Tibial Diaphyseal Fracture Rates Following Tibial Tuberosity Advancement Rapid (TTAR) and Traditional Tibial Tuberosity Advancement (tTTA)

  • Wye Li Chong Canberra Veterinary Emergency Services 21 Crinigan Cir, Gungahlin ACT 2912



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PICO question

In dogs with cruciate disease, is the use of TTA Rapid (TTAR) compared to traditional TTA (tTTA) associated with a higher risk of tibial diaphyseal fractures?

Clinical bottom line

Based on studies published between January 2013 and January 2018, the rate of tibial diaphyseal fractures as a complication of Tibial Tuberosity Advancement Rapid (TTAR) surgery is within the published limits of traditional Tibial Tuberosity Advancement (tTTA). In this period, seven studies were related to tTTA, comprising of four; one case series, two retrospective case-control studies, and one retrospective cohort study. Five case series were related to TTAR.  All evidence within this period has been observational (Level 3 and 4 evidence). No direct head-to-head comparison between the techniques has been studied. 

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Arican, M., Parlak, K., & Şahin, H. (2017). Evaluation and application of the TTA-rapid method in dogs with cranial cruciate ligament rupture. Acta Veterinaria, 67(2), 238–253. http://doi.org/10.1515/acve-2017-0020

Brunel, L., Etchepareborde, S., Barthélémy, N., et al. (2013) Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the modified Maquet technique. Veterinary and Comparative Orthopaedics and Traumatology 26, 47–53.

Bleakley, S. (2015) TTA-2: Research Prokects, Kyon Symposium

Butterworth, S. J., & Kydd, D. M. (2017). TTA-Rapid in the treatment of the canine cruciate deficient stifle: short- and medium-term outcome. Journal of Small Animal Practice, 58(1), 35–41. http://doi.org/10.1111/jsap.12610

Costa, M., Craig, D., Cambridge, T., Sebestyen, P., Su, Y., & Fahie, M. A. (2017). Major complications of tibial tuberosity advancement in 1613 dogs. Veterinary Surgery, 46(4), 494–500. http://doi.org/10.1111/vsu.12649

Danielson, B., Barnhart, M., Watson, A., Kennedy, S., & Naber, S. (2016). Short-Term Radiographic Complications and Healing Assessment of Single-Session Bilateral Tibial Tuberosity Advancements. Journal of the American Animal Hospital Association, 52(2), 109–114. http://doi.org/10.5326/JAAHA-MS-6194

de Sousa, R., Egan, P., Parsons, K., Butterworth, S., Calvo, I., Roch, S., & Moores, A. P. (2017). Treatment of tibial diaphyseal fractures following plateless tibial tuberosity advancement to manage cranial cruciate disease. Journal of Small Animal Practice, 58(7), 372–379. http://doi.org/10.1111/jsap.12673

de Lima Dantas, B., Sul, R., Parkin, T., & Calvo, I. (2016). Incidence of complications associated with tibial tuberosity advancement in boxer dogs. Veterinary and Comparative Orthopaedics and Traumatology, 29(1), 39–45. http://doi.org/10.3415/VCOT-15-02-0036

Dyall, B., & Schmökel, H. (2017). Tibial tuberosity advancement in small-breed dogs using TTA Rapid implants: complications and outcome. Journal of Small Animal Practice, 58(6), 314–322. http://doi.org/10.1111/jsap.12654

Hans, E. C., Barnhart, M. D., Kennedy, S. C., & Naber, S. J. (2017). Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight. Veterinary and Comparative Orthopaedics and Traumatology, 30 (4), 299–305. http://doi.org/10.3415/VCOT-16-07-0106

Kiefer, J. E., Langenbach, A., Boim, J., Gordon, S., & Marcellin-Little, D. J. (2015). Single-stage bilateral tibial tuberosity advancement for treatment of bilateral canine cranial cruciate ligament deficiency. Veterinary and Comparative Orthopaedics and Traumatology, 28 (3), 215–219. http://doi.org/10.3415/VCOT-14-08-0130

MacDonald, T. L., Allen, D. A., & Monteith, G. J. (2013). Clinical assessment following tibial tuberosity advancement in 28 stifles at 6 months and 1 year after surgery. Canadian Veterinary Journal, 54 (3), 249–254.

Montavon PM, Damur DM, Tepic S (2002). Advancement of the tibial tuberosity for the treatment of cranial cruciate deficient canine stifle. Proceedings of the 1st World Orthopedic Veterinary Congress; 2002 September 5–8; Munich, Germany. 152.

Ness M (2016) The Modified Maquet Procedure (MMP) in Dogs: Technical Development and Initial Clinical Experience, Journal of the American Animal Hospital Association, 52 (4), 242–250.

Proot, J. L. J., & Corr, S. A. (2013). Clinical audit for the tibial tuberosity advancement procedure. Veterinary and Comparative Orthopaedics and Traumatology, 26 (4), 280–284. http://doi.org/10.3415/VCOT-12-04-0052

Samoy, Y., Verhoeven, G., Bosmans, T., Van der Vekens, E., de Bakker, E., Verleyen, P., & Van Ryssen, B. (2015). TTA Rapid: Description of the Technique and Short Term Clinical Trial Results of the First 50 Cases. Veterinary Surgery, 44 (4), 474–484. http://doi.org/10.1111/j.1532-950X.2014.12298.x





Vol. 4 No. 1 (2019): The first issue of 2019

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /