Effect of 9 mm Tibial Tuberosity Advancement on Cranial Tibial Translation in the Canine Cranial Cruciate Ligament‐Deficient Stifle

Abstract

Objective-To assess the effect of 9 mm tibial tuberosity advancement (TTA) on cranial tibial translation (CTT) in cranial cruciate ligament (CCL) deficient canine stifles.Study Design-In vitro cadaveric study. Animals-Twelve canine pelvic limbs.Methods-Each stifle was placed in a jig at 135° with a simulated quadriceps force and tibial axial force, and the distance of CTT was measured with the CCL intact (iCCL), transected (tCCL), and after performing a TTA using a 9 mm cage. In addition, a material testing machine was used to assess the force required to elicit CTT in each scenario.Results-The mean CTT for iCCL was 0.42 mm, 1.58 mm after severing the CCL, and 1.06 mm post TTA. The tCCL CTT measured without any quadriceps force was 2.59 mm. Differences between the intact and tCCL (p<0.0001) and tCCL and TTA (p=0.0003) were significant. The difference between the tCCL with and without the quadriceps force was not significant (p=0.0597). The force required to cause CTT was greater in the TTA than the tCCL up to 6mm (p<0.0001). As axial load increased, the force required to advance the tibia increased in both treatment groups (p value for overall weight effect =0.0002). Conclusions-

Modified stabilization method for the tibial tuberosity advancement technique: a biomechanical study

“…This residual instability is attributed to the character of the study using cadavers. The cranial tibial thrust force is minimized by the balance between the quadriceps muscle group and the flexor mechanism, and the stability is dependent upon the full action of these muscles during locomotion (FALCIS et al, 2006;HOFFMANN et al, 2006;MILLER et al, 2007). Dog 3 had an excessive tibial subluxation of 7mm attributed to a sloped tibial plateau of 28° (VEZZONI, 2006).…”

“…According to some authors, the magnitude of transformation of the cranial tibial thrust force is directly proportional to the amount of cranial displacement of the tibial tuberosity (APELT et al, 2007). This observation highlights the necessity for other studies to determine the ideal distance for tibial tuberosity advancement and the effects of excessive reduction on caudal cruciate ligament and other joint components (REIF et al 2002;TEPIC, 2006;MILLER et al, 2007).…”

“…The contraction of the quadriceps and flexor muscle in the original joint results in a force whose vector is approximately parallel to the patellar tendon and cranially sloped in relation to the tibial plateau (MONTAVON et al, 2002;INNES, 2006). The biomechanical principle of the method consists of the neutralization of the cranial tibial thrust force by placement of the patellar tendon perpendicular to the tibial plateau (TEPIC, 2006;MILLER et al, 2007). The new position is achieved by osteotomy of the tibial tuberosity and insertion of a spacing cage in the defect, followed by stabilization with a special titanium plate fixed by fork and screws.…”

“…It is necessary to emphasize however, that like Slocum's TPLO both specialized training and acquisition of specific instruments are needed to perform TTA (MONTAVON et al, 2002). Despite the theory behind the technique, there are few reports about the exact biomechanical modifications after TTA on the stifle joint (APELT et al, 2007;HOFFMANN et al, 2006;MILLER et al, 2007).…”

Mechanical resistance of the modified stabilization method for the tibial tuberosity advancement technique: ex vivo experimental study in dogs

“…Despite overall acceptance by most surgeons, studies using force plate analysis showed similar results in long-term outcome for the lateral suture technique and the Slocum TPLO (CONZEMIUS et al, 2005). Tibial Tuberosity Advancement (TTA) was described as a new alternative for stabilizing the cranial cruciate deficient stifle (MILLER et al, 2007). According to the authors, the method promotes less alteration to the intraarticular and periarticular components, and therefore leads to superior clinical results (TEPIC, 2006).…”