1. Anterior Cruciate Ligament

2. -GENETIC -ENVIRONMENT -OTHER

3.  GENETIC  Conformation ▪ Stifle angle >135 deg ▪ Valgus /Vargus ▪ Medial Patella Luxation(MPL) ▪ Sloping Posterior Tibial Plateau ▪ Small Bone Structure/Muscle Mass

4. -USE/ACTIVITIES =Field Trial =Agility =Frisbee =squirrel chaser

5. -DIET/CONDITIONING -OTHER -injury -tumor

6. -Anterior Drawer Sign -Tibial Thrust -Radiography -Anesthesia

7. -Extracapsular -Non-Absorbable Suture -Artifical Ligament Implant -Geometric Altering Procedures -Aronosky “Over the Top”

8. -Tibia Plateau Leveling Operation- TPLO Licensed by Slocum Enterprises –Eugene, OR

10. -First “Break-Through” for RCCL Repair, esp. Active and Obese Patients -Allows for the Correction of Vargus/Valgus in one operation -Increases Pressure in the Posterior joint space and on the menisci -Most Invasive and Traumatic of current procedures -Most likely to require Rehabilitation - Corrects the sloping posterior tibia -Can be used when other procedures have been performed -Implants made of SS, are quite massive, limited industry standards

11. Immediate Post-op TPLO

12. 4-week Post-op TPLO

13. Tibial Tuberosity Advancement Developed by Slobodan Tepic and Pierre Montavon University of Zurich, Switzerland KYON-Zurich, Switzerland and KyonPharma, Boston

14. TTA

15.  Restores stability by adjusting joint force vectors  Maintains congruency of joint  Allows unimpeded full range of motion  Preserves primary loading axis of tibia  Increases lever arm of quadriceps force and thus reduces all internal joint reactions  Implants are made specifically for TTA and are Titanium for reduced body reactivity  Implants and instruments made in Switzerland and Germany and of highest quality and standards

16.  Requires a bone graft  Less Allowance for Technical Errors  More difficult to correct Valgus/Vargus  Potential for Non-Union is greater  Patients will weight-bear immediately upon recovery from anesthesia which lessens requirement for rehab  Unkown if Osteoarthritis is reduced but is expected to do so with current case experience  Over 40,000 cases world-wide have been performed

17.  Both require surgeon with training and experience  Both require strict aseptic techniques  Both require extensive inventory of implants  Both require Orthopedic Power Equipment  Both require extensive array of Orthopedic Instrumentation  Both require extensive Follow-Up

18.  Common Tangent of Femur Condyles and Tibial Plateau  German Method  Elimination of Tibial Thrust  Weight and Plate Size

24. Field-Trail Lab 7m0 PostSurgery TTA

25.  KYON.CH (Swiss website)  KYONPHARMA.COM(Boston)  SLOCUM ENTERPRISES.COM  JEFFMAYO.COM

26. R-9-17-08 L-11-20-09 Dates of surgery, TTA, both legs

28. Two Days Post Op Cocker Male-5yr

29. Thanks for fixing my leg, Griffen

30. STAGE ROAD ANIMAL HOSPITAL,PC James Ritchie Pearce, BS,DVM,DABVP