Tibial Tuberosity Advancement – TTA
Tibial Tuberosity Advancement – TTA
a surgical procedure used to return normal function to knees (stifles) in dogs and cats that have suffered from a ruptured cranial cruciate ligament (same as the anterior cruciate ligament in people).
Cruciate ligament rupture is the most common orthopedic injury in dogs of all breeds and sizes. The TTA procedure is designed to return the cruciate deficient stifle to full function by surgically changing the biomechanics of the knee. This change is accomplished by moving the attachment of the straight patella tendon forward and involves an osteotomy of the tibia. The portion of the tibia that is moved is stabilized by a permanent titanium implant system. The major advantages of the TTA over other cruciate ligament augmentation procedures are:
- Rapid (1-2 weeks) return to full weight bearing.
- Protection of articular cartilage through rapid return of normal joint range of motion.
- Decreased progression of arthritis over time
- Good prognosis for return to full athletic activity.
Symptoms:
- Acute onset of a rear limb non-weight bearing or toe-touching lameness
- If left unattended the lameness cycles in severity over 6-8 weeks.
- Decreased Range of Motion (stilted gait)
- Hind leg outstretched while sitting
- Weight shift while standing
Diagnosis:
The diagnosis of cruciate injury is made by manipulating the stifle into a position of anterior drawer (tibia slides forward). The only injury which allows this type of movement is cranial cruciate ligament injury. In addition soft tissue thickening on the inside of the stifle is often present, indicating the chronic nature of this disease (medial buttress.) If the meniscus is damaged an audible “click” or “pop” may be heard when the dog is walking or when the stifle is put through a normal range of motion.
Procedure:
The TTA procedure involves an osteotomy (cutting bone) of the tibial tuberosity (insertion of the straight patellar ligament). The top portion of the tuberosity is advanced forward and held in place with a titanium basket, plate, bone fork and screws. The stifle joint is inspected, if the medial meniscus is damaged the damaged portion is removed, remnants of the ruptured ligament are removed and the joint is flushed to remove inflammatory debris. A bone graft is collected from the femur and placed in the osteotomy gap.
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The diagnosis of a ruptured cruciate ligament can be suggested by your general practice veterinarian, and ultimately determined by consulting with a specialist, who will physically manipulate the joint and if needed evaluate radiographs to decide if your pet is a good candidate for the TTA procedure.
The TTA surgery is minimally invasive, with low complication rates, and can minimize the progression of degenerative joint disease by decreasing patellar-femoral pressure and femoral-tibial pressure. It is the only cruciate ligament repair procedure that uses titanium, which is more biocompatible than stainless steel and reduces the risk of infection and rejection of the implants.
After Care:
Hospitalization:
- Your pet will need to stay overnight one night and a pick up can be scheduled during our regular business hours, 7:30 am to 5:00 pm the day after surgery.
- When you get your pet home, place your pet in a cool/warm (season dependent), quiet and dark room. If you leave your pet alone, he/she will sleep and be comfortable. You can increase your pet’s anxiety by doting. Your pet will have adequate medication for pain so you do not need to worry about discomfort.
Medication:
- A transdermal pain patch will be sutured on to your pet and will provide pain relief for three days following surgery. On the fourth day after surgery, you may remove the patch by clipping the sutures with a nail clipper and peeling it off like a band-aid. Please dispose of the patch by flushing down the toilet.
- The transdermal pain patch used for pain relief can cause constipation. Dr. Dew will ask that you feed your pet a certain amount of tuna in oil (Starkist®, Chicken of the Sea®, Etc.) for four days following surgery to prevent constipation. The tuna in oil is to be given in addition to your pet’s regular feedings.
- If your pet is not already on a joint supplement, Dr. Dew will send home a sample of Glycoflex®. Glycoflex® will supplement the cartilage and improve your pet’s joint health. Your pet may stay on Glycoflex® for the remainder of his/her life. The charge for a full bottle or bag of GlycoFlex® is NOT included in the surgery fee; this will be an additional charge to you.
- Your pet will also be sent home with a 14 day supply of Previcox®. Previcox is a non-steroidal anti-inflammatory that is used for the control of pain and inflammation associated with osteoarthritis in canines. Please follow the package instructions.
Food & Water:
- When you get your pet home, offer him/her a small amount of water. If your pet drinks it and does not vomit, then offer twice the original amount.
- Two hours later if no vomiting has occurred, offer ¼ of the amount of food in a normal meal.
- If your pet eats and no vomiting occurs in a 2-hour time period, then you may resume normal feeding(s).
- Please call Dr. Dew’s or your veterinarian’s office if your pet does not drink within the first 6 hours of being home or if vomiting occurs.
Rechecks:
- Your pet should be rechecked by Dr. Dew 10-14 days following surgery. Please call (866) 838-4282 to schedule this appointment.
- Radiographs (x-rays) will need to be taken 12 weeks following surgery to assess healing. These radiographs may be taken by your veterinarian or by Dr. Dew. Once the radiographs have been taken, Dr. Dew will need to review them; please schedule an appointment. The charge for the radiographs is NOT included in the surgery fee; this will be an additional charge to you.
Exercise Restriction:
Your pet’s leg has been repaired using a combination of bone graft, plate/fork, basket and screws. These implants and the tibial tuberosity advancement technique have been designed to maximize the opportunity for successful bone healing and return to function. HOWEVER, they are initially not as strong as normal bone or tissue! Therefore, exercise restriction is mandatory to prevent catastrophic failure of the fixation hardware.
- For 3 months following surgery, your pet will need to be restricted to leash activity only.
- Free running, rough play or jumping on/off furniture or decks should not be allowed.
- If more than 1 or 2 stairs need to be negotiated on a regular basis, this should be done in a controlled fashion with your pet on a leash.
Physical Therapy:
With this procedure, it is not uncommon to see some bruising and edema around the hock (ankle) and on the inside of the leg below the incision. These changes are not painful and will resolve without treatment 3-10 days following surgery.
This is an example of normal edema, or swelling
It is normal to see some bruising and swelling, which should resolve itself without treatment in 3-10 days
- For the first 2 weeks, your pet should be walked in the yard on a leash 3-4 times daily.
- During the second week, you may take your pet on 2 daily walks of 1-2 blocks.
- After the second week, you can double the length of the walks each week.
- You wish to see slow steady progress. At the end of each week, limb use should be improved slightly.
- Slow leash walking up a moderate hill will cause your pet to use the operated legs and regain function.
- Swimming is excellent activity to promote and improve joint function. Swimming may begin three weeks after surgery.
- If your pet’s limb use is not improving or you notice a sudden decrease in limb use, please call Dr. Dew’s office immediately – (866) 838-4282.
