Your Dog's Cranial Cruciate Ligament

The cranial cruciate ligament (CCL) is one of two ligaments in a dog's knee. This band of connective tissue helps connect the femur and tibia (the bones that are situated above and under the knee), allowing the knee to function. This ligament is also the one most susceptible to injury.

A dog's CCL is similar to the anterior cruciate ligament (ACL) in people. Just like a human's ACL is often subject to tears, a dog's cranial cruciate ligament can also rupture, either suddenly (acute rupture) or tear slowly, gradually worsening until a complete rupture happens.

Tibial Tuberosity Advancement (TTA) Surgery

Tibial tuberosity advancement surgery is less invasive than other types of surgical procedures used to treat a torn CCL, such as TPLO surgery (Tibial Plateau Leveling Osteotomy).

When a vet or veterinary surgeon performs TTA surgery, the front part of the tibia is cut and separated from the rest of the bone. Next, a special orthopedic spacer is screwed into the space between the tibia's two sections to move the front section forward and up.

By doing this, the patellar ligament, which runs along the front of the knee, is shifted into better alignment and helps to prevent much of the abnormal sliding movement. Once this process has been completed, the vet will attach a bone plate to hold the front section of the tibia in its proper position.

Tibial tuberosity advancement surgery is typically recommended for dogs with a steep tibial plateau (angle of the top section of the tibia). Your veterinarian will evaluate the geometry of your dog's knee to decide if TTA surgery is the best surgical treatment option for your dog's torn CCL.

What Does TTA Surgery for Dogs Involve?

Your veterinarian will begin by assessing your dog's knee to assess the extent of the injury, how severe it is, and if TTA surgery is the best option for your dog's treatment. Your vet may conduct some of the following tests:

X-rays of the tibia and stifle
Laboratory analysis of fluid drawn from the knee
Palpation (your dog may be sedated or given light anesthesia for this)

Your dog's surgery may be scheduled on the same day these tests are done, or at a later date.

During the surgery, your dog will be sedated with anesthesia and your vet will provide your pup with antibiotics and pain killers during the procedure. The vet will clip your dog's limb from the level of their hip to the ankle. Before the surgery starts, they will ten make a small cut or incision in the knee to be able to inspect its internal structures. The damaged parts of the cartilage are then removed and any remaining ruptured ligaments will also be shortened.

At the end of your pup's surgery X-rays will be taken to evaluate the angle of the top of the shin bone (the tibial plateau) in relation to the patellar tendon and to inspect the position of the implant.

After the surgery, your dog may be given a bandage, and oftentimes patients can go home the day after their TTA procedure.

How Much Will My Dog's TTA Surgery Cost?

The cost of TTA surgery for dogs can differ significantly depending on:

Your dog's size and weight
The location of your vet clinic
Which pre-surgical examinations and diagnostic tests may be required
The expertise of the vet or veterinary surgeon performing the procedure, and
What type of post-operative care and rehabilitation may be needed, including medications, followup visits, and physical therapy

After Surgery Care

Your dog's rehabilitation after their surgery may take several months and it's imperative to follow the post-operative care instructions your vet gives you carefully. Your vet will prescribe a course of antibiotics and painkillers at the time your dog is sent home after their surgery. If your dog has a habit of licking their wound they may also need to wear an Elizabethan collar while the incision site heals.

You will need to visit your vet during the first couple of weeks following your dog's surgery so they can check in on the recovery process, as well as remove any sutures.

It's imperative to your dog's recovery that you restrict their activity and movements, limiting it to toiletry purposes only. You must keep them on a leash to prevent any running, stair climbing, and jumping. When they are off of their leash you must keep your pup in a small room or pen to prevent these movements. After several weeks have passed you may gradually increase your dog's activity and movement.

After approximately 6 to 8 weeks have gone by since your pooch's procedure you will have a follow-up appointment with your veterinarian. At this visit, your vet will monitor the function of your dog's leg, take X-rays to assess the healing of the cut bone, and provide you with advice about increasing your dog's daily activity. Additional tests and evaluations may be recommended based on your dog's individual case.

The Benefits of TTA Surgery in Dogs

There are a handful of benefits for dogs that have their torn CCL treated with Tibial Tuberosity Advancement surgery including:

Increased range of motion in the knee
Faster healing time than with some other surgeries used to treat CCL tears
90% surgery success rate
Dogs can return to their normal activities quicker

Risks of TTA Surgery

While the success rate is high and most dogs go on to make a smooth and complete recovery there are several complications associated with TTA surgery including:

Infections
Fractures
Loosening implants

Another possible complication occurs in a very small percentage of dogs that have undergone TTA surgery without having injured cartilage, where they later go on to tear their CCL and require a second surgical procedure to have the torn cartilage removed.

Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet's condition, please make an appointment with your vet.

TTA Surgery for Dogs With Cruciate Ligament Rupture