Lecture Notes: TTA vs TPLO Debate

Overview

• Purpose: Compare, contrast, and examine evidence for TTA (Tibial Tuberosity Advancement) and TPLO (Tibial Plateau Leveling Osteotomy).
• Format: Mike and Andy present their preferences and rationale for TPLO and TTA, respectively, followed by audience participation.

TPLO (Presented by Mike)

Rationale for Choosing TPLO

• Versatility: Suitable for any condition, including deformities.
• Reliability: Easy planning and execution, results mirror the plan.
• Precision: High accuracy in achieving intended outcomes (e.g., plateau angle).
• Outcomes: Achieves normal function sooner than TTA, based on forceplate studies.
• Complications: Low complication rate with modern locking implants.
• Comparison to TTA: Easier implant removal, more predictable outcomes.

Critiques of TTA

• Planning and Execution Challenges: Difficulty in achieving accurate patellar tendon angle.
• Meniscal Tear Rate: Higher rate of tears reported with TTA (28% vs. 4% with TPLO).

TTA (Presented by Andy)

Rationale for Choosing TTA

• History: Evolved from other techniques, saw potential in TTA early on.
• Rapid Recovery: Notable for quick recovery in cases, especially in young dogs.
• Meniscal Management: Opted not to release meniscus to reduce injury rates.
• Complications: Zero percent infection rate, never had to remove implants.
• Execution: Planning is reliable with experience, execution requires precision.

Critiques of TPLO

• Complications: Historically high infection rates with older stainless steel plates.
• Meniscal Release: Seen as unnecessary and harmful.

Discussion Points

Experience of Surgeons

• Importance of surgeon experience in outcome quality.
• Need for detailed pre-and post-operative radiographs for study validation.

Dogs with Excessive TPA

• TPLO Approach: Calculate safe rotation, combine with cranial closing wedge if necessary.
• TTA Approach: Larger advancements needed but feasible even with high slopes.

Meniscal Release

• Neither Mike nor Andy practice meniscal release; prefer handling meniscal issues as they arise post-operation.

Angular Limb Deformity

• TPLO: Check for deformities and treat for best stability.
• TTA: Typically use a spacer under the cranial ear, do not usually address these deformities.

Long-Term Outcomes

• Lack of data on 10+ year outcomes for both techniques.
• Debate about intrinsic differences in causing cartilage damage.

Audience Questions and Comments

• Training Quality: Variation in training impacts technique execution.
• Bias in Studies: Highlighting issues in study biases and planning challenges.
• Call for Improved Studies: Need for studies with comprehensive planning and execution data.

Conclusion

• Ongoing debate on TTA vs TPLO with differing opinions on reliability and outcomes.
• Future directions include better individualized planning and execution to enhance outcomes.