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Step by Steps


Triple Tibial Osteotomy

A Step By Step Guide

This operation is based on the biomechanical analysis performed by Dr Slobodan Tepic, which revealed that in order to remove the shear strain from the cranial cruciate ligament the tibial plateaux should be perpendicular to the patellar ligament. There are two ways to achieve this; i) advance the tibial crest (the basis of the Tibial Tuberosity Advancement (TTA) technique described by Professor Montavon) and ii) alter the alignment of the tibial plateaux to the patellar ligament to 90° (a modification of the Slocum technique). Dr Warrick Bruce reasoned that rather than doing one technique or the other, there is merit in doing a little of both to achieve the same outcome, but with less radical angular changes. In the operation of triple tibial osteotomy (TTO) a partial tibial crest osteotomy and small closing wedge osteotomy are performed; closing the wedge simultaneously advances the tibial crest.

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