Tibial Tuberosity Advancement

Dr. Knox is now performing a new procedure for cruciate ligament injury in medium and large dogs.

Rupture (tearing) of the cranial cruciate ligament (CCL) in the dog's stifle (knee) is a very common injury. (In people it is called the anterior cruciate ligament, or ACL). The ligament damage results in chronic joint instability, which rapidly leads to degenerative joint disease (DJD). Traditional procedures to surgically restore stability have involved attempts to functionally replace the CCL. This has been accomplished through the use of sutures, orthopedic wires, or bands of tissue. While in most dogs results have been very good, sometimes the outcomes have been less satisfactory in larger dogs. It is for this reason that there has been an ongoing search for more effective procedures in larger dogs.

In recent years, two newer techniques have emerged. The tibial plateau leveling osteotomy (TPLO) was released in the 1990s and has met with great success. More recently the tibial tuberosity advancement (TTA) has been introduced. Since its release in 2005, over 30,000 cases have had successful outcomes. Both procedures involve cutting and repositioning regions of the tibia (shin bone) to eliminate joint instability. While the TPLO has been available longer, the veterinary profession believes the TTA has equally favorable results now, and we expect similar results as more are done.

In the past two years Dr. Knox has received training in both techniques. Because the techniques are so similar, it seems unnecessary to be equipped to do both. Because TTA is a slightly simpler technique, and may not alter forces inside the joint as much as the TPLO, Dr. Knox has chosen TTA as his preferred procedure for medium and large dogs with CCL rupture. The cost of TTA is more than the older technique, but we feel the benefits of earlier weight bearing and less long-term DJD outweigh the additional cost.

If you have any questions regarding the TTA - or any procedure for CCL ruptures - feel free to ask Dr. Knox or one of his assistants. We are excited to be stepping into this new era of veterinary orthopedic surgery, and will be happy to answer your questions.