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                   515JoDinetnStaulrEgqeuryipment & Instrumentation
Triple Tibial Osteotomy
A cruciate management technique
combining tibial plateau levelling and tibial
tubercle advancement.
Based on the work of Slocum,Tepic and Montavon, the Triple Tibial Osteotomy has been developed by Dr Warrick Bruce to overcome some of the problems encountered in the Slocum TPLO technique, the Montavon TTA (Tibial Tubercle Advancement) and the closing wedge TPLO technique.
Multi Saw
One of the advantages of the TTO (and TWO) procedure is that it uses simple flat blades which are easily replaced when they become blunt.The TTO uses a saw guide to direct the saw very accurately ensuring a ‘good fit’ once the osteotomy is complete. Surgical air or battery driven saws are ideal for the procedure but the Multi Saw with a sterile shroud and convertor works very well. Make sure that the blade selected fits through the saw guide (cut thickness less than 1.0mm)
TTO Starter Kits
   Some of the problems include:
Work by Tepic suggests that the tibial plateau should be perpendicular to the patella ligament to minimise shear strain at the CrCL.The Slocum technique does not always address this issue.
The bi-radial Slocum blade is inefficient and difficult to resharpen resulting in the generation of significant amounts of heat which leads to delayed healing and other complications.
The Montavon TTA technique creates a large defect in the cranial tibia which requires an expensive titanium cage and plate to prevent collapse during the healing phase.
The closing wedge TPLO shortens the tibia and creates a defect in the tibia which has to be protected from the pull of the straight patella ligament by a figure of eight wire.
The TTO technique deals with all of these problems:
A long osteotomy is made in the tibial crest to allow the tibial tubercle to move forward.The angle correction is made by making a small wedge osteotomy in the caudal tibia which, when closed creates a small tibial tubercle advancement.
TTO Basic Starter Set plus Multi Saw Kit contains:
• TTO Basic Instrument Set
• Very Large Fragment Forceps
• Tissue Protector 2.0mm
• 10 x TTO Plates (common sizes)
• Arthrodesis Wire (1.6mm x 10)
• Multi Saw Surgical Kit
• 2 x Sagittal Saw Blades
• Plate Overlay Acetate
 Osteometer and Saw Guide
Three Osteotomies
TTO Starter Set Basic
TTO Starter Set Enhanced
TTO Starter Set Basic plus Multi Saw Kit TTO Starter Set Enhanced plus Multi Saw Kit
Case Warrick Bruce
An Enhanced Kit with the Improved TTO Osteometer and the new Clasper is also available. Both Kits are available with or without the Multi Saw Surgical Kit.All Starter Kits are discounted by at least 10% compared to the component price.

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