Tibial Tuberosity Advancement (TTA) : ACL Rupture

Anterior Cruciate Rupture

(also known as Cranial Cruciate Rupture - ccr)


  • Anterior Cruciate Ligament (ACL) rupture is the most common orthopedic problem in dogs.
  • Canine ACL rupture almost always leads to progressive osteoarthritis and is almost always debilitating if left untreated.
  • The underlying cause of ACL rupture is biomechanical stress caused by a downward sloping tibial plateau and its relationship to the patellar tendon. Stifle joint stability is achieved when the tibial plateau is perpendicular to the patellar tendon.
  • The diagnosis of ACL rupture ranges from simple to complex.
  • Palpation to identify instability is accurate in complete acute tears.
  • Approximately 50% of all dogs have partial or chronic tears without
    obvious instability.
  • Palpation, radiography and/or arthroscogt lead to an accurate
    diagnosis in nearly all cases.
  • Almost all dogs with ACL tears sit to the side (see image below).
                                                                                                                
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Choosing which ACL Repair Technique is best for your pet:

 > The TTA produces less postoperative discomfort, reddening and swelling than other ACL repair techniques including TPLO.
 
> Dogs that undergo TTA recover sooner than with other ACL repair techniques including TPLO.
 
> The TTA osteotomy (bone cut) is made in a non-weight bearing area of the tibia, while the TPLO osteotomy is weight bearing.
 
> Dogs with crooked legs and/or an extreme tibial plateau slope may be better suited for TPLO.
 
> Dr. Freedman will be happy to discuss the pros and cons of each surgery and help you make an informed decision.

FAQ's About TTA

Q: How many veterinarians perfom the TTA surgery?A:  Worldwide, there are 300 surgeons that perform this specialized surgery.

Q:  How many TTA surgeries have been performed at this time?A: To date, there have been approximately 18,000 TTA procedures performed worldwide.

Q: Does my pet have to spend the night in the hospital?A: Yes. They will be admitted for 2-5 days and released when the doctor feels it's appropriate.
Q: Will this have a negative affect on the opposite leg?A: No. Both of the current ACL repair techniques (TTA and TPLO) provide the best possible outcome with no negative affect on the opposite leg.

Q: Will the opposite knee have the same problem?A: Forty percent of all dogs with ACL rupture on one side will have the problem on the opposite side. The most effective ways to decrease this percentage are early surgical repair to allow for even weight distribution and weight loss in obese dogs.

Q: Is TTA only for large dogs?A: No. Small breed dogs also have an excellent outcome following TTA.

Q: Is the postoperative period more difficult following TTA than following older techniques?A: Absolutely not. Because the TTA involves an osteotomy in a non-weight bearing portion of the bone, patients are very comfortable and recover more quickly than with all older techniques including TPLO.

Q: Will my pet experience pain in the postoperative period?A: Minimal. All dogs undergoing TTA here are given a morphine epidural. Most clients feel their pet's discomfort level is quite tolerable.

Q: How long does it take for healing?A: The osteotomy takes 6 - 8 weeks to heal. During this time your pet can have a reasonable amount of leash activity.