There are many different methods to treat cruciate ligament rupture, and some are more suited to certain patients than others.

Triple Tibial Osteotomy

The triple tibial osteotomy involves reshaping the top part of the tibia to flatten the tibial plateau as well as achieve some advancement of the tibial tuberosity. In this way, the TTO is a hybrid of the tibial plateau levelling osteotomy (TPLO) and the tibial tuberosity advancement (TTA). These two principles work together to compensate for the lack of a functional cranial cruciate ligament. Three cuts are made in the tibia (triple tibial osteotomy) to remove a small wedge of bone. Once this wedge has been removed, the top of the tibia is collapsed onto the bottom of the tibia and the pieces of bone are held together using a stainless steel plate and several screws.

Triple tibial osteotomy in a small dog using a 2.4mm locking plate

Post-operative appearance of a triple tibial osteotomy in a large breed dog.

(This patient also had a medial collateral ligament rupture that needed repair with a spiked washer and screw in the distal femur and eyelet screw in the proximal tibia and prosthetic ligament running between them).

Lateral fabellotibial suture

Also called “modified de Angelis”, essentially acts like replacing the handbrake in a car with a broken handbrake.