Cruciate ligament tears are fairly common in dogs. Your vet may recommend tibial tuberosity advancement (TTA) surgery to treat this injury. Today, our Stockton vets explain everything you need to know about the procedure.
Your Dog's Cranial Cruciate Ligament
The cranial cruciate ligament (CCL) is one of several ligaments located in your dog's knee. This band of connective tissue connects the femur to the tibia (the bones situated above and under the knee), allowing the knee to function.
This ligament has three main functions:
- Prevent cranial displacement of the tibia in relation to the femur (cranial drawer sign)
- Prevent hyperextension of the knee
- Prevent internal rotation of the tibia
This ligament is also the one most susceptible to injury. A dog's CCL is similar to a person's anterior cruciate ligament (ACL). Just like a human's ACL, the CCL can tear. A dog's cranial cruciate ligament can also rupture suddenly (acute rupture) or tear slowly, gradually worsening until a complete rupture occurs.
Tibial Tuberosity Advancement (TTA) Surgery
Tibial tuberosity advancement surgery is less invasive than other types of surgical procedures that are sometimes used to treat a torn CCL, such as TPLO (Tibial Plateau Leveling Osteotomy) surgery.
When a vet or veterinary surgeon performs TTA surgery, the front part of the tibia is cut and separated from the rest of the bone. A special orthopedic spacer is then screwed into the space between the tibia's two sections to move the front section forward and up.
This will shift the patellar ligament, which runs along the front of the knee, into better alignment and help prevent much of the abnormal sliding movement. Once this process has been completed, the vet will attach a bone plate to hold the front section of the tibia in the correct position.
Tibial tuberosity advancement surgery is typically recommended for dogs with a steep tibial plateau (angle of the top section of the tibia). Your veterinarian will assess the geometry of your dog's knee to determine whether TTA surgery is the best surgical treatment option for your dog's torn CCL.
What's involved in TTA surgery for dogs?
Your veterinarian will examine your dog's knee to assess the extent of the injury, its severity, and whether TTA surgery will be the best treatment option. Your vet may conduct some of the following diagnostic tests to determine this:
- X-rays of the tibia and stifle (also taken to rule out other potential causes of hind-limb lameness and to evaluate the extent or arthritis in the joint)
- Laboratory analysis of fluid drawn from the knee
- Palpation of the knee (your vet will feel the knee for cranial drawer motion. While this procedure is not painful, your dog may be sedated or given light anesthesia if they are too tense to allow thorough palpation)
Patients with chronic ruptures associated with a large amount of scar tissue and arthritis may not display cranial drawer. Other signs of CCL rupture include thickening or scarring on the inside of the knee and tibial thrust (another method to check for cranial displacement of the tibia).
Your dog's surgery may be scheduled on the same day these tests are done, or for a later date.
During the surgery, your dog will be sedated with anesthesia, and your vet will provide your pup with antibiotics and painkillers during the procedure. The vet will clip your dog's limb from the level of their hip to the ankle. Before the surgery starts, they will then make a small cut or incision in the knee to be able to inspect its internal structures. The damaged parts of the cartilage are then removed and any remaining ruptured ligaments will also be shortened.
At the end of your pup's surgery, X-rays will be taken to evaluate the angle of the top of the shin bone (the tibial plateau) in relation to the patellar tendon and to inspect the position of the implant.
After the surgery, your dog may be given a bandage, and oftentimes patients can go home the day after their TTA.
How Much Will My Dog's TTA Surgery Cost?
The cost of TTA surgery for dogs can differ significantly depending on:
- Your dog's size and weight
- The location of your vet clinic
- Which pre-surgical examinations and diagnostic tests may be required
- The expertise of the vet or veterinary surgeon performing the procedure, and
- What type of post-operative care and rehabilitation may be needed, including medications, follow-up visits, and physical therapy
After-Surgery Care
Your dog's rehabilitation after their surgery may take several months and it's imperative to follow the post-operative care instructions your vet gives you carefully. Your vet will prescribe a course of antibiotics and painkillers at the time your dog is sent home after their surgery. If your dog has a habit of licking their wound they may also need to wear an Elizabethan collar while the incision site heals.
You will need to visit your vet during the first couple of weeks following your dog's surgery so they can check in on the recovery process, as well as remove any sutures.
It's imperative to your dog's recovery that you restrict their activity and movements, limiting it to toiletry purposes only. You must keep them on a leash to prevent any running, stair climbing, and jumping. You must keep your pup in a small room or pen to prevent these movements when they are off their leash. After several weeks have passed, you may gradually increase your dog's activity and movement.
After approximately six to eight weeks have gone by since your pooch's procedure you will have a follow-up appointment with your veterinarian. At this visit, your vet will monitor the function of your dog's leg, take X-rays to assess the healing of the cut bone and provide you with advice about increasing your dog's daily activity. Additional tests and evaluations may be recommended based on your dog's individual case.
The Benefits of TTA Surgery in Dogs
There are a handful of benefits for dogs that have their torn CCL treated with Tibial Tuberosity Advancement surgery, including:
- Increased range of motion in the knee
- Faster healing time than with some other surgeries used to treat CCL tears
- 90% surgery success rate
- Dogs can return to their normal activities quicker
Risks of TTA Surgery
While the success rate is high and most dogs go on to make a smooth and complete recovery, there are several complications associated with TTA surgery, including:
- Infections
- Fractures
- Loosening implants
Another potential complication occurs in a very small percentage of dogs that have undergone TTA surgery without having injured cartilage, where they later go on to tear their CCL and require a second surgical procedure to have the torn cartilage removed.
Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet's condition, please make an appointment with your vet.
