Canine knee injuries, particularly cranial cruciate ligament (CCL) tears, are common in dogs and can significantly impact their mobility and quality of life. When conservative treatments are insufficient, surgical intervention becomes necessary. Two primary surgical options for addressing CCL tears are Tibial Tuberosity Advancement (TTA) and Tibial Plateau Leveling Osteotomy (TPLO). Understanding the difference between TTA and TPLO surgery can assist pet owners in making informed decisions about their dog’s treatment.
Overview of Canine Knee Anatomy and CCL Injuries
The canine knee, or stifle joint, is a complex structure comprising bones, ligaments, and cartilage that work together to provide stability and movement. The cranial cruciate ligament (CCL) is a key component, preventing the tibia from sliding forward relative to the femur. When the CCL is damaged, dogs may experience pain, lameness, and joint instability.
CCL injuries can result from various factors, including trauma, degeneration, and genetics. Common symptoms include limping, difficulty bearing weight on the affected leg, and swelling. In severe cases, surgical intervention is often necessary to restore function and alleviate pain. For more detailed information on CCL injuries and their treatment, read “Cranial Cruciate Ligament: Injuries And Repair”.
TTA Surgery
Tibial Tuberosity Advancement (TTA) is a surgical technique designed to stabilize the knee joint by altering the biomechanics of the tibia.
Prior to surgery, a thorough examination and diagnostic imaging (X-rays) are conducted to plan the procedure.
During the surgery, the tibial tuberosity, a bony prominence on the tibia, is cut and advanced forward using a specialized implant and screws. This advancement changes the angle of the patellar tendon, reducing the shear forces on the CCL and stabilizing the joint.
Implants, such as cages and plates, are used to secure the tibial tuberosity in its new position.
Benefits:
- Minimally alters the overall structure of the knee.
- This may result in a quicker initial recovery compared to TPLO.
- Suitable for dogs with less severe CCL injuries.
Potential Complications:
- Risk of infection or implant failure.
- Potential for continued joint instability in some cases.
Dogs with partial CCL tears or less severe injuries and smaller to medium-sized dogs with lower activity levels are the ideal candidates for TTA surgery.
TPLO Surgery
Tibial Plateau Leveling Osteotomy (TPLO) is another surgical option that aims to stabilize the knee by altering the slope of the tibial plateau.
Before surgery, detailed imaging and planning are done to determine the correct angle and placement for the osteotomy.
During surgery, the tibial plateau is cut and rotated to a more level position. This rotation neutralizes the forces that cause the tibia to slide forward, stabilizing the knee joint.
Plates and screws are used to fix the tibial plateau in its new position.
Benefits:
- Provides a more stable and sturdy long-term solution.
- Effective for dogs with severe or complete CCL tears.
- Higher success rate in returning dogs to their pre-injury activity levels.
Potential Complications:
- Longer initial recovery period.
- Higher cost compared to TTA.
- Risk of infection or implant-related issues.
Dogs with severe or complete CCL tears and large, active dogs requiring a strong and durable solution are the ideal candidates for TPLO surgery.
Key Differences Between TTA and TPLO Surgeries in Dogs
Surgical Approach and Techniques:
- TTA involves advancing the tibial tuberosity, while TPLO rotates the tibial plateau.
- TTA changes the patellar tendon angle, whereas TPLO alters the tibial plateau slope.
Mechanisms of Action:
- By advancing the tibial tuberosity, TTA changes the direction of the patellar tendon pull. This adjustment reduces the forward thrust of the tibia caused by the CCL deficiency. The new alignment of the patellar tendon helps stabilize the knee joint by decreasing the stress on the CCL.
- TPLO alters the angle of the tibial plateau, which effectively eliminates the forward thrust of the tibia when the dog bears weight on the leg. By leveling the tibial plateau, the knee joint becomes more stable, as the altered mechanics prevent the tibia from sliding forward.
Recovery Times and Rehabilitation:
- TTA may offer a quicker initial recovery, with your dog being able to put weight on the leg within a few days, but TPLO provides a more stable long-term outcome even though it may take several weeks before they start bearing full weight on the leg.
- Both surgeries require controlled exercise and physical therapy during recovery.
Cost Considerations:
- TPLO is generally more expensive due to the complexity of the procedure and hardware used.
- Both surgeries have high success rates, but TPLO may offer better long-term stability, particularly in large breeds and highly active dogs, due to the robust stabilization it provides.
The following factors might be an influence when choosing TPLO vs TTA.
Your dog’s size and activity level: TPLO is preferred for larger, more active dogs like Labradors, Rottweilers, Boxers, and Newfoundlands.
The severity of the injury: TPLO is more suitable for complete CCL tears, while TTA is effective for partial tears or less severe injuries.
Postoperative Care and Rehabilitation
Postoperative care is critical for successful recovery from both TTA and TPLO surgeries, although the recovery period is shorter after TTA surgery vs TPLO surgery which can take months. General guidelines for both include:
Pain Management: Administer prescribed pain medications and anti-inflammatories.
Activity Restriction: Limit activity and provide a controlled environment to prevent excessive movement.
Physical Therapy: Engage in prescribed physical therapy exercises to regain strength and mobility. You can consider making use of hydrotherapy as well.
Monitoring: Regular follow-up appointments with the veterinarian to monitor healing and address any complications.
Conclusion
TPLO vs TTA surgery for a torn ACL is all about which procedure is best to treat your dog’s specific CCL injury. Each procedure has its unique benefits and potential complications, and the TPLO or TTA choice should be made in consultation with a veterinary surgeon. By considering the dog’s size, activity level, and severity of the injury, pet owners can make an informed decision to ensure the best possible outcome for their furry companions.
Works Cited
Bergh, M.S. 2012. Complications of tibial plateau levelling osteotomy in dogs. Veterinary and Comparative Orthopaedics and Traumatology. 25(05):349–358. DOI: 10.3415/VCOT-11-09-0122.
