Triple Tibial Osteotomy

The triple tibial osteotomy was developed by New Zealand veterinary orthopedic specialist, Dr. Warrick Bruce, while he was working in Adelaide. By changing the geometry of the forces of gravity and muscle contractions that act on the stifle during weight-bearing, it aims to neutralise the shear force that causes the cranial movement of the tibia with respect to the femur.

The triple tibial osteotomy is a hybrid technique, combining features of both the TTA and TWO techniques to achieve the same outcome, but with less radical angular changes.

This shear force develops because the canine tibial plateau – the weight-bearing aspect of the joint – is sloped caudally (downwards towards the back of the joint) and there is an acute angle between the tibial plateau slope and the patella ligament. In the TTO procedure, the tibia has three osteotomies (cuts into the bone with a bone saw) performed upon it with the aim of realigning the tibial plateau slope so that it ultimately becomes aligned at right angles to the patellar ligament instead of sloping backwards. By achieving this, shear forces within the joint are neutralised and the joint is stable as the dog weight-bears.

The joint is not stable, however, when it is physically manipulated by attempting to move the tibia cranially.This contrasts with previous methods of CrCL repair which aimed to provide stability to the joint by replacing the ligament either with a fascial graft within the joint, or using a prosthesis made of nylon placed externally from the lateral fabella to a hole drilled in the tibial crest.

The TTO procedure has been developed as a hybrid of two previously available orthopaedic procedures, the tibial tuberosity advancement (TTA) and the tibial plateau leveling osteotomy (TPLO). The TTA neutralises shear force within the stifle by advancing the tibial tuberosity until the tibial plateau is at right angles to the patellar ligament. The TPLO neutralises shear force by rotating the tibial plateau so that it is approximately horizontal with respect to the long axis of the tibia. The TTO combines both of these procedures and as such less radical changes than either are required.

Geoff Freeth: is a graduate of Sydney University and under mentor, Glen Edwards of Melbourne University, gained membership to the Australian College of Veterinary Scientists in the surgery chapter. In 2006 he completed a Masters through Murdoch University and is currently enrolled in a Master of Veterinary Surgery at Massey University. With Lisa Brisbane he has owned and operated Canobolas Pet Hospital for the last 12 years. The clinic offers referral surgery services to vets across the Central West as well as stem cell therapy, chemotherapy and allergy testing and immunotherapy. Geoff has written for Dog's Life magazine, appeared on Animal Hospital and is the resident vet on ABC radio Central West every Wednesday morning. His particular interests include orthopedic surgery, oncology and cardiac ultrasound.

Have a look at our experience with a TTO

Advantages over DeAngelis Suture (Traditional Cranial cruciate repair)

a more rapid recovery

       better range of motion of the joint

       four times less arthritis

       return to athletic or working activity

Advantages over Slocum procedure (TPLO)

       Does not require expensive and inefficient bi radial saw and blade.

       Flat blades creates less heat and fewer complications.

       Procedure ensures that tibial plateau is brought square to the patella ligament.

       TTO instrument allow minimal errors Slocum technique requires much more guesswork.

Advantages over wedge osteotomy(TWO)

       Tibia is not shortened.

       Osteotomy is not exposed to stress of the pull of the patella ligament as the tibial crest remains intact.

       Does not require figure of 8 wire to neutralize this.

Advantages over Tibial Tubercle advancement (TTA)

       Does not leave large defect in tibial crest which requires expensive

       Titanium implants to protect