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TTA Surgery – Evidence Based Medicine, Optimising Outcome & Minimising Complications
G. Arthurs
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INTRODUCTION & BRIEF HISTORY
In 2002, Montavon & Tepic adapted a theory of human knee function to canine stifle and came ot the conclusion that cranial shear force on the stifle can be eliminated by making the patellar ligament perpendicular to the tibial plateau.
TTA EVOLUTION & EVIDENCE
- Vet Surg 2007: TTA 114 stifles. 12% minor post-op complications, 19% major (meniscal tear, tibial fracture). 81% good / satisfied outcome. 25% persistent lameness
- JSAP 2008: TTA 70 stifles. 8.5% late meniscal tear rate. 12 months later, 17% persistent lameness. 65% excellent outcome
- VCOT 2008: 40 TTAs. Dogs improve after TTA surgery but don’t regain control dog levels. 25% dogs complications – lower PVF. Dogs improve with TTA but only 90% normal.
- VCOT 2008: TTA converts cranial to caudal shear force in the cruciate deficient stifle.
- Vet Surg 2009: literature review; TPLO and TTA are similar but unclear which is superior
- JAAHA 2011: 193 TTAs, 11% complications, 5% late meniscal tear rate. Complications associated with increasing body weight & small TTA cage size. 92% owner satisfaction, 84% would choose procedure again
- Vet Surg 2011: TTA osteotomy heals regardless of bone graft; makes little difference
- JAVMA 2012: 501 TTAs. 95 (20% complication rate) including meniscal tear. Risk of complications higher with higher body weight & high patellar tendon angle
- Vet Surg 2013: outcome for TTA worse than TPLO or TR. TTA – higher major complication rates and subsequent meniscal tear rates. TPLO – higher major complication rate & meniscal tear rates than TR
- Vet Surg 2016: by 12 months postop, TPLO is similar to normal (walk and trot). For TTA walk is normal, but trot is not. For ECS, neither walk nor trot are normal.
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