view of TTA surgery.
view of MMP surgery.
In the early 1960’s a human orthopaedic surgeon named Maquet working in Liege, Belgium described a tibial tuberosity advancement (TTA) procedure for the treatment of knee joint arthritis. Human knee OA is a significant cause of pain and disability that is associated with loss of articular cartilage between the patella and femur. Maquet argued that advancing the tibial tuberosity would reduce patello-femoral pressure and therefore reduce the pain and disability.
During the 1980s and early 1990s the concept of managing cranial cruciate ligament (CCL) failure in the dog using osteotomies to alter the mechanics of the stifle joint appeared. The two pioneers of this work in dogs were Barclay Slocum and Slobodan Tepic who developed the tibial plateau levelling osteotomy (TPLO) and the tibial tuberosity advancement (TTA) respectively. Many tens of thousands of dogs have been treated using TPLO but since its more recent inception, TTA has become at least as popular. However, both TPLO and TTA are technically demanding surgical techniques.
TTA has some theoretical advantages when compared with TPLO. Notably, the long (weight bearing) axis of the tibia, which is cut in TPLO, is preserved in TTA. Additionally, the work of Kim, Pozzi and colleagues  showed that following TTA the stifle appears to retain a more normal femoro-tibial contact pattern. However, TTA remains an extremely complex and technically demanding surgical procedure
Fixation of the advanced tibial tuberosity relies on a multi-component cage, plate and bone-screw device along with grafting procedures to fill the considerable surgical dead space.
Serra Veterinary Hospital, Inc. has offered TTA for the management of cruciate ligament disease since 2005 with very good results and very low complication rate.
The Modified Maquet Procedure (MMP)
Orthofoam wedgeThe Modified Maquet Procedure – so named to acknowledge the instigator of these operations – uses a wedge shaped titanium implant of Orthofoam which both defines the degree of advancement of the tibial tuberosity and fixes the bone in its new place. The Orthofoam wedge can be manufactured in a range of sizes and provides a robust fixation with impressive early stability. The open porous structure encourages early in-growth of bone and removes the need to place graft/ bone substitute or similar. Initial stabilisation is achieved using a simple and inexpensive K wire and tension band. Because of the material properties of the Orthofoam, the precision of the instrumented osteotomy, the preservation of soft tissues and the high coefficient of friction between Orthofoam and bone, stability is predictable.
The MMP procedure capitalises on the known advantages of TTA. However, the MMP technique is rapid, relatively simple, reproducible and robust so most of the limitations of conventional TTA have been eliminated. MMP allows for an early return to full weight-bearing. Without the necessity to apply a plate, fork, cage and graft to the bone, morbidity and surgical time is greatly reduced, aiding the speed of recovery, reducing the cost to the client and most importantly, lowering the risk of complications and speeding their recovery.
Please don’t hesitate to call us if you would like any further information on this technique or if you want to schedule the surgery. Total cost including consultation is $3500.00 only. Cost does not include any complication or any preexisting condition that we may find after doing pre-anesthetic blood work before the surgery.