Tibial Diaphyseal Fracture as a Major Complication of Tibial Tuberosity Advancement With Cranial Fixation (TTA CF)-A Case Report.

This article reports a major complication of tibial tuberosity advancement with cranial fixation for the treatment of cranial cruciate ligament rupture in a Boxer. Twelve days postoperatively the dog underwent revision surgery for fracture of the tibia and tibial tuberosity. The tibial tuberosity fracture was secured to the tibial diaphysis using the 2 K-wires and a medial 3.5 dynamic compression plate was used to stabilize the tibial diaphysis fracture. The fracture was reduced and the plate applied using minimally invasive plate osteosynthesis to preserve the blood supply to the bone. Two weeks after revision surgery, the dog was using the operated limb without apparent lameness at a walk and trot. No complications were observed after revision surgery. Tibial tuberosity fracture and tibial diaphysis fracture as complications after tibial tuberosity advancement with cranial fixation healed with satisfactory clinical outcomes but revision surgery was required.

Single-stage Bilateral Tibial Tuberosity Advancement With Cranial Fixation in an English Bulldog - A Case Report.

This article presents a report of single-stage bilateral tibial tuberosity advancement for the treatment of cranial cruciate ligament rupture in an English bulldog. The reconstruction was performed by a new surgical technique involving tibial tuberosity advancement and fixation with two cranially placed lag screws. The patient was able to ambulate normally at a walk without lameness four days postoperatively. Except for bruising of the surgical site, no complications were observed during a six-month follow-up period.

Evaluation, Description of the Technique, and Clinical Outcomes After Tibial Tuberosity Advancement With Cranial Fixation (TTA CF) for Cranial Cruciate Ligament Rupture in 22 Dogs.

The objective of this study is to describe a modified surgical technique for tibial tuberosity advancement with cranial fixation (TTA CF) in dogs with cranial cruciate insufficiency and to report long term clinical outcomes and complications. TTA CF was performed with a novel titanium implant. A description of the specific implant with guide, drill and saw guide, instrumentation, and template are provided, along with clinical outcomes, complications, owners' evaluation, and a 1-year postoperation follow-up. Twenty two mixed breed dogs, with a median body weight of 23 kg (range, 11-45 kg) were included. The median age at surgery was 4 years (range, 1-8 years). Clinical bone healing was seen at a mean 10 weeks (range 6-14 weeks). The minor complication rate was 27% (n = 6). No major complication occurred, and no revision surgery was required. Twenty-one (95%) dogs had a good to excellent outcome 1 year after surgery. Currently there is no accepted best treatment of the canine cranial cruciate ligament deficient stifle. Most of TTA techniques are based on fixing the implant from the medial side of tibia. We report a modified TTA technique with cranial fixation of a titanium implant and suggest that the TTA CF surgical technique may be a feasible alternative to existing surgical procedures.

A novel tibial tuberosity advancement technique with cranial implant fixation (TTA CF): a pilot study in sheep.

BACKGROUND: Cranial cruciate ligament rupture is the most frequent orthopedic disorder in human and animals. An array of surgical techniques have been described to stabilize the stifle joint in dogs, including intraarticular stabilization, extraarticular stabilization, and tibial osteotomy techniques. Tibial plateau leveling osteotomy and tibial tuberosity advancement with a lot of modifications are the most common. In this study we report the possibility of fixing the novel titanium implant for tibial tuberosity advancement with two screws in a craniocaudal direction. The aim of our study was to improve the clinical benefit of the tibial tuberosity advancement surgical technique where an attempt was made to reduce the number of screws and obtain a strong implant fixation with minimal bone traumatization. This way of attachment allows to distribute the forces evenly on medial and lateral side of osteotomy gap. RESULTS: Tibial tuberosity advancement with cranial implant fixation was performed in four sheep. Complete radiographic and clinical follow up was recorded. All four sheep had a complete osteotomy line healing at a mean of 10 weeks postoperative (range 8-12 weeks). None of the animals had osteotomy gap healing grades of poor. Minor complication included the minimally cracked Maquet hole on the postoperative radiographs, without displacement of the tibial crest which occurred in 2 sheep. Major complication grade 1, major complication grade 2 and catastrophic were not found. CONCLUSIONS: The novel surgical technique for tibial tuberosity advancement with cranial implant fixation is technically comparable to the recent trend in tuberosity advancement techniques, where partial osteotomy of the cranial tibial tuberosity crest is performed. A cranial implant fixation allows to distribute the forces evenly on medial and lateral side of osteotomy gap, which may result in less number of major complications in dogs. A novel titanium implant decreases the tibial traumatisation by reducing the number of screws.