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In the 1980s Barclay Slocum reasoned that changing the angle of the tibial plateau would modify the forces acting upon the cruciate deficient stifle so that under load the stifle would be stable.
Slobodan Tepic considered the Slocum model of stifle biomechanics too simplistic and factored in many other muscles and tendons acting on the stifle. He concluded that, rather than correcting the tibial plateau to any arbitrary angle, the relationship of the tibial plateau to the straight patella ligament was more significant. By bringing the tibial plateau to sit at 90 degrees to the straight patella ligament the resultant forces acting on the stifle were effectively neutralised when the stifle
Tepic and Montavon in Zurich have devised a procedure which, rather than rotating the tibial plateau, makes the necessary adjustment by advancing the tibial tubercle until the 90 degree relationship is achieved. The resulting construct is stabilised using a system of cages, plates and screws. This procedure is known as Tibial Tubercle Advancement (TTA).