Canine TTA & TPLO Surgery

Canine ACL Repair: TTA & TPLO Surgery

The most common knee injury in the dog is rupture of the Cranial Cruciate Ligament (CCL), also frequently referred to as the Anterior Cruciate Ligament (ACL). ACL damage is also known as Anterior Cruciate Rupture (ACR) or Cranial Cruciate Rupture (CCR). This injury can occur at any age and in any breed, but most frequently occurs in middle aged, overweight, medium to large breed dogs.

This ligament frequently can suffer a partial tear, leading to slight instability of the knee. If this damage goes untreated, it most commonly leads to complete rupture and possibly damage to the medial meniscus of the knee. The meniscus acts as a cushion in the knee. Complete rupture results in front-to-back instability, commonly called Tibial Thrust, and internal rotation of the lower leg, commonly called Pivot Shift. Untreated legs usually become very arthritic and painful from the instability.

Dr. Hastain has been performing canine TPLO surgery since 2005 and is also qualified to perform canine TTA procedures in Colorado.

Read below for an explanation on some of the differences between these two procedures and for details on how each is performed.

Canine TTA Surgery
Canine TPLO Surgery
If you have any questions about our services, please don’t hesitate to call us directly at 970.453.0821 or email us your inquiry.

ACL Repair: My Choices

The canine knee joint, also known as the stifle joint, is similar to a human’s knee in many regards. The joint is made up of the meeting of the femur (thigh bone), tibia (shin bone), and the patella (kneecap). The cranial and caudal cruciate ligaments (CCL or ACL), medial and lateral collateral ligaments, and the patellar (kneecap) ligament hold these bones in place.

The top of the tibia that is in contact with the bottom of the femur is angled and sloped toward the back of a dog’s leg. When the ACL is torn, weight-bearing movement causes the femur bone to slide down this slope. Not only is this painful, but also causes the stifle to “give out” while the dog is walking. As the femur slides down the slope of the tibia, the meniscal cartilage—a cushion between the bones that acts as a shock absorber—may be crushed. In about 50% of the dogs with ACL injuries, the meniscal cartilage has been injured as well. This type of injury is often accompanied by a “click” that can be heard when a dog walks.

When the ACL is weakened or torn, the most significant long-term change in the joint is the development of arthritis. All joints with instability will develop arthritis; however the severity and the effect of the arthritis will vary from dog to dog.

Most dogs with a complete ACL tear show an immediate onset of lameness. While there may be some initial improvement over several days, there usually is a dramatic decline in limb function over time. There is no benefit gained from taking a “wait and see” approach. Stabilization of the joint soon after the injury has occurred is recommended.

The two current techniques most commonly used to treat ACL rupture or repair ar the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity advancement (TTA).

The TPLO changes the angle of the tibial plateau and has been a popular and reliable choice for surgeons and clients for the past 10-12 years. TPLO has a high success rate (about 95% of dogs return to 95-100% of normal).

The TTA is a newer technique that changes the relationship of the patellar tendon and tibial plateau angle via an osteotomy (bone cut) in a non-weight bearing area of the bone.

All animals with complete, partial or chronic tears are candidates for surgery.

Which procedure should I choose?
Our doctors would be happy to discuss the pros and cons of each procedure with you and how it relates to your specific case.

Here are a few guidelines:
* TPLO remains the highest standard of ACL repair.
* TTA is a newer ACL repair technique.
* Dr. Ed has extensive experience in TPLO surgery and is also certified to perform TTA procedures.
* TTA allows for a more rapid recovery in most dogs and is less invasive than TPLO surgery.
* By 4 months the outcome of TTA is usually equal to that of TPLO.
* If complications arise, those related to TTA are usually less devastating than with TPLO.

ACL Fast Facts:

* Average size dogs with partial ACL tears are candidates for TTA.

*A dog with a steep tibial plateau it is usually not a candidate for TTA.

* TTA is a slightly less invasive procedure than TPLO

* TTA may allow for a more rapid recovery in some dogs, although the outcome at 4 months post-op is usually equal to that of TPLO.

* TTA is a relatively new procedure for ACL repair in canines

* Post-op complications with TTA are usually less devastating than those with TPLO

More About TTA Surgery: Tibial Tuberosity Advancement

The TTA procedure involves making a cut in the front part of the tibia bone (tibial tuberosity) and advancing this portion of bone forward in order to realign the patellar ligament so that the abnormal sliding movement within the knee joint is eliminated.

A specialized bone spacer, plate and screws are used to secure the bone in place. Bone graft is collected from the top of the tibia and placed in the gap in the bone to stimulate healing.

The TTA procedure should not be used in dogs that have a steep tibial plateau, therefore your dog’s surgeon will make a decision which procedure is the best option for your companion.

The TTA is a somewhat less invasive surgery and gives similar results to the TPLO. Dogs that receive the TTA procedure will recover quicker initially, however, by 4 months after surgery both procedures have similar outcomes.

Below is an outline of how TTA or Tibila Tuberosity Advancement procedures are completed.

More about TPLO: Tibial Plateau Leveling Osteotomy

TPLO is the abbreviation for tibial plateau leveling osteotomy. TPLO Surgery for dogs is used to treat cranial (or anterior) cruciate ligament rupture (CCL or ACL) in dogs. It involves changing the angle of the top of the shin bone (the tibial plateau) by cutting the bone, rotating it, and stabilizing it in a new position with a plate and screws.

TPLO surgery first involves examining the ACL tear using a small arthroscope to document the type of tear and to remove the torn portion. Then the medial and lateral meniscus cartilages are examined for tearing. If a tear of either meniscus is found, the damaged part of the meniscus is removed using small instrumentation while viewing through the arthroscope.

Next a curved cut in the top of the tibia bone (osteotomy) to include the tibial plateau is made with a saw. The tibial plateau is then rotated along the curved osteotomy in order to change the slope of the top of the tibia according to a predetermined calculation. Next a plate and screws are inserted to hold the tibial plateau in place so the bone can heal.

For the past 10 – 12 years, TPLO has been the surgery of choice for ACR rupture or repair. Today, TPLO remains the number 1 choice of doctors for canine knee repair.

Below is an outline of how TTA or Tibila Tuberosity Advancement procedures are completed.

TPLO Fast Facts:

*TPLO surgery remains the trusted ‘gold standard’ of ACL repair in canines

Benefits of TPLO surgery include:
* a consistent recovery
* better range of motion of
the joint
* development of less
* return to athletic or
working activity

* TPLO yields the best results for virtually all dogs with ACL rupture, whether the patient is a Yorkie or Saint Bernard.

*Results with TPLO and TTA at 4 months post-op are usually equal.

* All animals receive a morphine epidural to ensure post-operative comfort.