OsteoSinter®
Vet-TTA implants
Treatment of canine cranial cruciate ligament rupture
The most common injury or pathology in canine trauma is a tear of the anterior cruciate ligament (ACL), which causes degenerative osteoarthritis in the knee joint. When the breakage is very advanced or complete, an osteotomy is applied. Its objective is to vary the biomechanics of the knee to displace the shear forces from the ACL to the PCL (posterior cruciate ligament).
Of all the different procedures for performing the osteotomy, the TTA (Tibial Tuberosity Advance) technique is the most modern. The cut is made in the tibia, but vertically, and a wedge is inserted into the cut space. The ultimate biomechanical goal is to achieve a right angle (90º) between the tibial plateau and the patellar tendon. In this way, the shear component in the total joint force is canceled, and the tension on the cruciate ligaments is canceled.
The most important advantage of the TTA technique is that the effectiveness of the intervention depends less on the skill of the surgeon than in other techniques, which is why it is gradually becoming the preferred technique.
OsteoSinter® Vet-TTA implants: description and indications
OsteoSinter® Vet-TTA implants are porous titanium wedges with attachment plate, used for the treatment of canine cranial cruciate ligament rupture using the tibial tuberosity advancement (TTA) technique.
These implants are indicated for osteotomies of the tibial tuberosity, which aim to modify the biomechanics of the knee to stabilise the joint and compensate for the loss of the cranial cruciate ligament.
An OsteoSinter® Vet-TTA implant consists of an OsteoSinter® porous titanium spacer integrated with an anodised titanium plate using screws made of grade 5 titanium. The plate is fixed to the bone with osteosynthesis screws.
• The spacer, made of OsteoSinter® material, is highly porous and induces osteointegration of the surrounding bone through the interconnected porosity, so that the implant becomes firmly fused.
• The plate is made of grade 2 anodised titanium with a thickness of 1 mm. It is both strong and deformable. Anodising eliminates the risk of corrosion between plate, spacer and screws.
• The connecting screws between plate and spacer are made of grade 5 titanium.
OsteoSinter® Vet-TTA implants allow very precise control of the amount of tibial tuberosity advancement, are easy and safe to fit, do not require cerclage, and provide the surgeon with great versatility and convenience in the procedure.
• The product is interchangeable and can therefore be used on both hind legs.
• OsteoSinter® Vet-TTA implants are initially delivered in an autoclavable kit containing the 15 sizes of spacer and plate, a Torx T5 key, an Hx 0.9 key and a saw guide. Used sizes are restocked in unit packaging in a plastic bag.
BENEFITS
Surgically less invasive
The OsteoSinter® Vet-TTA implant is easy and quick to position, is surgically less invasive, and avoids pivoting or unwanted movement of the spacer in the early stages of ossification.
Greater osteointegration capability
Thanks to the characteristics achieved, the OsteoSinter® material provides greater osteointegration capacity of the spacer than the lattice or reticular geometries on the market.
The adaptation of the implant to each patient
The shape of the plate provides the surgeon optimal angulation to be adapted to the specific tibia type and much greater surgical versatility than current solutions.
Avoids the requirement for a cerclage
The plate is designed to compensate biomechanically the traction of the patellar tendon and avoids the requirement for a cerclage.
Design-related advantages of the OsteoSinter® Vet-TTA implant
SIZES
OsteoSinter® Vet-TTA implant
Each plate allows 2 spacer sizes (established and superior) to be installed without varying the extension of the osteotomy, thereby achieving greater advancement.
