As the inventor of TTA, we continue to provide the highest quality research, manufacturing, development and training available.

In early 2004, KYON launched TTA for cranial cruciate deficiency in dogs following three years of clinical testing. The rapid acceptance of TTA has motivated several other companies to offer similar implants. The TTA technique was developed on the basis of systematic observation and simple biomechanical analysis of the canine knee.

There are a variety of reasons to choose TTA to resolve the most common cause of lameness in dogs:

TTA is less invasive than other geometry modifying techniques such as TPLO when treating the most common cause of lameness in dogs.

Clinically proven. KYON‘s TTA procedure has been used in over 150,000 cases by more than 1,000 surgeons worldwide.

TTA does not change the joint geometry. It neutralizes cranial tibial thrust in cranial cruciate deficient stifles and thus decreases internal joint reactions by a sound biomechanical rationale.

Reduced post-surgical complications and accelerated recovery through:

• A broad range of sizes: more than 30 different cage sizes available
• Extra long shape, providing a better fit and easier cut, ideal for skinny tibia breeds
• Superb biocompatibility through titanium material

Principles

The TTA technique was developed on the basis of systematic observation and simple biomechanical analysis of the canine knee joint:

• Total joint force in the stifle is approximately parallel to the patellar ligament
• If the angle between the patellar ligament and the common tangent at the tibio-femoral point of contact (call it alpha) is 90 degrees, neither of the cruciates is loaded.
• In the canine stifle, alpha is 90 degrees at 110 degrees of flexion (call this a crossover flexion point). In full extension (approximately 135° stifle angle) alpha is approximately 105 degrees. In full flexion it is approximately 80 degrees.
• With the stifle in extension with respect to the crossover point, the load is on the cranial cruciate ligament. With the stifle flexed past the crossover point, the load is on the caudal cruciate ligament.
• With the cranial cruciate ligament gone, the stifle can be stabilized by shifting the crossover point to the full extension.
• This can be done by either TPLO (turning the plateau) or by TTA (advancing the patellar ligament).

Execution

The TTA involves an osteotomy of the non-weight bearing portion of the tibia. The patellar ligament is aligned perpendicularly to the common tangent of the femorotibial joint, eliminating cranial tibial thrust. This new alignment eliminates the need for the CrCL and results in a stable joint.

• The required advancement of the patellar ligament insertion at the tibial tuberosity is measured from a radiograph of the stifle in extension.
• With a frontal plane osteotomy, the tibial tuberosity is advanced and held in position by:

(1) A cage transferring the compression component of the patellar ligament force from the tuberosity to the proximal tibia
(2) A tension band plate transferring the patellar ligament force to the proximal diaphysis of the tibia

• The open osteotomy, distal to the cage, is grafted with autologous cancellous bone or other graft material such as allograft or hydroxyapatite (HA) to accelerate healing.

Whitepaper Download the following whitepaper, to learn more about TTA’s history and rational Do’s and Don’ts in preoperative planning Important steps in the technique to improve outcomes. WHITEPAPER

Technical Specifications

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CATALOG

Principles

Calvo I¹, Aisa J, Chase D, Garcia-Fernandez P, San Roman F, Bennett D.
Tibial tuberosity fracture as a complication of tibial tuberosity advancement.
Vet Comp Orthop Traumatol. 2014;27(2):148-54. doi: 10.3415/VCOT-13-06-0071. Epub 2014 Jan 20.
¹University of Glasgow, School of Veterinary Medicine, Small Animal Hospital, Bearsden Road, Bearsden, G61 1QH Glasgow, Scotland, United Kingdom, ignacio.calvo@glasgow.ac.uk.

Cadmus J¹, Palmer RH, Duncan C.
The Effect of Preoperative Planning Method on Recommended Tibial Tuberosity Advancement Cage Size.
Vet Surg. 2014 Jan 10. doi: 10.1111/j.1532-950X.2014.12126.x.
¹Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado.

MacDonald TL¹S, Allen DA, Monteith GJ.
Clinical assessment following tibial tuberosity advancement in 28 stifles at 6 months and 1 year after surgery.
Can Vet J. 2013 Mar;54(3):249-54.
¹Small Animal Surgery Department, VCA Mission Animal Referral and Emergency Center, Mission, Kansas 66202, USA. Tamaramacd@gmail.com

Proot JL¹, Corr SA.
Clinical audit for the tibial tuberosity advancement procedure: establishing the learning curve and monitoring ongoing performance for the tibial tuberosity advancement procedure using the cumulative summation technique.
Vet Comp Orthop Traumatol. 2013;26(4):280-4. doi: 10.3415/VCOT-12-04-0052. Epub 2013 Mar 22.
¹Calder Vets Ltd, Dewsbury, West-Yorkshire, United Kingdom. caldervets@me.com

Skinner OT¹, Kim SE, Lewis DD, Pozzi A.
In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs.
Vet J. 2013 Apr;196(1):86-91. doi: 10.1016/j.tvjl.2012.08.003. Epub 2012 Sep 16.
¹Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.

