Tibial Tuberosity Advancement (TTA)


Dr. Sharp is the only veterinarian certified by Jeff Mayo, DVM, CVLS, Diplomate ABVP, in TTA (tibial tuberosity advancement) surgery in Arkansas. TTA is considered to be the most advanced treatment for cranial cruciate disease in dogs.

The cranial cruciate ligament is located within the stifle (knee) joint and acts to stabilize the femur on the tibia. The ligament can be torn as a result of an acute traumatic event or, more commonly, it ruptures due to a slow progressive breakdown.

When the tear is sudden and complete, lameness may be severe and such that your dog refuses to bear weight on the leg. When the tear is partial or incomplete, an intermittent lameness or one that is more noticeable only after heavy exercise may be seen. Your dog may seem more lame on some days than others.

In large dogs (greater than 30 pounds), the joint usually becomes arthritic and thickens if surgical stabilization is not performed.

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Diagnosis

The diagnosis is generally made by your veterinarian during physical examination. Your veterinarian will want to know whether the lameness occurred gradually or suddenly, whether it is intermittent or continuous, and whether or not it is exacerbated by exercise.

Your dog will be observed at rest, walking and trotting. The leg will be palpated (felt) and the knee joint will be evaluated for swelling, evidence of pain, thickening, “clicking” on flexion and extension, and the range of motion (flexion and extension) determined.

Specific tests to evaluate the integrity of the cranial cruciate ligament include a cranial drawer test or a tibial compression test, which are used to determine if there is increased movement in the joint. The movement in one knee will be compared to the movement in the other rear limb.

Both stifle joints should be radiographed for comparison. X-rays may show joint swelling and various degrees of arthritis depending on the length of time the rupture has been present.

TTA Surgery

The TTA changes the mechanics of the stifle joint in order to counteract the abnormal forces placed on the joint following injury to the cranial cruciate ligament. This is the latest surgical procedure designed for treating cranial cruciate ligament ruptures.

In order to change the joint mechanics, a cut is made in the tibia along the front edge (cranial surface) where the patellar (knee cap) ligament attaches. This segment of bone is advanced a pre-determined distance and stabilized using a titanium plate and screws.

**Post-Operative Instructions

Historically, rehabilitation on knee surgeries in general has been limited to one common recommendation – cage rest!

Veterinarians have been reluctant to allow their patients to perform even the slightest of exercise movements post-operatively, for fear that the patient will ruin the work (and expense) already performed. If we have learned one thing from human medicine, the sooner the patient is up and using the leg, the quicker will be the recovery. There is only one modification to this thought that should be stated here, if the leg does not hurt, the dog will use it, and premature overuse of the leg will result in critical damage to the proper healing process. We cannot overemphasize enough, do not let your dog run loose until the doctor has pronounced the surgery a success.

First Two Weeks: The first couple days when your pet comes home, the pain will be the worst. Why? Dogs are pretty smart, and they figure out right away that when they act like they are in pain, they will get more attention from their owners. It is important to not let your pet loose to run freely, particularly up and down stairs without assistance. They can go outside ON A LEASH to go to the bathroom, and then they must return inside and rest.

  1. First 48 hours – ice packs 3-4 times daily for 10-20 minutes. This will help significantly with the swelling.
  2. Pain medication – as written by the doctor. If this is not working, do not overdose, call the office for further recommendations or additional medications.
  3. After 48 hours, apply heat to the area 2-3 times daily for 10-20 minutes. Afterwards, begin GENTLE range of motion of the leg that was operated on after the heat pack has been applied. If you are not clear about this, ASK!
  4. No other exercise is recommended for the first two weeks.

Clean the wound daily if needed with diluted surgical scrub, and do not allow the dog to lick it. If he attempts to lick the wound, please get an e-collar.

Second Two Weeks: At this point, walking on leash is tolerated.

  1. Pain medication – should be off of prescription medicine, however, if additional pain medicine is needed please contact your veterinarian for recommendations.
  2. Apply heat to the leg for 20 minutes, then exercise the leg through range of motion.
  3. Walking on a leash is acceptable, but begin with one block and stop. If the dog returns home and is not in pain, you may increase this in 1 block increments every 4-5 days as tolerated, provided your dog is not in pain when the walk is over.
  4. While walking, push the dog’s hips towards the operated leg slightly to help convince him/her that the leg can be used.

Lift the front end of the dog for 5 second intervals prior to starting the walk to increase the strength of the leg. Try several repetitions.

Third Two Weeks: By this time, walks should be in the 20 minute range or better, and tolerated well. Do not run yet. Increase the duration of walking as much as you can without causing the dog pain. Do not exceed the 20 minute range.

If you have access to a pool, some hydrotherapy is OK, but NOT unattended nor allowed to swim in water over the dog’s head. Any hydrotherapy over 10 minutes is more likely to exaggerate patellar tendon inflammation and result in lameness.

Fourth Two Weeks: At the end of this period, it is time to come in for the follow up x-ray. We want to make sure everything has healed prior to increasing the exercise as tolerated. Be forewarned that if you just go home and turn the dog loose, he will be in pain. This is the point where you can SLOWLY build back up to full exercise.

*Information on this page is adapted from information provided by PetPlace.com and the University of Florida College of Veterinary Medicine under the “Fair Use” Act.

**Post Operative Instructions are provided by Jeff Mayo, DVM, CVLS, Diplomate ABVP. For more information on TTA and Dr. Mayo, visit JeffMayoDVM.com