Dr. Allan Dozier has been performing veterinary orthopedic surgery for 40 years and has been a certified Tibial Tuberosity Advancement (TTA) surgeon since 2005. He has performed this surgery on approximately 1,000 dogs of all sizes and on a wide range of ages and conditions. Rea Road Animal Hospital only uses all-titanium implants from their inventor, Kyon Inc.
One of the most common orthopedic problems in dogs is a ruptured ligament in the knee, called an anterior cruciate ligament (ACL) in humans or cranial cruciate ligament (CCL) in dogs. This injury makes the knee unstable and leads to severe arthritis if it is not treated. Also, on the surface of the tibia is a leathery cartilage structure called the meniscus that may be torn. A torn meniscus can intensify lameness and arthritis. Most cases we see today have a degenerative condition of the ligament and are not related to trauma alone. 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 to repair an ACL rupture in dogs. The simplest and least expensive procedure is called extracapsular stabilization/lateral suture, or figure eight technique. In this procedure, we place a piece of heavy suture on the outside of the joint to mimic the angle of the torn ACL. This suture material will break or become loose in all dogs in some months or years but fibrous (scar) tissue develops that replace the loosening suture. The disadvantages are
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. The material is anchored in the bone on both tibia and femur so is much more secure than the above procedure. Dr. Dozier is experienced in this procedure, and it has, for the most part, replaced extracapsular surgery at Rea Road. Disadvantages are that even though the material is very strong it will probably eventually wear, plus the bone itself may wear where the suture exits.
Alternatively, we can 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 and perpendicular to the patella tendon, changing the weight-bearing surface. A large plate enhances stability. The procedure has good results. It is versatile but also more intricate and invasive than other procedures.
The other geometric technique is tibial tuberosity advancement (TTA). Developed by Kyon Inc. in Switzerland, the attachment of the large patellar tendon moves forward to allow the patellar tendon to exert force, preventing instability caused by the ruptured ACL. The TTA changes the forces to match the tibial slope while the TPLO changes the slope to match the forces. In all the procedures, the joint is opened, remnants of the torn ligament removed, the meniscus is inspected and trimmed if also torn. Dogs recover quicker and the complication rate is lower than the other three procedures. TTA can be performed on very small dogs up to giant breeds. A recent study showed that 98.4% of dogs with ACL rupture were good candidates for TTA.
You can find out more about the surgery and your pet’s recovery here.
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8100 Williams Pond Ln
Charlotte, NC 28277