268 Surgical Treatment
TTA can also be used to manage CR com-
bined with PL (Newmanet al. 2014). The man-
agement of medial PL and CR often requires fix-
ation of the tibial tuberosity in a more lateral
and distal position. A medial approach to the
stifle and proximal tibia is performed with lat-
eral dissection and lateral arthrotomy of the sti-
fle joint. Any CrCL remnants are removed, and
a block resection sulcoplasty is performed. A
tibial tuberosity osteotomy is performed as pre-
viously described (Lafaveret al. 2007). A stan-
dard TTA plate is used and the plate can be
adjusted by lateral bending of the plate prox-
imal to the screw fixation. A recession in the
medial cortex of the tibia to accept the plate, and
a second recession in the proximal tibia for the
caudal cage screw, are made. A high-speed drill
can be used to make these adjustments. To aid in
the lateralized position of the TTA plate, a posi-
tional Kirschner wire can be placed from the tib-
ial tuberosity to the principal tibial fragment. In
patients with patella alta, the TTA plate can be
moved distally as well as laterally. One report
described the use of TTA to manage patella alta
in nine dogs (Puglieseet al. 2015). The patella
to patellar ligament ratio will need to be calcu-
lated from a mediolateral projection and taken
into account. Amean distal translation of 14 mm
was required for the nine dogs described in this
case series.
The outcome of surgery for the management
of CR and PL is good or excellent for the
majority of patients. Complications include
those described for each individual procedure,
with potentially an increase in the likelihood of
failure of fixation and a loss for patellar reduc-
tion. In one report, the risk of loss of patellar
reduction after tibial tuberosity transposition
was increased in dogs with concurrent CR
(Stankeet al. 2014).
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