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Stage Road Animal Hospital is a species specialty practice that concentrates on the conditions, diseases, and preventive health care of the canine and feline species.

The Staff at SRAH are pet owners and we identify with your desire to provide your loved ones with quality medical and surgical care.

TTA

TIBIAL TUBEROSITY ADVANCEMENT (TTA)

TTA surgery is the latest development in the geometric altering procedures for the correction of the Canine Cruciate Ligament Rupture in cruciate deficient dogs. This form of dog ligament surgery was developed by Slobadon Tepic and Pierre Montavon at the University of Zurich in Switzerland. The procedure alters the vector forces that place stress on the Canine Cruciate Ligament (Cr.C.L.).

The tibia is cut and a spacer called a cage is inserted to advance the tibia tuberosity cranially to allow the moment arm to be increased which in turn reduces the forces on the Cr. C.L. The tibia is stabilized with a titanium plate and a bone graft is inserted into the osteotomy. The osteotomy heals in most cases in about 8 weeks. The displacement of forces on the knee reduces the pressure on the menisci and most patients walk immediately after recovery from anesthesia.

Over the years, I have repaired cruciate ruptures by using many of the accepted procedures being used in the specific time frames, in the ‘70’s the Paatsama technique was used which involved fabricating a replacement ligament using the tensor facia lata. This provided short term stability but long term results were lacking. In the ‘80’s the extracapsular method was developed and still being used on small dogs today. This procedure used an artificial ligament of various types of nylon or other synthetic heavy suture that is placed parallel to the ligament.

The problem with this procedure is proper anchoring to prevent premature loosening of the implant, especially in large breed dogs. Also in the late ‘70’s – early ‘80’s, Arnoczky developed the over-the-top method which involved taking one-third of the patella (knee cap) and routing it, with the part of the patellar tendon, through a channel created in the femoral lateral condyle and anchored on the lateral condyle. I learned this procedure from Dr. Arnoczky in North Carolina.

I used it extensively in English Bulldogs and other massive breeds with very good to excellent results (there are many modifications by different surgeons on most of these procedures which is beyond the scope of this discussion – I do not intentionally omit these individuals – I do not have space here to cover all methods – my intent is to relate to you methods I have used and to give credit to those who taught me their techniques).

The 1990’s brought the profession a new concept and procedure that was widely accepted and is a widely used canine ACL surgery today, the TPLO. Tibia Plateau Leveling Osteotomy (TPLO) was developed by Barclay Slocum. I enrolled in the Slocum Enterprises TPLO course in early 2000’s. It is the first widely accepted geometric altering procedure. This procedure alters the tibia plateau by elevating the proximal tibia to counter the vector forces placed on the stifle. It involves cutting the tibia with a special saw, rotating the plateau and stabilizing the tibia with a plate.

The procedure has merit, especially large massive dogs with severely sloping tibias, i.e. – Rottweilers. I have used the TPLO for several years with very good to excellent results. I learned the TTA procedure in February 2008 from Jeff Mayo when he came to SRAH.

In September 2008, I went to Chicago to advance my knowledge and skill in the procedure from Dr. Slobadon Tepic who developed the TTA. Since that time, I have used the TTA almost exclusively for cranial cruciate ligament repair. I like the procedure in that most of all of the patients do not require rehabilitation because they walk normally so quickly. We use the KYON implants developed by Dr. Tepic which are made in Switzerland. The quality is far superior to any implants that I have used in the past.

I have rarely used any other method for Cr.C.L. regardless of the size of the dog because KYON makes implants for very small dogs and all TTA patients recover quicker than any other method. It is probably to early for me to make a concrete statement concerning the long term response on the TTA patients, but it is my belief that the TTA procedure tends to arrest or certainly slow the arthritic changes that often occur years after the Cr.C.L. repair.

I performed a TTA on a field trial Labrador in November 2008 and this dog was back in competition by July 2009, which is a great recovery for this injury. (Click below to see slide program – CrCL). The following are helpful links about the TTA procedure and materials. Also, below are videos and x-rays that track some of the patients recovery from the TTA procedure.