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TTA - Frequently Asked Questions
My veterinarian just told me
that my dog has a torn anterior cruciate ligament, what does
that mean?
The cranial cruciate ligament (CCL)
is one of two ligaments that
cross inside the knee joint. The
cruciate ligaments function to
prevent the femur and tibia from
sliding back and forth on each
other. Your pet has torn one of
these ligaments and this causes
the joint to be unstable and
painful. Tearing (partial or
complete) of the CCL is one of
the most common causes of
lameness in the dog.
Why did my dog's anterior cruciate ligament tear?
The top of the tibia is the
tibial plateau. During weight
bearing, the tendency of the
femur is to slide down the
tibial plateau. The CCL stops
this downward slide, and
therefore, is under constant
tension during weight bearing.
This bio mechanical stress on
the ligament leads it to fray
and eventually tear or rupture.
Less commonly the ligament may
be torn due to an injury to the
leg.
My dog was fine and then
suddenly couldn't walk on one of
the back legs. Is this common
with tears of the anterior cruciate ligament?
Affected dogs typically become
suddenly lame on one rear limb
to the point that they can
hardly bear weight on it. Some
of these pets may have a history
of milder lameness in the same
limb that seemed to come and go
before this sudden worsening of
symptoms.
Why is surgery required and
what if I don't do surgery?
Inflammatory factors released
from the torn ligament and
instability from loss of a
functioning CCL can lead to
arthritis developing quickly
within the joint. Also, when the
ligament is weakened or
ruptured, every time the pet
bears weight on the affected leg
the femur slides down the tibial
plateau with nothing o halt its
movement. This sliding action
damages a cartilage cushion in
the joint called the meniscus.
Once the meniscus is torn
arthritic change accelerates and
perceived pain worsens. The TTA
involves an osteotomy (a cut
made in bone) in the non-weight
bearing portion of the tibia,
just behind the tibial
tuberosity. The tibial
tuberosity is advanced to align
the patellar tendon
perpendicular (90 degrees) to
the tibial plateau slope. This
new alignment eliminates the
need for an CCL and results in a
stable joint. The advanced
tibial tuberosity is secured
using titanium implants. A bone
graft is packed in the open area
of the osteotomy to speed up
healing which takes about 8
weeks.
Someone told us about the TPLO
procedure, why don't you
recommend that surgery?
Over the last decade a better
understanding of the
biomechanics of the knee joint
led to the development of a
breakthrough surgical procedure
known as TPLO (tibial plateau
leveling operation). The entire
tibia is cut and rotated in such
a way that the natural weight
bearing of the pet stabilizes
the knee joint.
Results with TPLO have been
encouraging, however, the
dramatic cut and rotation of the
weight bearing tibia can and
sometimes does result in
serious, even catastrophic,
complications. Dr. Mann has
been trained in this technique
as well as the one we now
recommend (TTA) and our belief
is that the new technique is
less invasive, has fewer serious
complications, has a quicker
recovery, and has an anticipated
better outcome.
How does the TTA procedure
work?
Research shows that if the angle
between the patellar tendon and
the tibial plateau could be
reduced to a perpendicular (90
degree) angle, then weight
bearing strain would be
redistributed so that the joint
would be stabilized and the CCL
would not be needed.
Does my pet have to spend the
night in the hospital?
In most cases we like to keep
the patient one night.
Will this procedure have a
negative affect on the opposite
leg?
No. TTA repair of CCL tears has
no negative affect on the
opposite leg. In fact, early TTA
repair and subsequent early
return to function in the
affected leg may decrease the
stress on the unaffected leg.
Will the opposite knee have
the same problem?
Forty percent of all dogs with
CCL rupture on one side will
develop the same problem on the
opposite side sometime in the
future. The most effective ways
to decrease this percentage are
early surgical repair of the
first leg to allow for even
weight distribution and weight
loss in overweight dogs.
Is TTA only for large dogs?
No. Small breed dogs also have
an excellent outcome following
TTA
Is the postoperative period
more difficult following TTA
than following other techniques?
Absolutely not. Because the TTA
involves an osteotomy in a
non-weight bearing portion of
the bone, patients are very
comfortable and recover more
quickly than with all older
techniques. Most patients are
weight bearing in 24 to 48 hours
after surgery.
How long does it take for
the leg to heal?
The osteotomy takes 8 weeks to
heal. During this time your pet
can have a reasonable amount of
short-leash controlled activity. |
