The triple tibial osteotomy (TTO) is a technique which combines the features of tibial tuberosity advancement and wedge osteotomy for the treatment of complete and partial cruciate ligament injuries in dogs.

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 basic ways to achieve this;

• advance the tibial crest (the basis of the Tibial Advancement technique described by Professor Montavon) and
  
• 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 small closing wedge osteotomy is performed and this simultaneously advances the tibial crest
Enforced rest is required for the first 6 weeks following TTO surgery. Rest should be followed by moderate exercise. Injured animal can completely rehabilitate. There are no limitations in the damaged joint and no hobbling.