• The cranial cruciate ligament (CCL) is one of 2 ligaments that stabilize the knee from within the joint. The cruciate ligaments work together to prevent the femur (thigh bone) and tibia (shin bone) from sliding back and forth against each other. Your dog has torn one of these ligaments and this causes the joint to be unstable and painful. Tearing can be partial or complete and is the most common orthopedic injury in veterinary medicine.

• The top of the tibia is known as the tibial plateau. The tibial plateau may be sloped toward the back of the leg. During weight bearing, the femur tends to slide backward against the tibial plateau pushing the tibia forward (tibial thrust). The CCL functions to prevent this sliding and is therefore under constant tension when weight bearing. Also, the steeper the slope of the tibial plateau the more stress on the CCL. This biomechanical stress produces shear forces within the CCL leading to tearing and rupture.
  

• Affected dogs are typically suddenly lame on one rear limb. Many are so uncomfortable that they are reluctant to bear weight on the affected limb. While other pets have a history of having an intermittent lameness that suddenly got worse.

• Surgery is required to halt further damage to the knee and give your pet as much pain free use of the limb as possible. Inflammatory mediators are released into the joint when damage and instability are present within the joint. Without surgical correction this will undoubtedly lead to irreversible osteoarthritis. Also, when a pet uses a limb with a ruptured or even weakened CCL the femur slides backwards with nothing to prevent this movement. This action can damage the meniscus (a thick fibrous cushion between the femur and tibia). Furthermore, your pet’s weight will likely be shifted to the unaffected limb placing even more stress on the intact CCL. This can lead to undue wear and tear on the other knee. Surgery attempts to reduce these progressive and painful consequences of ruptured CCL.

• We do recommend these procedures in certain situations. TPLO is recommended for dogs with excessively severe tibial slope and in situations when TTA is not feasible due to limb deformities and previous surgeries. We also recommend lateral suture procedures for smaller dogs and in cases where financial constraints do not allow for a more sophisticated procedure. TPLO and Lateral Suture procedures have proven their merits and are recommended when they appear to be more suitable than TTA. However, TTA provides a better long-term prognosis than lateral suture for larger dogs and has potentially less complications than TPLO. In most instances, TTA is our procedure of choice.
  

• Current research shows that if the angle between the tibial plateau and the patellar tendon can be moved to 900 then weight bearing forces will be redistributed so that the CCL is not required to stabilize the joint. In short, following the TTA procedure tibial thrust is neutralized and the CCL is no longer necessary to stabilize the joint. The TTA involves an osteotomy (cut made in bone) in the non-weight bearing portion of the tibia. The tibial tuberosity is advanced to align the patellar tendon perpendicular to the tibial plateau. This creates a joint with virtually no tibial thrust and eliminates the need for the CCL. The tuberosity is then secured with a spacer cage and specially designed tension band plate. The osteotomy usually heals within 8 weeks post-op.
  

• In most instances it is best to have one to two overnight stays at the clinic. During this period your pet will be receiving intravenous medications to prevent infection and ease pain. Most patients can be discharged within 48 hours post-operatively and walk fairly comfortably out of the clinic.

• No. TTA repair has no negative effect on the opposite limb. In fact, early repair and return to function will lessen the stress on the opposite limb. Somewhere around 30% to 50% of all dogs with CCL rupture will develop the same problem in the other limb. The most effective means to reduce the odds of the other leg becoming injured is early surgical intervention of the affected limb.

• Although TTA is most commonly used for dogs weighing between 30lbs and 120lbs it has been successfully used in smaller dogs. Implants are made for dogs from 10lbs to over 120lbs.

• Because the TTA involves an osteotomy in a non-weight bearing portion of the tibia, patients are comfortable and recover more rapidly than with older techniques including TPLO. Most patients are weight bearing within 2 days.

• Some post-operative discomfort is unavoidable and all pets respond differently to surgery. All pets undergoing TTA receive pain management before, during, and after surgery. It is our goal to prevent as much pain and discomfort as possible rather than to try to alleviate it once it occurs. The main reason for the overnight stay is pain prevention and abatement. All pets receive intravenous pain medications while at the clinic and receive oral medications at discharge. Most clients feel their pet’s discomfort level is minimal.

• The osteotomy generally requires 8 weeks to fill in with new bone. During this period your pet will be allowed a reasonable amount of short-leash controlled activity.

• You will need to schedule a recheck visit at 10 days post-op to remove sutures or staples. Follow-up visits are required at 4 and 8 weeks post-op to assess healing. At the 8 weeks visit x-rays will be taken to evaluate bone healing.

• Our fee for the TTA procedure is between $2,200 and $2,500 depending on implant size and the size of your dog. This cost is a bit more than traditional lateral suture procedures which run about $1,500, but less expensive than TPLO fees which are around $3,000. Our fee includes surgery, pre and post-op x-rays, pain medications, antibiotics, anesthesia, over night stay, and 3 follow-up exams. It does not include pre-anesthetic blood work or antibiotics and pain medications that exceed 10 days use. It also does not include treatment for complications such as additional surgery, bandages, self-inflicted trauma, etc. While TTA is technically more sophisticated than previous procedures and requires expensive instruments and implants, we are attempting to make it as affordable as possible so that pet owners won’t have to settle for a less successful alternative. Always remember to compare the value of the procedure and not just the cost when price shopping.