Surgical repair of cranial cruciate deficiency is one of the most common small animal orthopedic procedures, due to the high incidence of the problem and the clinical success of recent surgical techniques.

In early 2004, following three years of clinical testing, KYON launched the original Tibial Tuberosity Advancement (TTA) procedure for cranial cruciate deficiency in dogs. Slobodan Tepic, Dr. Sci., Dipl. Ing., and Prof. Pierre M. Montavon, Head of Small Animal Surgery at the School of Veterinary Medicine, University of Zurich, invented and developed TTA to allow neutralization of cranial tibial thrust without compromising joint congruency. At the time, this technique was a major departure from conventional practice. KYON’s TTA procedure has been performed in >100,000 procedures by more than 1,000 surgeons.

Throughout the last decade of clinical experience, KYON continued to refine and improve TTA preoperative planning, surgical technique, implants and instruments. In 2012, KYON in collaboration with Dr. Joop Hopmans began in vitro testing and, soon after, safety and efficacy testing to explore the next step in the TTA evolution, TTA-2*. TTA-2 consists of an incomplete osteotomy, performed with a novel hinged saw guide and a new cage, designed to transfer shear and compression forces. The simplified surgical technique preserves the periosteum on the medial aspect of the tibial tuberosity, eliminates stress risers created by the plate, fork, and screws, shortens the surgery time, and reduces the implant inventory. TTA-2 implants are packaged sterile for surgical convenience. In vitro and in vivo studies have demonstrated that the saw guide and surgical planning for its use, combined with the use of the Fine Touch Osteotomy Spreader minimizes the risk of intraoperative or early postoperative fracture of the tuberosity.

With 2 years of clinical experience and over a decades’ experience in the basic mechanical and biological principles behind tibial tuberosity advancement as a geometry modifying procedure, TTA-2 was made commercially available in spring 2014. TTA-2 has the potential to reduce iatrogenic trauma, reduce the risk of infection, accelerate the incorporation of the implant into the bone and shorten the surgery time, thus providing surgeons and their patients with tangible benefits.
*patent pending

Surgical Technique

TTA-2 involves an incomplete osteotomy of the non-weight bearing portion of the tibia. The patellar ligament is aligned perpendicular to the common tangent of the femorotibial joint, eliminating cranial tibial thrust. This alignment takes the load off the CrCL even in full extension 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
• An incomplete frontal plane osteotomy is performed using the TTA-2 hinged sawguide
• The osteotomy gap is opened slowly and the tibial tuberosity is advanced and held in position by a cage implant, transferring the compression component of the patellar ligament force from the tuberosity to the proximal tibia

The Tibial Tuberosity Advancement 2 (TTA-2) procedure was invented and developed by KYON, through iteration during clinical testing, to best meet the exacting demands of the procedure and surgical convenience, with optimal selection of materials and manufacturing techniques for precision, durability, and maintenance. KYON products are manufactured in Switzerland with proprietary processes that produce superior products to those made by conventional manufacturing.