Tibial Tuberosity Advancement Techniques (TTAT): A Systematic Review

Abstract

(1) Background: Several surgical techniques were described for the treatment of cranial cruciate ligament rupture in dogs. This report aims to critically review the available literature focused on preoperative planning, surgical procedure, follow-up, and complications of cranial cruciate ligament rupture treated by tibial tuberosity advancement techniques; (2) Methods: three bibliographic databases: PubMed, Google Scholar, and Scopus were used for a board search of TTAT (canine OR dog). Five GRADE recommendations according to Grading of Recommendations Assessment, Development and Evaluation and Joanna Briggs Institute Critical Appraisal Checklists were applied to the studies included. Data regarding preoperative planning (a measure of advancement), meniscal disease (meniscectomy, meniscal release, and late meniscal tears), and postoperative patellar tendon angle were recorded. Time frame, outcome, and complications were classified according to Cook’s guidelines; (3) Results: from 471 reports yielded, only 30 met the inclusion criteria. The common tangent method was the most commonly reported measurement technique for preoperative planning. The 40.21% of stifles presented meniscal tears at surgery, while 4.28% suffered late meniscal tears. In short-, mid-and long-term follow-ups examined showed a full/acceptable function was shown in >90% of cases. Among all new generation techniques, minor complications were reported in 33.5% of cases and major complications in 10.67%; (4) Conclusions: Compared to traditional TTA, new generation TTAT resulted effective in the treatment of cranial cruciate ligament failure, showing a lower rate of late meniscal injury but a higher rate of minor complications.

Comparison and interobserver reliability of three different methods for measuring the amount of the tibial tuberosity advancement in the preoperative planning of TTAT

“…The main objective of this study was to evaluate interobserver reliability among CT, TAM, and BM. Although CT is the most commonly used method for preoperative planning of TTAT [18], our results showed a significant influence of the observers' experience and poor interobserver reliability consistent with the data previously reported [8].…”

“…The experience did not affect the interobserver reliability for TAM, although slight, moderate reliability was found. Despite its extensive use for TTAT, this method has been investigated only in terms of comparison [3,18]. Our results could be explained by the fact that TAM is based solely on tibial landmarks.…”

“…Although advances have been made in preoperative measurement methods, a discrepancy does exist between the desired tibial tuberosity advancement measured preoperatively and the true one surgically achieved [13,14]. Considering this literature background, the Authors decided to further investigate the reliability of preoperative measurement methods, including CT because it is the most widely used in reviewed literature [18], TAM for its promising results [12] and BM due to the lack of previous comparison study. The aim of this retrospective study was to analyse CT, TAM, and BM to compare interobserver reliability and assess differences in the amount of TTA measured.…”

Long‐term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

“…11,12,[19][20][21] Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires. 8,17,[22][23][24][25][26][27][28][29] Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs. [30][31][32] There are several questionnaires available, such as the canine orthopaedic index (COI), the Helsinki chronic pain index (HCPI), the Liverpool osteoarthritis in dogs, the canine brief pain inventory (CBPI) and the Bologna healing stifle injury index (BHSII).…”

“…Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires 8,17,22–29 . Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs 30–32 .…”