The most common knee injury in canines is rupture of the cranial cruciate ligament (CCL), also referred to as the Anterior Cruciate Ligament (ACL). This injury can occur at any age and in any breed, but most frequently occurs in middle aged, overweight dogs. This ligament frequently can suffer a partial tear, leading to slight instability of the knee. If this damage goes untreated, it most commonly leads to complete rupture and possibly damage to the medial meniscus of the knee. The meniscus acts as a cushion in the knee. In about 50 % of the dogs with ACL injuries, the meniscal cartilage has been injured as well. This type of injury is often accompanied by a “click” that can be heard when a dog walks. Complete rupture of the ACL results in Tibial Thrust (front & back instability), Pivot Shift (internal rotation of the lower leg), and severe pain for your pet. If injury is left untreated, your pet will become very arthritic and painful from the instability.
An injured ACL can only be corrected by surgery. There are numerous surgical corrections that can be performed. Dr.Pearce performs all orthopedic procedures including: (1) T.T.A – Tibial Tuberosity Advancement, (2) TPLO - Tibial Plateau Leveling Operation, and (3) E.C – External Capsular Repair.
This page will focus on the T.T.A, Dr. Pearce’s favorite procedure to repair a ruptured ACL. The T.T.A is one of the newest procedures and in his opinion the BEST repair for most dogs, in that rehabilitation time and expense is seldom needed or compared to older procedures. The T.T.A procedure allows a more rapid recovery in most dogs and is less invasive than the other procedures. Dr. Pearce has performed over 160 T.T.A surgeries since 2008.
Below, we will have pictures of what a knee looks like before and after the T.T.A procedure. As well as patients and their recovery after the procedure.
Refer to our commonly asked questions below for more information on the T.T.A procedure.
If you have a question about any of these procedures please feel free to call us or email us at Stagerdanimalhospital@yahoo.com.
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Canine ACL Repair: T.T.A- or Tibial Tuberosity Advancement
When a pet comes in that is suffering from a knee injury we do what we call a "work up". We make sure that it is indeed the pets cruciate that is injured and that there are no other injuries that would slow down the healing process or stop the doctor from performing the surgery needed for this pet. We safely sedate the pet so that they can be relaxed for their exam, blood work, and x-rays.
We take X-Rays of the spine and hips to verify that there is no other injury besides the cruciate.
**All of the x-ray images below are of the same pet. This shows the progress of the healing process.**
1 month after surgery.
2 months after surgery
3 months after
4 months after surgery
5 months after surgery
6 months after surgery
***With the pre and post- op x-rays you will notice the bone growth gradually getting better within time. It normally takes up to one year for the bone to remodel. ***
Commonly Asked Questions
How is the T.T.A Procedure performed?
Before the surgery is performed, we take all precautions on making sure the pet has no other injuries that would slow down the healing process. We take x-rays so that Dr. Pearce can measure the knee and see what size equipment your pet will need. We also do blood work prior to sedating your pet for these procedures. As long as everything checks out okay, we will then proceed with the surgery. The T.T.A procedure involves cutting the front part of the tibia bone and bringing this portion of the bone forward to realign the patellar ligament so that the abnormal sliding movement within the knee joint is eliminated. Then he places the proper Cage (Bone Spacer), Plate, and Screws to secure the bone in place. A bone graft is collected from the top of the tibia and placed in the gap of the bone to increase healing time. After everything is in place and secured the pet is closed up with sutures and staples. A post operative x-ray is performed followed by icing the leg for 20-30 minutes after surgery. The pet must be equipped with an E-Collar to ensure there is no licking or chewing of the incision site. It is VERY important that the E-Collar stays on the pet, if the pet licks or chews at the sutures you have a high chance of your pet getting a bone infection.
What does the after care include?--- Below is a copy of our discharge for T.T.A aftercare
You may also print off a copy by pressing this link ^^^
Return on ____________ for your pet’s follow up visit for post op care. The doctor will let you know when it is time to remove sutures. No bathing until the doctor authorizes it.
•STRICT CONFINEMENT IS MANDATORY!!!!
Prepare your house - Your pet MUST be confined to either a dog crate or a small individual room with no obstructions.
•Keep e-collar on at all times when pet is not supervised. If a pet removes their sutures they will have to be sedated to be resutured and have to start the healing process over from day one.
•LEASH ACTIVITY ONLY!!! It is extremely important that a pet remain at a steady speed of control when walking. No running!
