When a dog suffers from a cranial cruciate ligament rupture with a simultaneous patellar luxation, this can be addressed with a modified TTA Rapid procedure. Prior to the TTA Rapid surgery itself, it should be determined if the dog would benefit from a trochleoplasty. If so, this should be performed before the actual TTA Rapid procedure. The osteotomy used for the TTA Rapid procedure can also be used to achieve a medial or lateral tibial tuberosity transposition (TTT), depending on the kind of patellar luxation. The further described procedure focuses on a lateralization of the crest, needed for the correction of a medial patellar luxation.

Before reading the surgery instruction, please have a look at this video:

VIDEO: Patella Luxation Spacers and Instruments with TTA RAPID

VIDEO: Patella Luxation treatment with TTA RAPID Tibia Tappet and Hornet Micro Surgery Drill and Saw

 

TTA and Patella Luxation: Step 1

After performing the osteotomy, the appropriate cage is inserted into the osteotomy and all of the caudal screws are inserted in the tibia. Take care to choose a cage that has a bigger medio-lateral length than measured after the osteotomy, as both cortices of the transposed crest need to be supported! Usually, the longest cage is advised.

 

TTA and Patella Luxation: Step 2

Consecutively, the tibial crest is slightly advanced, so that it can be moved laterally.

Be very careful performing this and restrict the advancement to the absolute minimum to avoid crest avulsion. Ideally, the advancement is given above the cage.

 

TTA and Patella Luxation: Step 3

Once the desired position is reached, a bone holding forceps (or a small Kirschner wire) can be used as described above to keep the position, until a corresponding washer is placed between the crista tibiae and the ears of the cage.

 

TTA and Patella Luxation: Step 4

If the transposition is sufficient to prevent dislocation of the patella, the remaining screws are inserted and the operation finished as described

In case of a a lateral luxation, the tibial crest is shifted medially in a similar manner after fixating the cranial part of the cage in the tibial crest.