Tibial Tuberosity Advancement surgery is one of the less invasive ways to treat your dog's ruptured Cranial Cruciate Ligament (CCL). Find out more from our Benicia vets.
Cranial Cruciate Ligament (CCL) in dogs
The cranial cruciate ligament is one of the two ligaments in a dog's knee, it's a band of connective tissue that helps connect the femur and tibia (the bones located above and under the knee) allowing the knee to function. This is also the ligament that is most prone to getting injured.
A dog's cranial cruciate ligament (CCL) is similar to the anterior cruciate ligament (ACL) in humans and just like the rupture of the cruciate ligament in dogs, people are often subject to ACL tears.
A dog's cruciate ligament can rupture suddenly (acute rupture) or slowly tear, getting worse until a complete rupture occurs. Injury to a dog's CCL is one of the most common causes of difficulties walking (lameness). Because of this, TTA surgery and others that change the shape or structure of the dog's tibia are common veterinary orthopedic procedures.
Why could a dog need TTA surgery?
If a dog ruptures their CCL/ACL, their knee joint loses stability. When the dog puts weight on the injured limb, the tibia (shin) can slide forward incorrectly over the femur. One reason for this could be the tibial plateau (the top of the tibia) not being perpendicular to the tendon that attaches the kneecap to the top of the tibia. This leads to your pup's difficulty or inability to walk.
The aim of TTA surgery is to reposition the tibial plateau so that it is perpendicular to the kneecap's tendon and to prevent the shinbone from moving forwards. This helps the knee to feel more stable when your dog puts their weight on the compromised limb.
Although any dog of any age can injure or tear their CCL/ACL, there is some evidence that there are some breeds of dogs that are more susceptible to issues potentially needing TTA surgery, ranging from small breeds like Bichon Frise, medium- to large-sized dogs like German Shepherds, Labrador Retrievers, Rottweilers, Newfoundlands, and giant breeds like St. Bernards.
For breed-specific advice on preventing or reducing the likelihood of CCL/ACL tears in these breeds, consult with your primary veterinarian.
What happens during a TTA surgery?
If your vet suspects your dog may be a candidate for TTA surgery, they will order a number of diagnostic tests, including X-Rays of your pet's knee and shinbone. This is important for the vet to ascertain if there is the presence of osteoarthritis (and if so, how severe it is) and measure the angle of the tibial plateau. X-Rays are essential for both the planning stages (positioning of cut, how much the tibia should be moved forward, size of implants needed) and the post-surgery evaluation to ensure that the procedure was successful.
Before the surgery begins, your dog will be put under anesthesia to ensure their comfort, in addition to being provided with painkillers and antibiotics to address pain and fight infection. The limb to undergo surgery is then shaved from about hip to ankle before making a small incision in the knee to observe the joint's structures. The front of the tibia is then surgically cut before an orthopedic spacer is installed so that the front section can be moved forward and upward. Much of the sliding movement that causes walking issues will be addressed by this step. Finally, a bone plate is attached to keep the front section of the tibia in its new, corrected position. The vet or vet surgeon will then finish up the surgery, including removing the damaged parts of your dog's cartilage and any leftover ruptured ligaments.
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 procedure, your dog's surgical site might be bandaged; many patients are able to return home the day after their TTA surgery.
After your dog's TTA surgery, appropriate aftercare is essential to give your pet the best chance of fully recuperating. Your pooch's rehabilitation could take several months, during which you must follow your vet's advice carefully. Ensure you're following the dosing schedule for your dog's vet-prescribed painkillers and antibiotics, and if your dog is likely to lick or bite at their stitches they may have to wear an Elizabethan collar to prevent irritating or injuring the incision while it heals.
During recovery, your dog must be kept as sedentary as possible; remember they are recovering from major surgery and you both must be patient until the soft tissues and cut bone heal. Limit your pet's movements to toileting and eating/drinking only. This can be challenging for some pet parents, especially if your dog is energetic or active - but the risk of reinjuring or damaging the healing surgery site must be taken into account.
Keep your dog on a leash to stop them from running, climbing stairs, and jumping. When they are off-leash you must confine your pup in a small room or pen to prevent these movements. After several weeks have passed and your vet has given the go-ahead, you can incrementally increase your dog's activity and movement.
About 6-8 weeks after your dog's surgery, you will visit your vet for a follow-up appointment. During the follow-up, your vet will assess your dog's leg, including healing and function. X-rays will be taken to see how well the incision is healing, and further instructions or advice will be given. Depending on the particulars of your dog's case, additional testing might be necessary.
Benefits and risks of TTA surgery for dogs
TTA surgical procedures are considered less invasive than other procedures and provide a number of other benefits for dogs suffering from lameness or pain due to a torn CCL/ACL. As with any surgery, there are benefits and risks to consider.
Benefits of TTA surgery
- 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
- Loosening implants
- Later complications caused by TTA surgery being performed on uninjured cartilage, later experiencing injury to the CCL/ACL and needing further TTA surgery (occurs infrequently)
Dogs who have undergone TTA surgery have an excellent chance of recovering and returning to their activities with their favorite humans sooner. Talk to your vet for more information about this procedure, and whether your dog could be a candidate.
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.