns &
Boudrieau 2008) (Figure 28.10). It is possible to
buttress the tibial tuberosity above the cage with
a block of cancellous bone allograft. However,
adding this graft adds a considerable additional
expense to the procedure (Burns & Boudrieau
2008).(A) (B)Figure 28.10 Mediolateral
radiographs of a 2.5-year-old,
neutered male Labrador
Retriever. (A) Immediately
postoperatively a 9-mm cage is
observed 1.2 cm distally within
the osteotomy gap along the
tibia with 2.3 cm of tibial
tuberosity proximal to the cage.
The granular material observed
within and below the cage is the
allograft of corticocancellous
chips. (B) At 8 weeks
postoperatively the tibial
tuberosity has fractured just
above the cage. Source: Burns &
Boudrieau 2008. Reproduced
with permission from Schattauer.