Hirshenson MS¹, Krotscheck U, Thompson MS, Knapp-Hoch HM, Jay-Silva AR, McConkey M, Bliss SP, Todhunter R, Mohammed HO.
Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs.
Vet Comp Orthop Traumatol. 2012;25(5):402-9. doi: 10.3415/VCOT-11-12-0175. Epub 2012 Jun 13.
¹Department of Clinical Science, Cornell University, Ithaca, NY 14853, USA.

Wolf RE¹, Scavelli TD, Hoelzler MG, Fulcher RP, Bastian RP.
Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007-2009).
J Am Vet Med Assoc. 2012 Jun 15;240(12):1481-7. doi: 10.2460/javma.240.12.1481.
¹Garden State Veterinary Specialists, 1 Pine St, Tinton Falls, NJ 07753, USA. rewolf@gmail.com

Guerrero TG¹, Pozzi A, Dunbar N, Kipfer N, Haessig M, Beth Horodyski M, Montavon PM.
Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints.
Vet Surg. 2011 Oct;40(7):839-48. doi: 10.1111/j.1532-950X.2011.00866.x. Epub 2011 Aug 16.
¹Clinic for Small Animal Surgery, Vetsuisse-Faculty University of Zurich, Zurich, Switzerland. tguerrero@sgu.edu

Butler JR¹, Syrcle JA, McLaughlin RM, Elder SH.
The effect of tibial tuberosity advancement and meniscal release on kinematics of the cranial cruciate ligament-deficient stifle during early, middle, and late stance.
Vet Comp Orthop Traumatol. 2011;24(5):342-9. doi: 10.3415/VCOT-10-08-0122. Epub 2011 Jul 21.
¹College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA. rbutler@cvm.msstate.edu

Steinberg EJ¹, Prata RG, Palazzini K, Brown DC.
Tibial tuberosity advancement for treatment of CrCL injury: complications and owner satisfaction.
J Am Anim Hosp Assoc. 2011 Jul-Aug;47(4):250-7. doi: 10.5326/JAAHA-MS-5574. Epub 2011 Jun 14.
¹Valley Central Veterinary Referral Center, Allentown, PA, USA. ezrajs@yahoo.com

Bush MA¹, Bowlt K, Gines JA, Owen MR.
Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement.
Vet Comp Orthop Traumatol. 2011;24(3):205-10. doi: 10.3415/VCOT-10-07-0104. Epub 2011 Mar 3.
¹Department of Clinical Veterinary Medicine, University of Bristol, Langford, North Somerset, UK. mark.bush@scvetspecialists.co.uk

Hoffmann DE¹, Kowaleski MP, Johnson KA, Evans RB, Boudrieau RJ.
Ex vivo biomechanical evaluation of the canine cranial cruciate ligament-deficient stifle with varying angles of stifle joint flexion and axial loads after tibial tuberosity advancement.
Vet Surg. 2011 Apr;40(3):311-20. doi: 10.1111/j.1532-950X.2011.00807.x. Epub 2011 Mar 1.
¹Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.

Guerrero TG¹, Makara MA, Katiofsky K, Fluckiger MA, Morgan JP, Haessig M, Montavon PM.
Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft.
Vet Surg. 2011 Jan;40(1):27-33. doi: 10.1111/j.1532-950X.2010.00772.x. Epub 2010 Dec 23.
¹Department of Small Animal Surgery, University of Zurich, Zurich, Switzerland. tguerrero@vetclinics.uzh.ch

Etchepareborde S¹, Mills J, Busoni V, Brunel L, Balligand M.
Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture.
Vet Comp Orthop Traumatol. 2011;24(1):27-31. doi: 10.3415/VCOT-10-01-0013. Epub 2010 Nov 19.
¹School of Veterinary Medicine, University of Liège-Department of Clinical Sciences, Liège, Belgium. sebetche@yahoo.com

Dymond NL¹, Goldsmid SE, Simpson DJ.
Tibial tuberosity advancement in 92 canine stifles: initial results, clinical outcome and owner evaluation.
Aust Vet J. 2010 Oct;88(10):381-5. doi: 10.1111/j.1751-0813.2010.00627.x.
¹Animal Referral Hospital, South Strathfield, New South Wales, Australia. nickdymond@hotmail.com

Etchepareborde S¹, Barthelemy N, Mills J, Pascon F, Ragetly GR, Balligand M.
Mechanical testing of a modified stabilisation method for tibial tuberosity advancement.
Vet Comp Orthop Traumatol. 2010;23(6):400-5. doi: 10.3415/VCOT-09-08-0088. Epub 2010 Sep 9.
¹Department of Clinical Sciences, School of Veterinary Medicine, University of Liège, Belgium. sebetche@yahoo.com

Yeadon R¹, Fitzpatrick N, Kowaleski MP.
Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Surgical technique, radiographic and clinical outcomes.
Vet Comp Orthop Traumatol. 2011;24(1):18-26. doi: 10.3415/VCOT-10-01-0015. Epub 2010 Sep 9.
¹Fitzpatrick Referrals, Halfway Lane, Eashing, Surrey, GU7 2QQ, United Kingdom. r.yeadon@vet.gla.ac.uk

Kim SE¹, Pozzi A, Banks SA, Conrad BP, Lewis DD.
Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion.
Vet Surg. 2010 Apr;39(3):363-70. doi: 10.1111/j.1532-950X.2010.00655.x.
¹Departments of Small Animal Clinical Sciences, Mechanical and Aerospace Engineering, and Orthopedics and Rehabilitation, University of Florida, Gainesville, FL 32610, USA.

