One of the most common injuries that our domestic pets suffer is the knee injury of a dog or, in a somewhat rarer case, cats. To be more specific, we are talking about rupture of the Cranial Cruciate Ligament (CCL) which is sometimes called the Anterior Cruciate Ligament (ACL) as well. This is something can happen in any breed but is mostly associated with with overweight, middle age, medium to large breed dogs. This ligament can also be only partially torn and provoke only a slight instability of the knee. If this state is left untreated it can easily lead to complete rupture and possibly provoke damage to the medial meniscus of the knee. This part of the knee has a role of a cushion. If it raptures completely it will result in front-to-back instability (Tibial Thrust) and internal rotation of the lower leg (Pivot Shift). If the legs are left untreated there is a high risk of arthritis and pain from instability.
The only way to treat an injured Cruciate Ligament is by undergoing a surgical treatment. There are numerous different methods: External Capsular Repair, Tibial Plateau Leveling Operation (TPLO), TightRope Procedure and Tibial Tuberosity Advancement (TTA). In this article we are going to cover the last technique. TTA surgery is the newest procedure and probably the best option in most cases. It was developed by Dr. Slobodan Tepic and Professor Pierre Montavon in Zurich, Switzerland during the late 1990s.
The description of the treatment
The only way to successfully correct CrCL deficient stifles is by going to the TTA surgery. The main goal of this treatment is to advance the tibial tuberosity. This changes the the angle of the patellar ligament and neutralizes the tibiofemoral shear force in the moments of weight bearing. By using the microsaggital saw the surgeon cuts the Tibial Tuberosity off. In that place a special titanium cage is used for the advancement of the tibial tuberosity. To hold that tibial tuberosity in place a special titanium plate is required. With this we are neutralizing the shear forces that can erupt in the stifle that is caused by a weakened or ruptured CrCL. This way the joint will become much more stable without making any severe changes to joint congruency.
The previously mentioned statement is probably the most important reason behind the current prevalence of this method. Unlike (TPLO) Tibial Plateau Leveling Osteotomy and (TWO) Tibial Wedge Osteotomy this procedure doesn’t disrupt the primary loading axis of the tibia and is thus considered to be the least invasive technique for stabilizing the deficient cranial cruciate ligament.
This isn’t the only advantage when compared to other surgeries. For example, (TPLO) Tibial Plateau Leveling Osteotomy still allows otational instability (Pivot Shift). This might lead to the progression of arthritis with dog’s age. With TTA there is no such problem because there is much more control of the rotation by the large quadriceps muscle. Those of you who are interested in more information should definitely search the internet for comparison articles and papers.