| Dr. Allan Dozier has been doing general orthopedics for 35 years and has been a certified TTA surgeon since 2005. He has performed the surgery on dogs of all sizes with a wide range of ages and conditions. We only use the all titanium implants from the inventor, Kyon Inc. More Information can be obtained on their website: www.kyron.ch/current-products/tibial-tuberosity-advancement-tta/tta-principles |
| One of the most common orthopedic problems in dogs in a ruptured ligament in the knee, called an Anterior Cruciate Ligament (ACL) in humans or Cranial Cruciate Ligament in dogs. This injury causes the knee to be unstable and leads to severe arthritis if untreated. Also on the surface of the tibia is a leathery cartilage structure called the meniscus which may also be torn which would add to the lameness and arthritis. There are different surgical procedures used to repair the injured knee and not one method is best for all dogs. There are three main procedures performed these days for ACL rupture repair in dogs. |
| The simplest and least expensive procedure is called Extracapsular, lateral suture, or figure eight technique, they are all similar in that a piece of heavy suture is placed on the outside of the joint that mimics the angle of the torn ACL. We still do this procedure occasionally in some very small dogs. We know this suture material will break or become loose in all dogs some months or year down the road but we think fibrous (scar) tissue develops along the tract and around the joint which takes over the function from the loose suture. The disadvantages are that it takes longer for the patient to recover and develop use of the leg, the fibrosis that needs to develop causes more thickening of the leg. Another disadvantage is that the dog could tear this artificial ligament just like it did the original before the fibrosis takes place which would result in a failure of the surgery and it may need to be redone. |
| The latest procedure is called the Tightrope technique. This is a modification of the extracapsular method but uses a very strong braided material of gel-spun polyethylene. It is anchored in bone on both tibia and femur so is much more secure than the above procedure. Dr. Dozier is also trained in this procedure and it has for the most part relaced extracapsular surgery in our practice. |
| The other two procedures alter the geometry of the knee. Tibial Plateau Leveling Osteotomy (TPLO) involves sawing the top of the tibia and rotating the top piece until the plateau is level (which changes the weight-bearing surface) and placing a large plate on the side for stability. The procedure has good results and an acceptable complication rate. It is versatile but also more intricate and invasive than other procedures. |
| The latest of these two technique is Tibial Tuberosity Advancement (TTA). Developed by Kyon Inc. in Switzerland, it involves moving the attachment of the large patellar tendon more anterior to allow the patellar tendon to exert force to prevent th instability caused by the ruptured ACL. The joint is opened, the remnants of the torn ligament are removed, the meniscus is inspected and trimmed if it’s torn, the front edge of the tibia is moved forward and a metal plate applied so that the joint remains stable. The patients return to function quicker and the complication rate is considered to be lower than the other two procedures. It can be performed in very small dogs up to giant breeds. A recent study showed that 98.4 percent of dogs with ACL rupture presented to an orthopedic center were good candidates for TTA. More information can be obtained on their web site: |