240 Surgical Treatment
Etcheparebordeet al. 2014; Bleakley 2015; Botte
2015; Hopmans 2015; Samoyet al. 2015; Torring-
ton 2015).
All second-generation TTA methods have
varying techniques to decrease the stress-riser
at the distal end of the axially oriented incom-
plete frontal plane osteotomy, such as a tension-
band wire, staple, relief drill-hole at the termi-
nation of the osteotomy, or increased osteotomy
length. No data are available indicating which
technique, if any, is superior for preventing sub-
sequent problems. All of these techniques use
a distal tuberosity-based advancement which
will result in some distal patella displace-
ment and an underestimation of the degree
of tibial advancement obtained. Whether dis-
tal patella displacement results in any clini-
cal problems is unclear. However, inadequate
advancement may result in continued instabil-
ity with tibiofemoral shearing and an increased
frequency of subsequent meniscal tears (Wolf
et al. 2012; Boudrieau 2013). An additional and
related complication is the possibility of tib-
ial shaft fractures (Botte 2015; Hopmans 2015;
Torrington 2015). Some recommendations have
been proposed, along with newer saw guides,
to improve the osteotomy with regard to its
length, curvature, orientation in the frontal
plane, width of hinge area, and the need to mod-
ify or supplement the distal aspect of the cut
(Etcheparebordeet al. 2011; Brunelet al. 2013;
Etcheparebordeet al. 2014; Bleakley 2015; Botte
2015; Hopmans 2015; Samoyet al. 2015; Tor-
rington 2015). Further studies are needed to
determine which of these strategies are most
effective. Clinical studies are also needed to
determine the frequency of complications with
second-generation TTA.
Conclusions
Currently there is no peer-reviewed evidence
of any substantial superiority for any one of
the surgical techniques for stifle stabilization
in dogs with cruciate ligament rupture over
the long term, and the specific technique cho-
sen primarily depends on individual surgeon
preference (Leighton 1999). Anecdotal evidence
suggests that there may be a quicker recov-
ery and return to full mobility in a shorter
period of time with TTA, similar to TPLO. The
rapid return to function is one of the primary
reasons that this technique is frequently per-
formed. In addition, there is anecdotal evidence
from owners that dogs treated with TTA and
TPLO do better, interpreted as returning to
work such as hunting or field trials, than dogs
with either extra-articular lateral suture stabi-
lization or intra-articular stabilization using an
over-the-top or similar method. Long-term clin-
ical outcomes after TTA relative to other surgi-
cal techniques need to be documented.References
Apelt D, Kowaleski M, Boudrieau RJ. Effect of tib-
ial tuberosity advancement on cranial tibial sub-
luxation in canine cranial cruciate-deficient stifle
joints: anin vitroexperimental study. Vet Surg
2007;36:170–177.
Barthel ́ ́emy N, Ramirez JM, Noel S,et al.Modi-
fied Maquet technique for treatment of canine cra-
nial cruciate ligament injury: Early results, com-
plications and risk factors in 109 dogs. Vet Surg
2014;43:E129.
Bleakley S. TTA-2: Research Projects, 2015 Kyon Sym-
posium.
Bottcher P, Ray J, Fisher M. ̈ In vivostifle kinematics:
The truth about TPLO and TTA. Proceedings of the
2013 ACVS Veterinary Symposium. San Antonio,
TX, October 24–26, 2013, pp. 415–417.
Botte R. Kyon TTA Masterclass. 2013ACVS Veterinary
Symposium. San Antonio, TX, October 23, 2013.
Botte R. TTA-2 planning: Tips and tricks. 2015 Kyon
Symposium.
Boudrieau RJ. Tibial tuberosity advancement (TTA):
Clinical results. Proceedings of the ACVS Veteri-
nary Symposium, 2005, pp. 443–445.
Boudrieau RJ. Tibial plateau leveling osteotomy or
tibial tuberosity advancement? Vet Surg 2009;38:1–
22.
Boudrieau RJ. Letter to the Editor; Comparison of
healing of the osteotomy gap after tibial tuberos-
ity advancement with and without use of an auto-
genous cancellous bone graft [Vet Surg 2011;40:27–
33]. Vet Surg 2011;40:641–643.
Boudrieau RJ. Why I cut the meniscus. Kyon TTA
Masterclass. 2013ACVS Veterinary Symposium.San
Antonio, TX, October 23, 2013.
Brown NP, Bertocci GE, Marcellin-Little DJ. Canine
stifle biomechanics associated with Tibial Tuberos-
ity Advancement predicted using a computer
model. Vet Surg 2015;44:866–873.
Brunel L, Etchepareborde S, Barthel ́emy N, ́ et al.
Mechanical testing of a new osteotomy design for
tibial tuberosity advancement using the modified
Maquet technique. Vet Comp Orthop Traumatol
2013;26:47–53.