Surgical Treatment of Ruptured Cranial Cruciate Ligament

The TTA surgery was first revealed to the veterinarian profession in early 2005, with the introduction of the plate and cage. As the procedure was not copyrighted like the TPLO was, early adopters were free to improve the technique and implants. We started offering TTA in late 2005 and performed the procedure many times since then, as well as adopted many of the improvements to the procedure and implants.

The most current form of the TTA is called the TTA-RAPID from https://leibinger.vet. The improvements include; titanium implant exclusively, shorter and simpler procedure, quicker recovery, adaptable to patella luxation repair, more implant availability for sizes of dogs.

The TTA-RAPID is available for dogs 6 pounds and higher. The procedure itself works by changing the way the quadriceps muscles (front of the leg) pull on the knee, stabilizing it. The TTA places much less pressure on the knee than the TPLO, and restores the pressure distribution across the knee better than TPLO causing less damage to the meniscus after surgery.

Tibial Tuberosity Advancement (OnSite Training) available for the TTA-RAPID and the TTA plate/cage procedures. Patella luxation can be concurrently covered during the training.

Goal: To acquaint the participant with the biomechanics of the canine stifle and how tibial tuberosity advancement alters those biomechanics to produce a stable knee when the cranial cruciate ligament has torn.

Method: On-site training in your hospital using cadavers, real patients, or models, to instruct you hands-on in the proper technique of tibial tuberosity advancement for the treatment of cranial cruciate ligament disease in the dog. We send notes and a video prior to showing up in your hospital, and bring our own equipment to show you what you need to perform the procedure properly. We will even help you acquire the equipment if needed. We are available after the training by telephone or email to assess your technique radiographically, and help you develop postoperative rehabilitation programs.

Instructional Itinerary Includes:

  • Pre-visit material includes videos, notes, www.surgerysam.com, and assistance selecting patients
  • Diagnostic methods for detecting cranial cruciate ligament disease, and rule outs for other causes of hindlimb lameness.
  • Radiographic analysis of the hindlimb
  • Radiographic analysis of tibial plateau angle, and proper preoperative choice of TTA implants; both the mTPA and common tangent methods of implant selection
  • Pain control, using Nocita®
  • Choosing the right patient for TTA
  • The TTA surgical procedure, including potential mishaps surgical and postoperative
  • Postoperative radiographic analysis
  • Using the TTA to correct for MPL or LPL, patella alta
  • Model building for client “show and tell”
  • Some equipment acquisition – may include supplementing onsite training program

Participants are free to schedule as many surgeries as they feel their staff can handle in a one-day period. I would highly encourage you to limit it to 2-3 cases in one day, else consider two days of training on-site. You may also bring in one other veterinarian if you wish, and I encourage you to videotape the procedures. Group teaching rates are also available, as well as state convention presentations. To keep prices down, if you already have equipment (drill, saw, TTA equipment), please let me know that when requesting a training session, as I am willing to adjusts costs accordingly.

Costs vary depending on location, number of procedures performed, and number of days at your location. For an estimate, send an email to me at consultwithmayodvm@gmail.com.

Documents on Tibial Tuberosity Advancement

TTA Chart This chart is a summary of how to select for an implant, cage, and the appropriate width of screw for each of the parts. This is best taped to the wall in your surgery room, updated 11/2009.
TTA Template This is the acrylic overlay for assessing the TTA implant sizes.
TTA Common Tangent Discussion This file discusses the common tangent method of picking your advancement cage for implementing the TTA surgery.
Controversies in RCCL Repair This short paper briefly discusses controversial topics in repair techniques for ruptured cruciate ligaments in dogs.
Cranial Cruciate Ligament Disease This paper is a discussion on diagnosis and pathology of ruptured cruciate ligaments in dogs.
Mayoetta This is an article from the May ’08 issue of Vet Practice News on TTA.
Post-Operative Instructions This short paper discusses postoperative rehab for dogs with TTA repair. For more information, please refer to www.topdoghealth.com.
Reasons for Poor Recovery from TTA This paper covers the top reasons I have seen clinically as to why patients may not recover from TTA surgery as expected.
TTA for the Client A short paper to give to pet owners if their pet is going to have the TTA procedure done.