•NO JUMPING or STAIRS AT ALL!!! An over extension of the pet’s knee could compromise the repair and healing time. This includes jumping on/off bed, couch, and yourself. If stairs are unavoidable, the pet must be supported by a towel or harness when lifting up/down stairs.
•Playtime with other pets and family members is not allowed until the doctor authorizes it.
•Walking surfaces – wood, tile, and linoleum can be very slippery for your pet. Rubber backed throw rugs are your best option.
•No baths until sutures are removed.
•Limping? Initially your pet may limp after surgery because their leg is sensitive and has just been repaired. In the weeks to follow, you may notice some limping when a pet is over active. If this should occur, apply ice to leg for thirty minutes and confine pet for at least 24 hours.
Normal symptoms after surgery:
•Swelling around the incision and to the repaired leg for the first 3-4 days following surgery
•Bruising around the incision or on the leg
•A small amount of discharge for the incision that is clear or even a little blood tinged.
Abnormal symptoms after surgery:
•Swelling that lasts longer than 3 – 4 days after surgery
•Bruising in other areas other than the incision site
•Discharge that is not clear
•Excessive amounts of discharge
•Bleeding that does not stop – if your pet should start bleeding apply a clean cloth and apply pressure gently for several minutes. If bleeding does not stop contact your veterinarian.
•Discomfort that causes your pet to cry out or bite
Week 1 Therapy
1.Massage 5 – 10 minutes 3 – 4 times per day to the affected limb from the toes upward to the pelvis area
2.Flexing pet’s leg – while pet is laying on their side gently extend and flex pets leg. Support the leg with both hands when doing this gentle therapy. If your pet seems uncomfortable, stop and try again later.
3.Short and Controlled Leash Walks 5 minutes 3 – 4 times per day - The slower your dog walks the better. If necessary, use a towel to support your pet’s hind end.
Notify the Hospital:
1.If tranquilizers are needed for proper restraint
2.If excessive swelling occurs
3.If pet is lethargic or not eating or drinking
4.If pet licks or chews out sutures
5.If pet’s behavior is not normal
6.If something about your pet just does not seem right, when in doubt, CALL
*Additional charges apply for tranquilizers, pain medications, antibiotics, and sedation if necessary.
How long is the recovery after surgery?
Recovery time is based on that particular pet. A more athletic dog will take more time to heal than a calmer dog. Generally, sutures are removed within 14 days, sometimes a little longer based on how quickly the pet heals. There is a restriction of activity for a minimum of 6 months and maximum of 1 year. It takes up to a year for the bone to remodel. Leash activity for a minimum of 8 weeks, and depending upon pet, full activity level can occur after 6 months.
Is the T.T.A procedure only for large breed dogs?
No, we have performed the T.T.A procedure on 10 lb dogs up to a 195 lb dogs. This procedure can also be done on CATS as well but it is much less common.
If my pet injures one leg , does this mean the opposite leg will be injured?
In about 60% of our cases the pet will have the same injury to the opposite leg. This occurs within 2 years after surgery. Normally, we see this injury happen within one year of their operation,but it can take longer. The best way to prevent this is to have surgery on your pet immediately after the injury. The longer you wait for the surgery the more weight they bare on the opposite leg, which in time causes that opposite leg to tear its cruciate as well.
What is the cost of the T.T.A procedure?
The cost of this procedure varies upon the pets weight. Our pricing includes the surgery, any routine medication (antibiotics, pain meds, etc...) for 2 weeks, and 2 post op x-rays normally taken at 4 and 8 weeks.
Please call us today to get your quote and consultation appointment. 901-382-1950
Is it possible for my pet to have both legs injured at the same time? If so, can both legs be operated on at the same time?
We have had several cases where the pet has a double cruciate injury. It is very painful for the pet so as always it is very important to act immediately. Normally, the Doctor prefers to do the surgeries on separate occasions, usually 2-4 weeks apart. Pet will be kept comfortable with pain medication and will be relieved after his/her first surgery.
***Below we are providing video on patients that have had the T.T.A procedure.***
What is the T.T.A ?
The T.T.A is a biophysics altering procedure that changes the moment arm of the tibia to reduce caudal pressure on the knee cap and femur (which is neutralized by the ACL in a normal dog). Other cruciate procedures involve various methods, ("Rope-A-Dope", exterior capsular, and TPLO) to neutralize this caudal force. In brief, all methods deal with neutralizing and/or reducing this caudal force.