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FAQ about knee surgery in dogs - reading material for anyone contemplating surgery for their dog with a torn cruciate ligament
 

Q. What is the "best" surgery for a torn ACL in the canine?

 

A. There is no one best surgery. What is important to remember is that NO surgical procedure will completely heal your dog. Treatment of ACL injury in the dog is a lifelong process, involving rehabilitation, weight control, and chronic/intermittent use of pain control medications and/or neutraceutical products. Dogs that have had TPLO or TTA surgery can and often do have intermittent periods of stiffness and lameness for the rest of their lives because no procedure is capable of stopping and/or reversing the osteoarthritis that is present in the knee, although PRP-HA or stem cell therapy MAY slow it down or even reverse some of it. Ligament, muscle, and scar tissue strain in the knee are an infrequent problem for the rest of your dogs' life. Despite our best efforts, some dogs never return to their pre-injury athletic status due to the chronicity of the initial injury to their leg.  More recent research has shown that TPLO or TTA are probably better considerations for most dogs.
 

Q. What is the lateral suture procedure for stabilization and "treatment" of an ACL tear in the dog?

 

A. The lateral suture procedure involves using suture material to replace the torn ligament in a different position than where it normally is. Although it mimics the function of the original ligament, it does not have the same biomechanical properties as the ligament, thus the knee is not capable of performing like it originally did. Some of the normal range of motion is lost. Eventually, this temporary ligament will break. The theory is that your dog will build up scar tissue around the temporary ligament in the knee to act as a long term stabilizer. This scar tissue will result in decreased range of motion of your pet's knee long term.

 

Q. What is the TPLO procedure?

 

A. TPLO stands for tibial plateau leveling osteotomy. In the normal knee, the top of the tibia slants at a backwards angle. This allows the femur to slide backwards down this tibial slope. It is this sliding that causes the pain once the ligament tears. TPLO removes this backwards slant of the tibia and stabilizes the knee. Removal of this slant of the tibia changes the way the quadriceps muscle pulls on the tibia and allows the muscle to assume the job of the torn ACL.  More recent research has shown TPLO surgery to be more superior than the lateral suture techniques. 

 

Q. What is the TTA procedure?

 

A. TTA stands for tibial tuberosity advancement. The procedure involves moving the patellar tendon attachment on the tibia forward which allows the quadriceps muscle to assume the normal job of the torn ACL by pulling forwards on the tibia to oppose the torn ACL. TTA works equally well for ACL injuries, though some very small and very large dogs may not do as well.

 

Q. Why do veterinarians recommend one surgical procedure over another?

 

A. Many veterinarians are confident at performing the lateral suture procedure for your dog. Complications are more easily dealt with compared with TTA or TPLO, and the TTA or TPLO can be used to replace the lateral suture if something should go wrong. TTA and TPLO are better at more closely restoring the normal biomechanics of the canine knee. A veterinarian will tend to recommend the procedure they are most comfortable with, and have the most success with.

 

Q. What is the HEAVIEST dog Dr. Mayo has ever performed a TTA on?


A. 212 pounds (normal body weight, a Great Dane)

 

Q. What is the smallest dog Dr. Mayo has ever performed the TTA on?

 

A. 3 pounds, a Chihuahua.The mini-TTA.

 

Q. Why is my doctor NOT recommending a TTA over the TPLO?

 

A. TPLO is only indicated over TTA if your dog has a steep tibial plateau angle (the top of the tibia) or if your dog has crooked legs (walks like a "bull rider"). There are no other reasons to perform TPLO over TTA except for comfort in performing (or recommending) one procedure over the other for the doctor. Many doctors do not understand the TTA yet. 

 

Q. My dog recently had a TTA done, and now the leg is swollen. What should I do?

 

A. The swelling is usually located just past the surgery site. This is usually due to extensive bleeding from the bone grafting site in the tibia to fill the grafted area. This can be avoided by using a bone graft from somewhere else in the body, or by using a synthetic product such as Velocity(R). If you see this swelling, make sure your pet stays off of the leg as much as possible for a few days, and that you ice the leg 3-4 times a day for the next week. The swelling will go away. If it gets to be too much, it could cause the incision to swell.

