374 Canine Sports Medicine and Rehabilitation
superior to LFS, with dogs undergoing TPLO
returning to normal peak vertical force 1 year
following surgery compared with only 85%
in dogs undergoing LFS (Nelson et al., 2013).
Limitations include cost associated with the
procedure compared with other treatment
options, the high learning curve for the surgeon,
the potential for serious complications, and the
lack of suitability in geriatric patients or those
with poor bone quality (Priddy et al., 2003;
Lazar et al., 2005; Boudrieau, 2009; Christopher
& Cook, 2011).
Tibial tuberosity advancement (TTA). The TTA
procedure involves a linear osteotomy caudal
to the tibial tuberosity (Figure 14.26). The tibial
tuberosity is advanced so that the patellar
tendon is perpendicular to the tibial plateau.
The advanced portion of bone is held in place
with a titanium cage (that acts as a spacer
between the two bones) and plate (Kowaleski
et al., 2012). A graft may be applied to the space
between the bones to promote bone healing.
Modifications of the TTA procedure that do not
rely on bone plate fixation have been described
(Samoy et al., 2015). The procedure relies on
neutralizing the tibial thrust by changing the
force through the knee to be parallel to the
patellar tendon (Kowaleski et al., 2012). TTA
provides a biomechanical advantage to the
quadriceps muscles, and subsequently stabi
lizes the stifle. Biomechanical studies suggest
that TTA may neutralize the forces exerted on
the stifle and preserve the contact mechanics of
the stifle better than TPLO (Guerrero et al., 2011;
Kim et al., 2009, 2010). However, post‐stabiliza
tion meniscal tears are reported more com
monly with TTA than with TPLO (Lafaver et al.,Figure 14.25 The tibial plateau leveling osteotomy is the
authors’ procedure of choice for active, large, and giant
breeds of dogs with a ruptured cranial cruciate ligament.
Figure 14.26 Tibial tuberosity advancement involves a
linear osteotomy caudal to the tibial tuberosity. The tibial
tuberosity is advanced so that the patellar tendon is
perpendicular to the tibial plateau.