Allegheny Veterinary Associates,PC common orthopedic injury in veterinary medicine. Furthermore, your pet’s weight will likely be shifted 2. Why or how did my dog’s cruciate liga-ment

TTA Frequently Asked Questions 1. My dog has been diagnosed with a torn

cranial cruciate ligament, what does that mean?

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 fe-mur (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 unsta-ble and painful. Tearing can be partial or complete and is the most common orthopedic injury in veterinary medicine. 2. Why or how did my dog’s cruciate liga-

ment tear? 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 func-tions to prevent this sliding and is therefore under con-stant 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 rup-ture. 3. My dog was fine and then suddenly couldn’t walk on one of the back legs. Is this common with tears of the CCL? Affected dogs are typically suddenly lame on one rear limb. Many are so uncomfortable that they are re-luctant to bear weight on the affected limb. While other pets have a history of having an intermittent lameness that suddenly got worse.

4. Why is surgery required and what could

happen if I don’t do surgery? 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 undoubt-edly lead to irreversible osteoarthritis. Also, when a pet uses a limb with a ruptured or even weakened CCL the femur slides backwards with noth-ing to prevent this movement. This action can dam-age 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. 5. I’ve heard about the TPLO and Lateral Su-

ture procedures, why don’t you recommend these procedures?

We do recommend these procedures in certain situa-tions. TPLO is recommended for dogs with exces-sively severe tibial slope and in situations when TTA is not feasible due to limb deformities and previous surgeries. We also recommend lateral suture proce-dures for smaller dogs and in cases where financial constraints do not allow for a more sophisticated pro-cedure.

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The tuberosity is then secured with a spacer cage and specially designed tension band plate. The osteotomy usually heals within 8 weeks post-op. 7. Does my pet have to spend

the night in the hospital? 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 medi-cations to prevent infection and ease pain. Most pa-tients can be discharged within 48 hours post-operatively and walk fairly comfortably out of the clinic. 8. Will this procedure have a negative affect

on the opposite limb? Will the opposite knee have the same problem?

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 inter-vention of the affected limb. 9. Is TTA only for large dogs? Although TTA is most commonly used for dogs weigh-ing between 30lbs and 120lbs it has been successfully used in smaller dogs. Implants are made for dogs from 10lbs to over 120lbs.

Tibial Fracture Fo llowing TPLO

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.

6. How does the TTA procedure work?

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.


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10. How does the post-operative period com-

pare to other techniques? Because the TTA involves an osteotomy in a non-weight bearing portion of the tibia, patients are com-fortable and recover more rapidly than with older techniques including TPLO. Most patients are weight bearing within 2 days. 11. Will my pet experience pain after the TTA

surgery? Some post-operative discomfort is unavoidable and all pets respond differently to surgery. All pets un-dergoing TTA receive pain management before, dur-ing, 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 dis-charge. Most clients feel their pet’s discomfort level is minimal. 12. How long does it take for the limb to heal? 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 con-trolled activity. 13. What kind of follow-up can we expect? You will need to schedule a recheck visit at 10 days post-op to remove sutures or staples. Follow-up vis-its 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. 14. How much does TTA surgery cost? 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 pre-vious procedures and requires expensive instruments and implants, we are attempting to make it as afford-able as possible so that pet owners won’t have to set-tle for a less successful alternative.

Always remember to compare the value of the proce-dure and not just the cost when price shopping.

TTA surgical procedures can be completed every weekday except Thursday. Please call for an appoint-

ment if you would like to further inquire about the TTA procedure.


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Allegheny Veterinary Associates,PC common orthopedic injury in veterinary medicine. Furthermore, your pet’s weight will likely be shifted 2. Why or how did my dog’s cruciate liga-ment