TTA-2 Surgery


“Thank you for putting my leg back together! Life today at 10 weeks post-surgery is very good. I play, lounge, eat, walk (preferably in the forest), cause appropriate amounts of pit bull-induced chaos (or so I'm told), and pose for the occasional photo. I am not yet allowed to rough-house with my brother Miles (a 4 year old Lab/Rottie) yet but I will again soon! I am healing very well and every day my leg is getting stronger. Soon I will be back to running 10 miles with my family!”
Hazel aka Fire Chicken

Cranial cruciate injury is the most common orthopedic injury suffered by dogs of all sizes and breeds. This is usually apparent to owners as a sudden rear leg limp that occurs after some type of activity. This injury is similar to an "ACL" tear in humans. However, the anatomy of the dog differs in the fact that this ligament is utilized to a greater extent including activity and passive stance. With an injured cruciate ligament the dog’s knee joint becomes very unstable, often painful, and may lead to injuries of the meniscus (cushion structure) and cartilage tissues. Most patients require a surgical procedure to stabilize the stifle (knee) joint.

Continental Animal Wellness Center performs two techniques for this injury: the lateral suture and the Tibial Tuberosity Advancement (TTA-2). The decision between which repair would be appropriate for your pet can be made at a consultation with Dr. Maciulla. Factors such as breed, size, age, activity level, and owner expectations may indicate a preferred procedure.

Lateral Suture The lateral suture method involves placing a nylon material on the outside of the knee in a similar orientation to the injured cranial cruciate ligament. This stabilizes the joint and after the nylon is then replaced by fibrous tissue for joint stability. The majority of dogs recover 80-85% of normal within 6 months and may improve further by 1 year. However, smaller dogs are better candidates for this procedure compared to larger dogs, active dogs, or working dogs.

Tibial Tuberosity Advancement (TTA, TTA-2)

The Tibial Tuberosity Advancement (TTA) technique was developed in 2004 in efforts to improve the outcome of surgically repaired cruciate injuries and reduce the severity of osteoarthritis that follows. This procedure changes the mechanics of the knee joint to compensate for the deficient cruciate ligament. A "cage" and plate secured with forks and screws are used to advance the tibial tuberosity (and therefore the insertion of the patella ligament). Compared to other repair methods, the TTA offers a lower complication rate and excellent recovery. Typical recovery for patients undergoing this procedure is limited activity for 8-10 weeks, but most are full weight bearing within 2 weeks. Patients receiving this repair have a good to excellent prognosis for returning to full athletic activity. Additionally, associated osteoarthritis formation within the knee joint is lower with the TTA compared to other repair techniques. Dogs of all sizes, breeds, and ages can benefit from the TTA or TTA-2.

The TTA-2 is the next improvement of this procedure that uses less implant material and preserves more of the surrounding soft tissue compared to the TTA. The TTA-2 consists of placing a single implant made of coated titanium within the tibial bone that advances the insertion of the patella tendon forward. The implant cage is coated with a ceramic material that stimulates bone growth to accelerate healing. A plate and fork is unnecessary with the TTA-2. This achieves the change in biomechanics necessary to stabilize the joint and reduce cartilage damage while preserving more of the surrounding soft tissue due to the minimally invasive approach.

Benefits of TTA-2

  • Rapid recovery: full weight bearing within 2 weeks for most cases
  • Good prognosis for return to full activity and reduction of lameness
  • Decreased progression of osteoarthritis
  • Less invasive than TTA, TPLO
  • Lower complication rate
  • Done locally saving money on the surgery and travel
  • Images courtesy of KYON Pharma, Inc.