TTA Surgery for Cruciate Ligament Rupture


Why Should I Bring my Pet to Willows for TTA Surgery?

Willows is one of Europe’s leading small animal Orthopaedic referral centres treating over 1000 new patients a year. Our state-of-the-art hospital is led by internationally renowned Certified Specialists committed to providing the highest standards of veterinary care. Our team of Orthopaedic Specialists have performed thousands of surgeries on dogs with cranial cruciate ligament ruptures.

Our Orthopaedic Surgeons are supported by our multi-disciplinary team of Specialists across a number of disciplines including; Anaesthesia, Diagnostic Imaging and Emergency and Critical Care. Willows has a large dedicated team of Nurses and clinical support staff available 24 hours a day, every day of the year to provide the best possible care for your pet.


What is TTA Surgery?

TTA is the abbreviation for Tibial Tuberosity Advancement. This a surgical procedure used to treat cranial (or anterior) cruciate ligament rupture in the knee joints (stifle) of dogs. It involves cutting the top of the shin bone (the tibia), moving it forward and stabilising it in its new position.

Cranial cruciate ligament rupture is the most common cause of hind limb lameness in dogs. As a result, TTA and other operations that involve altering the shape of the shin bone are common orthopaedic procedures performed in dogs at Willows.

How does TTA Surgery Work?

Following rupture of the cranial cruciate ligament, the knee becomes unstable. When the dog takes weight on the limb this instability allows the shin bone to move forward relative to the thigh bone (femur). The knee feels as though it is ‘giving-way’ and this can cause the dog to appear severely lame.

TTA surgery changes the shape of the knee so that the pull of the quadriceps muscle helps to stabilise the joint. The knee then feels stable for the dog when weight-bearing, despite the fact that the ligament has been ruptured and not directly repaired.


Does my Dog need TTA Surgery?

Tibial Tuberosity Advancement surgery is a major procedure with possible complications. As a result, it is only performed in dogs where the benefits of surgery outweigh the possible risks, and where alternative methods of treatment are less successful.

Fig 1: X-rays showing implants following TTA surgery with advancement of the tibial tuberosity (arrow)


What does TTA Surgery Involve?

Very specific X-rays need to be obtained of the knee and shin bone. The presence and severity of osteoarthritis can be assessed and the angle of the top of the shin bone (the tibial plateau) measured to allow planning prior to surgery. The position of the cut on the bone, the amount the bone that needs to be advanced, and the size of implants to stabilise the bone in its new position can be evaluated. It may be necessary to take a sample of fluid (synovial fluid) from the knee and send it to a laboratory for analysis.

Surgery may be performed on the same as the investigations. Antibiotics and painkillers are administered at the time of anaesthesia and the limb is clipped from the level of the hip to the ankle (hock). Prior to performing the TTA a small incision or cut is made into the knee joint to enable inspection of the structures within it. Many dogs with ruptured cranial cruciate ligaments tear one of their cartilage pads within the joint (menisci) and damaged portions of the cartilages need to be removed. After cutting and repositioning the bone metal implants are placed to hold the bone in position and allow healing.

X-rays are obtained at the end of the operation to assess the new angle of the top of the shin relative to the patellar tendon and to check the position of the implants. Most dogs can go home the day after surgery.


What can I Expect if my Pet undergoes TTA Surgery?

Aftercare following TTA surgery is very important, and rehabilitation can take several months. Courses of painkillers and antibiotics are prescribed at the time the pet goes home. If the dog tends to lick the wound excessively it may be necessary to use a plastic collar. Visits to a local Vet are necessary within the first two weeks to check the wound and remove any sutures.

Exercise must be very restricted for the first few weeks to allow healing, and is primarily for toileting purposes. Dogs must be on a lead or harness to prevent strenuous activity, such as running, jumping or climbing stairs. At other times confinement to a pen or a small room is necessary with avoidance of jumping and climbing. After a few weeks, exercise may be gradually increased in a controlled manner (on a lead). Hydrotherapy may also be recommended.

A check-up will be carried out at Willows six to eight weeks after the operation, to monitor the function of the leg and knee. X-rays are obtained to evaluate healing of the bone cut (osteotomy). Depending on progress, advice is given regarding increasing exercise. Further clinical and radiographic examination may be necessary on an individual case basis.

Risks and Complications

TTA surgery is associated with potential complications including infection, implant loosening and fracture. A small percentage of dogs that didn’t have an injured cartilage at the time of TTA surgery go on to tear it at a later date. In this event a sudden increase in lameness usually develops and a second operation (key hole or arthroscopic) is necessary to remove the torn piece of cartilage. However, in the vast majority of dogs that undergo TTA surgery, knee pain is reduced and the function of the limb is markedly improved.

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