Surgical Correction of Cruciate Ligament Injuries
Impressive Results:
- Currently employed by over 300 surgeons worldwide
- Over 18,000 procedures completed to date
- Minimal complications, possibly fewer than any previous CCL procedure
- Rapid recovery as the osteotomy is made in non-weight bearing bone — weight bearing usually resumes within 72 hours post-op
- After full recovery, weight bearing returns to nearly 100%
Research shows that if the angle between the patellar tendon and the tibial plateau could be reduced to 90 degree then the weight bearing forces would be redistributed so that the knee would be stabilized and the CCL no longer necessary.
Unlike TPLO, TTA involves a cut or osteotomy in the non-weight bearing portion of the tibia. The tibial tuberosity is then advanced to achieve a 90 degree angle between the patellar tendon and tibial plateau.
This new alignment eliminates the shear forces acting on the CCL and thereby eliminates the need for a functional CCL.
Although TTA and TPLO produce similar biomechanical changes TTA does so without invading the weight bearing aspect of the knee joint.
This change in technique helps eliminate serious complications sometimes encountered with other procedures such as TPLO.
Although no surgery is without risk it is our belief that TTA is very effective while safer than alternatives and may soon be regarded as the standard for CCL repair.
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TTA...State of the art cruciate ligament repair
Rupture of cranial cruciate ligament (CCL) is one of the most common causes of hind limb lameness in dogs.
Affected dogs typically become lame on one rear limb to the point that weight bearing is limited or absent. Although, concurrent rupture or tearing of the CCL in both limbs has been documented and does occur. Some patients may have a history of milder intermittent lameness before worsening to the point of having an obvious limp.
The intact CCL primarily functions to stabilize the knee joint by limiting forward motion of the tibia (tibial thrust). Normal weight bearing forces can push the femur toward the back of the tibial plateau. The intact CCL stops this backward motion and this places the CCL under constant load when weight bearing.
These constant biomechanical forces can lead to fraying, tearing, and rupture of the CCL.
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Effects of the ruptured CCL
Once the CCL is injured or deteriorates, a combination of inflammatory products and instability within the knee can cause arthritis to develop rapidly. If this damage goes unabated it can lead to meniscal tears and irreversible osteoarthritis.
When the CCL is ruptured knee stability is lost and the femur and tibia slide against each other and can produce tears within the meniscus. Meniscal tears are a common complication of CCL rupture and are a significant source of pain for the dog with an injured ligament.
Animals with injured and painful knees also tend to shift their weight to the unaffected limb. It is believed that this weight shift if left untreated places undue stress on the CCL of the opposite limb. This may eventually lead to injury and disease of the opposite limb.
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Ruptured CCL Sugery
The treatment of choice for CCL rupture is surgery. It has been proven that surgery will improve the weight bearing ability and reduce perceived pain no matter which procedure is used. Conversely, treatment without surgical intervention will undoubtedly lead to advanced osteoarthritis and limited use of the limb. Modern surgical treatment options include a lateral suture method, TPLO (Tibial Plateau Leveling Osteotomy), and most recently TTA (Tibial Tuberosity Advancement).
Lateral Suture Technique
The lateral suture method involves placing a heavy suture on the outside of the joint to mimic the torn CCL. This method works well for smaller pets and can be used in larger animals when other methods are not applicable.
TPLO
Developed over the last decade, the TPLO procedure changes the biomechanical forces of the joint. A cut (osteotomy) is made in the tibia directly under the femur and the tibial plateau is rotated in such a way that natural weight bearing stabilizes the knee.
Results of TPLO have been encouraging and many patients have significant improvement following this procedure.
However, due to the dramatic cut and rotation of the weight bearing portion of the tibia serious and even catastrophic complications can and do occur.
The most recent published complication rate of TPLO has been near 28%.
TTA — The newest breakthrough in CCL repair
The latest research into the biomechanics of how the knee functions has led to the development of another less invasive procedure with excellent results. This new procedure is known as TTA (Tibial Tuberosity Advancement).
