Cranial Cruciate Rupture Surgery — Tibial Tuberosity Advancement (TTA)


The orange line shows where the tibia is cut for the advancement

The orange line shows where the tibia is cut for the advancement

The second surgery we want to discuss for cranial cruciate rupture is the Tibial Tuberosity Advancement technique.

The knee has three major bones:  the femur (thigh bone), the tibia (shin bone) and the patella (kneecap).  The cruciate ligaments (cranial and caudal) along with the medial and lateral collateral ligaments and the patellar ligament hold these bones in place.  Ligaments are extremely strong tissues that keep the leg from shifting.

A rupture of the cranial cruciate ligament will cause this whole mechanism of the knee to become moveable, painful, and typically will cause tearing of the medial meniscus which is the shock absorber of the knee.  Arthritis develops very quickly in the joint when this happen so stabilization of the joint soon after injury is recommended.

Tibial Tuberosity Advancement (TTA) is considered less invasive and similar results to a TPLO (Tibial Plateau Leveling Osteotomy).  Tibial Tuberosity Advancement initially has a quicker recovery than TPLO.

A typical joint angle between the tibia and the femur is approximately 115 degrees and TTA surgery will change the angle to about 90 degrees.  If the tibial plateau is too steep then TTA should not be used as the surgery.  Both TTA and TPLO surgeries are not usually done by general practitioners because they use specialized equipment along with specialized training.

Tibial Tuberosity Advancement surgery actually cuts the tibial tuberosity (boney projection on the front of the shin) and moves it forward.  A specialized bone spacer, plates and screws are used to hold the bone in place.  Bone graft tissue is placed in the space between to stimulate bone growth and healing.  The patellar ligament is aligned when the bone is moved and the ligament stops the abnormal movement from the rupture.

Post-surgical care is very similar to TPLO with cryotherapy, laser therapy, passive range of motion, massage, pain management and slow short controlled leash walks during the first few weeks. 

If your pet is not being treated by one of these therapies, he should be completely confined and quiet with no running, jumping, playing or climbing stairs due to the bone being fractured and needing to heal.  Rehabilitation using the above therapies along with controlled exercises can be started at about 3-4 weeks.

The rehabilitation therapy continues to increase exercises and endurance from 4-12 weeks using different modalities.  Radiographs of the surgical site will most likely be performed at 4, 8 and 12 weeks.

We at ARCC — Animal Rehab & Conditioning Center are here for your pet’s rehabilitation needs.

On a personal note, thank you to everyone for your kind thoughts and good wishes during our time of tragedy — you guys are the best.  Dr. Dicki

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