| Reference | Designation(mm) [W] | Plate | Measurements | Range(Kg) | Wedge-plate screw | Ø osteosynthesis screw | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| W(mm) | α(º) | L(mm) | H(mm) | Recommended(mm) | Maximum(mm) | |||||
| P00601 | OsteoSinter® Vet-TTA4.5A x 12B x 15H |  |
4.5 | 8 | 12 | 15 | 7-12 | HexagonalM 1,2(ref. C1003235) | 2.1 | 2.4 |
| P00609 | OsteoSinter® Vet-TTA6sA x 12B x 15H | 6 | 10.7 | |||||||
| P00602 | OsteoSinter® Vet-TTA6A x 16B x 20H |  |
6 | 8.5 | 16 | 20 | 12-16 | |||
| P00610 | OsteoSinter® Vet-TTA7.5sA x 16B x 20H | 7.5 | 10.6 | |||||||
| P00603 | OsteoSinter® Vet-TTA7.5A x 16B x 20H |  |
7.5 | 10 | 16-23 | Torx M2 (ref. C1003234) | 2.4 | 2.7 | ||
| P00611 | OsteoSinter® Vet-TTA9sA x 16B x 20H | 9 | 12 | |||||||
| P00604 | OsteoSinter® Vet-TTA9A x 19B x 25H |  |
9 | 10.3 | 19 | 25 | 23-32 | |||
| P00612 | OsteoSinter® Vet-TTA10.5sA x 19B x 25H | 10.5 | 12 | |||||||
| P00605 | OsteoSinter® Vet-TTA10.5A x 19B x 25H |  |
10.5 | 11.2 | 32-35 | |||||
| P00613 | OsteoSinter® Vet-TTA12sA x 19B x 25H | 12 | 12.8 | |||||||
| P00606 | OsteoSinter® Vet-TTA12A x 22B x 25H |  |
12 | 11.2 | 22 | 30 | > 35 | 2.7 | > 3.5 | |
| P00614 | OsteoSinter® Vet-TTA13.5sA x 22B x 30H | 13.5 | 12.6 | |||||||
| P00607 | OsteoSinter® Vet-TTA13.5A x 22B x 30H |  |
13.5 | 12 | ||||||
| P00615 | OsteoSinter® Vet-TTA15sA x 22B x 30H | 15 | 13.3 | |||||||
| P00608 | OsteoSinter® Vet-TTA15A x 22B x 30H |  |
15 | 12.5 | ||||||
| Reference | Designation(mm) [W] | Plate | Measurements | Range(Kg) | Wedge-platescrew | Ø osteosynthesis screw | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| W(mm) | α(º) | L(mm) | H(mm) | Recommended | Maximum | |||||
| P00601 | OsteoSinter® Vet-TTA4.5A x 12B x 15H | |
4.5 | 8 | 12 | 15 | 7-12 | Hexagonal M 1.2 (ref. C1003235) | 2,1 | 2,4 |
| P00609 | OsteoSinter® Vet-TTA6sA x 12B x 15H | |
6 | 10.7 | 12 | 15 | 7-12 | Hexagonal M 1.2 (ref. C1003235) | 2,1 | 2,4 |
| P00602 | OsteoSinter® Vet-TTA6A x 16B x 20H | |
6 | 8,5 | 16 | 20 | 12-16 | Hexagonal M 1.2 (ref. C1003235) | 2,1 | 2,4 |
| P00610 | OsteoSinter® Vet-TTA7.5sA x 16B x 20H | |
7,5 | 10,6 | 16 | 20 | 12-16 | Hexagonal M 1.2 (ref. C1003235) | 2,1 | 2,4 |
| P00603 | OsteoSinter® Vet-TTA7.5A x 16B x 20H | |
7,5 | 10 | 16 | 20 | 16-23 | Torx M2 (ref. C1003234) | 2,4 | 2,7 |
| P00611 | OsteoSinter® Vet-TTA9sA x 16B x 20H | |
9 | 12 | 16 | 20 | 16-23 | Torx M2 (ref. C1003234) | 2,4 | 2,7 |
| P00604 | OsteoSinter® Vet-TTA9A x 19B x 25H | |
9 | 10.3 | 19 | 25 | 23-32 | Torx M2 (ref. C1003234) | 2,4 | 2,7 |
| P00612 | OsteoSinter® Vet-TTA10.5sA x 19B x 25H | |
10,5 | 12 | 19 | 25 | 23-32 | Torx M2 (ref. C1003234) | 2,4 | 2,7 |
| P00605 | OsteoSinter® Vet-TTA10.5A x 19B x 25H | |
10,5 | 11,2 | 19 | 25 | 32-35 | Torx M2 (ref. C1003234) | 2,4 | 2,7 |
| P00613 | OsteoSinter® Vet-TTA12sA x 19B x 25H | |
12 | 12,8 | 19 | 25 | 32-35 | Torx M2 (ref. C1003234) | 2,4 | 2,7 |
| P00606 | OsteoSinter® Vet-TTA12A x 22B x 25H | |
12 | 11.2 | 22 | 30 | > 35 | Torx M2 (ref. C1003234) | 2,7 | > 3,5 |
| P00614 | OsteoSinter® Vet-TTA13.5sA x 22B x 30H | |
13,5 | 12,6 | 22 | 30 | > 35 | Torx M2 (ref. C1003234) | 2,7 | > 3,5 |
| P00607 | OsteoSinter® Vet-TTA13.5A x 22B x 30H | |
13,5 | 12 | 22 | 30 | > 35 | Torx M2 (ref. C1003234) | 2,7 | > 3,5 |
| P00615 | OsteoSinter® Vet-TTA15sA x 22B x 30H | |
15 | 13,3 | 22 | 30 | > 35 | Torx M2(ref. C1003234) | 2,7 | > 3,5 |
| P00608 | OsteoSinter® Vet-TTA15A x 22B x 30H | |
15 | 12,5 | 22 | 30 | > 35 | Torx M2 (ref. C1003234) | 2,7 | > 3,5 |
The OsteoSinter® material
Ultraporous pure titanium
The OsteoSinter® material is pure titanium grade 2 according to ASTM F67, biocompatible, according to ISO 10993:2018, and manufactured by means of Power Metallurgy technology.
