Mill Road Vet Hospital / Tuesday, 27 June 2017

Cruciate Surgery Tibal Tuberosity Advancement

A ruptured cranial cruciate ligament (“ACL” in humans) is the most common stifle (knee - see box!) injury in dogs. The stifle joint is held together by a number of ligaments, including the two cruciate ligaments that cross inside the joint. The cranial cruciate ligament prevents the tibia (shin bone) from slipping forward out from under the femur (thigh bone).

Typically a ruptured cruciate is seen either in a large - breed young athletic dog that injures itself playing (much like the soccer player that tears his ACL) or often older large dogs can have weakened ligaments that slowly stretch or partially tear over time. In these dogs a small jump can be all it takes to break the ligament and it’s common for the same thing to happen later on the other leg.

Left unattended the injury will invariably lead to severe osteo - arthritis due to the instability of the joint.

20 years ago veterinary surgeons used the same technique used in human ACL reconstruction; using a tendon to replace the torn ligament. The long - term success rate of this surgery in dogs was not good though, presumably due to the different stance of dogs and consequently quite different forces acting on the joint. Over the years various techniques have been developed.

In general practice the most common technique is “extracapsular repair” which utilizes a large strong suture passed around a small bone at the back of the joint and through a hole drilled in the front of the tibia. This tightens the joint and effectively takes over the job of the cruciate ligament.

In small dogs this is generally still the best option, but more and more of our large breed patients have been benefitting from more specialized surgical procedures which address the biomechanics of the joint.

The Tibial Plateau Leveling Osteotomy (TPLO) involves cutting and rotating the tibia in such a way that the natural weight bearing of the dog actually stabilizes the joint. This procedure is not performed in Whangarei.

A Tibial Tuberosity Advancement (TTA) is the latest development in cruciate surgery. It neutralizes the forward thrust of the tibia by separating the front of the tibia where the patellar ligament attaches and anchoring it in a new, more forward position with a titanium cage and a bone graft. The success of this surgery makes it a great option for most large dogs.

Mill Road’s vet surgeon Didier recently attended a workshop on TTAs in The States, we have purchased the specialized equipment required and Didier has been working away perfecting his technique. We are thrilled to now be able to offer this advanced surgical procedure to both our own canine patients and any dogs throughout Northland that would benefit from the surgery.