Tibial Tuberosity Advancement

Rupture of the Anterior Cruciate Ligament (ACL) in the knee is the most Orthopedic Injury in the Dog

How the does the Tibial Tuberosity Advancement (TTA) Works?

During weight bearing, the femur slides down the tibial plateau. The Anterior Cruciate Ligament (ACL) acts against this downward force. Dogs having a more steep slope are more predisposed to rupturing the ACL. A more perpendicular angle between the tibial plateau and the patellar tendon will result in a more stable joint.

The TTA corrects for this slope by adjusting the angle between the tibial plateau and the patellar ligament. This technique offer more advantages than other surgical techniques by being less invasive and faster to perform. The patients undergoing this procedure don’t need to wear any bandage when going home. By advancing the tibial tuberosity in a ACL deficient knee, the patellar ligament is adjusted perpendicular to the tibial plateau. This eliminates the tendency of the femur to move downward over the sloped tibia.

The tibial tuberosity is osteotomized with a special saw and advanced using a special titanium cage. This cage is secured by screws and acts as a bone expander. To achieve final stability a titanium plate is secured to the tibial tuberosity by a titanium fork. The plate is secured to the tibia by two more titanium screws.

FAQs About TTA:

Q: Does my dog really needs to have surgery? Can I just restrict its activity and use pain medication or glucosamine?

A: Our goal is to return your dog’s knee to the same level of function it had previous to be injured. Currently the only option to achieve complete return to normal is surgery. Alternative methods of treatment are available that can help the patient to cope with the pain and long term inflammation suffered when the knee becomes unstable after the ligament damage. Arthritis will be an inevitable consequence from this injure and could be seen as soon as 6 months to 1 year after the initial insult. Once the joint develops arthritis the prognosis for repair and return to normal is poor.

Q: My friend told me that their dog had the same problem and that after a while it was able to walk again with out limping so bad.

A: After approximately 1 year of the initial injury to the knee the joint capsule and the tissue surrounding it will suffer fibrosis. Extra scar tissue will form in response to the chronic inflammation of the joint (arthritis) that will provide extra support to the affected knee. The mobility of the knee will be affected and your pet will be able to walk but not to run, jump and play as before the injury to the ACL. We unfortunately see this patients gaining weight and eventually injuring the opposite joint a few months to years later. The prognosis for those patients is very poor even if the TTA is performed then. The cost involved in giving oral medications to control arthritis for the rest of the life of the dog will be greater than any money spent in the surgery. Also it is very possible that they will suffer damage to the medial meniscus since the knee is not stable any more.

Q: How much pain is my pet going to experience in the post operative?

A: Your pet will experience minimal pain. We use the new ultrasonic device Harmonic Scalpel for the procedure that leads to no bleeding and less post op pain associated to less soft tissue damage. Intra operative pain medication (Hydromorphone and Fentanyl) is used as well as additional pain medication to go home ( Tramadol and NSAID’s). All patients returning for suture removal are bearing weight on the knee 14 days post op.

Q: Is the postoperative period more painful compared to other procedures like TPLO?
A: It is less painful. The TTA is performed in a non-weight bearing portion of the bone. All the patients are very comfortable in a short time.

Q: Which one do I choose the TTA or the TPLO?
A: The TPLO has been performed for over 10 years and it was the best technique available for repair of the diseased ruptured cranial cruciate ligament. Unfortunately it is more invasive and requires more patient confinement and a longer recovery (the osteotomy of the tibia is done on the weight bearing part of the bone, technically the TPLO can be seen as a fracture repair from the proximal tibia) when compared to the TTA. There are cases where the TTA is not recommended and the TPLO is the only acceptable technique.

Q: How long does it take for my pet to be back to normal activity?
A: The osteotomy takes 6-12 weeks to heal. The recovery is associated to the length of time between injury to the ACL and the surgery. Muscle atrophy on the affected knee my lead to longer recovery time. The great majority of dogs are able to run again between 8 and 12 weeks.

Q: Will my dog injure the other knee in the future?
A: 40 to 50 % of dogs with ACL rupture in one knee will experience the same problem in the opposite knee. The best way to decrease the percentage is to perform the TTA as soon as possible to avoid over load of the healthy knee.

More questions? Please give us a call at (949) 859-2101.