A special design of the manufacturing process allows to obtain a product of high interconnected porosity (62-66% in volume), an with great stochasticity of pores distribution.
The result is a material that mimics the trabecular structure of human bone and its mechanical properties.
The manufacturing process of the OsteoSinter® material guarantees a high homogeneity of porosity and material characteristics piece by piece in large serial production.
Trabecular
bone
OsteoSinter®
material
Rapid osteointegration
The high porosiy of the OsteoSinter® material and its special pore size distribution favor the osteointegration of the surrounding bones through the interconnected porosity.
The performed studies indicate that 57% of bone colonization is achieved in just 4 weeks after its implantation.
AFTER 4 WEEKS
The result is a very fast osteointegration, reaching 57% of bone colonization.
Mechanical properties
The OsteoSinter®material exhibits a mechanical behaviour very similar to bone, both in elastic modulus as in compression and fatigue strength.
It also has a high friction coefficient, which ensures high primary fixation to the bone, and great wear resistance.
| Property | Material | |
|---|---|---|
| OsteoSinter® | Trabecular bone®[1,2,3] | |
| Elastic modulus (GPa) | 2.5-3.5 | 2.0 |
| Compressive yield strength (MPa) | 40-45 | 10-30 |
| Compressive fatigue limit | 5 M ciclosa > 18 MPa sin fallo | - |
| Friction coefficient | 0.38 | 0.44-0.63 |
| Abrasion (% of weight loss at 1,000 N) | 0.34 | - |
[1] ADVANCE® BIOFOAMTM Cancellous Titanium_Tibial implants_Technical Monograph.
[2] Bobyn, J. D., Stackpool, G. J., Hacking, S. A., Tanzer, M., & Krygier, J. J. (1999). Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. The Journal of Bone and Joint Surgery. British Volume, 81-B(5), 907–914.
[3] Shirazi-Adl A1, Dammak M, Paiement G. Experimental determination of friction characteristics at the trabecular bone/porous-coated metal interface in cementless implants. J Biomed Mater Res. 1993 Feb;27(2):167-75.
REFERENCES
Samoy Y, Verhoeven G, Bosmans T, Van der Vekens E, de Bakker E, Verleyen P, Van Ryssen B.
TTA rapid: description of the technique and short term clinical trial results of the first 50 cases.
Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ
Tibial tuberosity advancement for stabilization of the canine cranial cruciate ligament-deficient stifle joint: surgical technique, early results, and complications in 101 dogs.
Voss K, Damur DM, Guerrero T, Haessig M, Montavon PM.
Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease.
Steinberg EJ, Prata RG, Palazzini K, Brown DC.
Tibial tuberosity advancement for treatment of CrCL injury: complications and owner satisfaction.
Retallack LM, Daye RM.
A modified Maquet-tibial tuberosity advancement technique for treatment of canine cranial cruciate ligament disease: short term outcome and complications.
Stein S, Schmoekel H.
Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage.
Hirshenson MS, Krotscheck U, Thompson MS, Knapp-Hoch HM, Jay-Silva AR, McConkey M, Bliss SP, Todhunter R, Mohammed HO.
Evaluation of complications and short-term outcome after unilateral or single-session bilateral tibial tuberosity advancement for cranial cruciate rupture in dogs.
Apelt D, Kowaleski MP, Boudrieau RJ.
Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study.