Tibial Tuberosity Advancement (TTA) is a biomechanical procedure used to treat cranial cruciate ligament disease (knee injuries) in dogs. Similar to the TPLO technique, the TTA procedure alters the stifle (knee) joint geometry to compensate for the failure of the cranial cruciate ligament (CCL).
During the procedure, the surgeon cuts the forward region (tuberosity) of the tibia (the larger, weight-bearing bone in between the knee and ankle in dogs) and uses implants to secure it in a more forward (advanced) position. This allows the patella (kneecap) tendon to carry the load of the failed CCL. A bone graft is then placed within the gap of the tibia, where the existing bone grows and heals over during recovery.
Our board-certified surgeons perform several of these surgeries per week at our Boundary Bay Veterinary Specialty Hospital in Surrey, BC, and at our sister hospital in Bellingham, Washington.
At Boundary Bay Veterinary Specialty Hospital, we recommend arthroscopy (a minimally invasive surgical technique that employs the use of a small camera called an arthroscope) to visualize inside the knee joint at the time of surgery. This allows the surgeon to examine the joint structures and surfaces for abnormalities and injuries.
Our surgeons are certified by the American College of Veterinary Surgeons (ACVS), which means they have completed an additional 4-5 years of specialized training, rigorous board exams, and must have published research in peer reviewed journals. Collectively, our surgeons have over 35 years of board-certified experience.
In dogs, the top of the tibia (shin bone) is sloped, so when dogs stand and the femur (thigh bone) pushes down on the tibia, the tibia tries to slide out from under the femur. The cranial cruciate ligament (analogous to the anterior cruciate ligament, or ACL in people) prevents this motion. The ligament also provides some rotational stability to the knee. There is also a structure inside the knee called the meniscus, that helps the tibia and femur to fit together well, and distributes the forces across the joint.
Cruciate ligament disease (CLD) is one of the most common orthopedic injuries in dogs. Over time, the cruciate ligament can degenerate, often going through multiple cycles of progressive tearing. Eventually, the ligament gets weak enough that it cannot prevent the motion between the tibia and femur, and the resulting abnormal motion causes both substantial discomfort, and potentially damage to the meniscus.
These conditions can affect dogs of any age or breed, causing joint instability (mild to severe) which can lead to arthritis, lameness, muscle atrophy, pain and wasting of the limb.
If your dog has had an acute or progressive hindlimb lameness, or is frequently getting sore on one or both of their back legs following activity, it can be a sign they have a cruciate ligament injury.
Diagnosis of CCL rupture varies from one dog to the next and may occur at the same time as other problems and sources of lameness. It is important that the surgeon evaluate each patient directly with the client present to confirm the diagnosis and determine the appropriate treatment
plan.
At BBVSH, the surgeon will perform an examination of your dog, including palpation and manipulation of their knees, and potentially take x-rays of the knee to help determine if they may have a cruciate ligament injury.
If your dog has a lameness associated with a cruciate ligament injury, your board-certified surgeon and family veterinarian can discuss the options and techniques that will work best for your pet.
Dogs will typically stay overnight with us and go home the day after a TTA, which helps reduce psychological stress on both you and your pet and keeps the final costs lower.
This 24-hour aftercare in our hospital is to ensure they are fully recovered from surgery, are comfortable on medications you can give at home, and they are starting to use the leg appropriately as the local anesthetic blocks used during surgery wear off.
During their stay, our patients are under the care and supervision of board-certified critical care specialists who have access to any of our other board-certified specialists on an on-call basis.
Recovery is relatively quick; you can expect your dog to be up on their feet and putting weight on their leg within a few days, and after a period of restricted activity defined by your veterinary surgeon, they’ll likely be able to participate in all or most of the activities they enjoyed before their CCLR symptoms first appeared. Most dogs are capable of 10-20 minute walks within four weeks of surgery, and up to 30-45 minutes by two months post-operatively.
Written instructions will be provided at the time of your pet’s discharge. Someone on your pet’s care team will go over these instructions with you.
Due to the Canada-wide TELUS phone outage, our phone lines are functioning intermittently. If you cannot reach us by phone, please contact us at info@bbvsh.com
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