 

Q. My vet told me my pet has a "torn ACL" and that it should have a TPLO done. What are my options?

 

A. Not all dogs require TPLO to restore knee function.  This procedure does not work as well in larger dogs. Your pet may also be a very good candidate for the TTA procedure.


Q. When would you pick TPLO over TTA?

 

A. Dogs with excessive tibial plateau angles over 30 degrees, or angular limb deformities should have TPLO performed instead of TTA.  These are rarely seen.

 

Q. What are the advantages of TTA over TPLO?


A. TTA is quicker, easier to perform, and in the right hands there are very few complications. TTA can treat chondromalacia, a common sequalae in dogs with a torn cruciate, makes the knee extend easier, and does not inflame the patellar tendon postoperatively.  TPLO causes increases in the forces within the knee, permanent loss of some range of motion, pivot shift due to more muscle dissection, and the knee is more difficult to extend for the patient after surgery. I find it easier to correct concurrent patellar luxation with TTA.  In some instances, TPLO is indicated over TTA.

 

Q. My dog recently had knee surgery and is not using the leg. What should I do?

 

A. Most dogs start using the leg again around 2 weeks postoperative. Some of the simple exercises you should start doing include: "Sit to stand", hip balancing, 60-90 flexion & extension, and cavelleti work. Under no circumstances, should you allow your dog to run fee on a leash until your doctor tells you it is ok. See the rehab-section on the TTA or TPLO website for more details. Consider having the leg x-rayed to look for potential problems.

 

Q. My dog had TTA/TPLO surgery 10-12 weeks ago and is still limping. What could be wrong?

 

A. The first thing to ask is, is there something else wrong? Have your veterinarian re-x-ray the leg. If the x-ray and exam show nothing obvious, then the next thing to suspect is that the medial meniscus is torn. This should be addressed by either: re-operating on the leg, through an open incision or arthroscopy, or giving the pet some more time. If you have concerns about your pets' recovery, call your veterinarian. If we find no obvious other cause, we may recommend return to pain control, NSAID use, or even injections into the knee of steroids or PRP-HA.

 

Q. How can I tell if my vet has any experience with TTA or TPLO?

 

A. Check the website for the hospital, search the internet, ask for references, find out how and when your doctor learned the procedure. Ask your doctor how many times he/she has performed the procedure. Ask them to show you some postoperative radiographs or offer names of people that have had the procedure done in his/her office.

 

Q. My dog has bad hips and a torn ACL. Should I proceed with surgery?

 

A. Absolutely. The hips are rarely the cause of acute limping. If the ACLs are torn, your pet is only going to get worse.

 

Q. My dog has a torn ACL, and I was told he could tear the other one any time. What should I do?

 

A. First of all, get the knee fixed. Secondly, be prepared that at any time, the other leg could tear. Lastly, to avoid any confusion, mark the leg to be operated on when you drop your pet off. Most dogs have a 50% chance of tearing the other ACL within 5 months. To avoid this, restrict exercise during recovery, work on the rehabilitation, and reduce your pet's weight.  Consider using a brace to protect the good leg during the recovery period.

Q. Is there a brace that can support my dog's knee prior to, after, or in lieu of performing surgery?

A. Historically, I would answer this question NO. However, I am evaluating a knee brace that does appear to work very well. It is important to remember that there are 3 uses for a brace in torn cruciate ligament dogs; (1) to support the leg PRIOR to having surgery, (2) to support the leg AFTER having surgery, or (3) to support the leg because your dog is too old  to have surgery or you do not want to have it done. Braces DO NOT heal the knee. They only help your dog walk better. If you are interested in obtaining a brace for your pet, you may visit our page entitled Knee Braces. Please email us at Nicole@jeffmayodvm.com.