Kim SE¹, Pozzi A, Banks SA, Conrad BP, Lewis DD.
Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics.
Vet Surg. 2009 Jan;38(1):33-9. doi: 10.1111/j.1532-950X.2008.00471.x.
¹Departments of Small Animal Clinical Sciences, Mechanical and Aerospace Engineering, and Orthopedics and Rehabilitation, University of Florida, Gainesville, FL 32610, USA.

Boudrieau RJ.
Tibial plateau leveling osteotomy or tibial tuberosity advancement?
Vet Surg. 2009 Jan;38(1):1-22. doi: 10.1111/j.1532-950X.2008.00439.x.
Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA 01536, USA. randy.boudrieau@tufts.edu

Inauen R¹, Koch D, Bass M, Haessig M.
Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog.
Vet Comp Orthop Traumatol. 2009;22(1):16-20.
¹Koch & Bass Referral Practice for Small Animal Surgery, Basadingerstrasse 26, 8253 Diessenhofen, Switzerland. info@kochbass.ch

Kim SE¹, Pozzi A, Banks SA, Conrad BP, Lewis DD.
Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics.
Vet Surg. 2009 Jan;38(1):33-9. doi: 10.1111/j.1532-950X.2008.00471.x
¹Departments of Small Animal Clinical Sciences, Mechanical and Aerospace Engineering, and Orthopedics and Rehabilitation, University of Florida, Gainesville, FL 32610, USA.

Kipfer NM¹, Tepic S, Damur DM, Guerrero T, Hässig M, Montavon PM.
Effect of tibial tuberosity advancement on femorotibial shear in cranial cruciate-deficient stifles. An in vitro study.
Vet Comp Orthop Traumatol. 2008;21(5):385-90.
¹Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland. nkipfer@vetclinics.unizh.ch

Kim SE¹, Pozzi A, Kowaleski MP, Lewis DD.
Tibial osteotomies for cranial cruciate ligament insufficiency in dogs.
Vet Surg. 2008 Feb;37(2):111-25. doi: 10.1111/j.1532-950X.2007.00361.x.
¹Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL 32610, USA.

Burns CG¹, Boudrieau RJ.
Modified tibial tuberosity advancement procedure with tuberosity advancement in excess of 12 mm in four large breed dogs with cranial cruciate ligament-deficient joints.
Vet Comp Orthop Traumatol. 2008;21(3):250-5.
¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, USA. randy.boudrieau@tufts.edu

Voss K¹, Damur DM, Guerrero T, Haessig M, Montavon PM.
Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease.
Vet Comp Orthop Traumatol. 2008;21(3):243-9.
¹Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland. kvoss@vetclinics.uzh.ch

Guerrero TG¹, Geyer H, Hässig M, Montavon PM.
Effect of conformation of the distal portion of the femur and proximal portion of the tibia on the pathogenesis of cranial cruciate ligament disease in dogs.
Am J Vet Res. 2007 Dec;68(12):1332-7.
¹Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland.

Lafaver S¹, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ.
Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs.
Vet Surg. 2007 Aug;36(6):573-86.
¹Alameda East Veterinary Hospital, Denver, CO, USA.

Miller JM¹, Shires PK, Lanz OI, Martin RA, Grant JW.
Effect of 9 mm tibial tuberosity advancement on cranial tibial translation in the canine cranial cruciate ligament-deficient stifle.
Vet Surg. 2007 Jun;36(4):335-40.
¹Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24060, USA. millerj@vt.edu

Apelt D¹, Kowaleski MP, Boudrieau RJ.
Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study.
Vet Surg. 2007 Feb;36(2):170-7.
¹College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.

Dennler R¹, Kipfer NM, Tepic S, Hassig M, Montavon PM.
Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease.
Am J Vet Res. 2006 Nov;67(11):1849-54.
¹Tierklinik Dennler AG, Poststrasse 2, 8910 Affoltern am Albis, Switzerland.

Schwandt CS¹, Bohorquez-Vanelli A, Tepic S, Hassig M, Dennler R, Vezzoni A, Montavon PM.
Angle between the patellar ligament and tibial plateau in dogs with partial rupture of the cranial cruciate ligament.
Am J Vet Res. 2006 Nov;67(11):1855-60.
¹Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.

Stein S¹, Schmoekel H.
Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage.
J Small Anim Pract. 2008 Aug;49(8):398-404. doi: 10.1111/j.1748-5827.2008.00592.x. Epub 2008 Jul 10.
¹Great Western Referrals, Shrivenham Road, Swindon SN1 2NR, UK.