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Understanding cruciate ligament injury and TTA surgery

December 16, 2009 by  
Filed under Surgery

Dr. Peuser has had special surgery training for a procedure called tibial tuberosity advancement, or TTA. This surgery is performed on dogs who have torn their cranial cruciate ligament (the “ACL” in people).  The cranial cruciate ligament prevents internal rotation of the knee and also keeps the lower leg from sliding forward.


Immediately after surgery

ACL rupture in dogs is one of the most common causes of hindlimb lameness, and it almost always requires surgical correction.

Veterinarians can diagnose a torn ACL in dogs with a physical exam and radiographs (x-rays). While holding above and below the knee, pressure to the joint is applied.  If the lower leg slides forward like a drawer, this confirms cruciate ligament injury.

The goal of TTA surgery is to keep the lower leg from sliding forward when the pet walks, which can be quite painful. Surgery begins by inspecting the knee and removing the

remnants of the torn ligament and inspecting the meniscus for damage. The goal of the TTA is to transfer the load of the joint from the patellar ligament to the quadriceps muscle. To achieve this, the tibia is cut. The cut piece (tuberosity) is then advanced forward, removing the load from the ruptured ligament. To keep this newly positioned tibial tuberosity in place, a metal implant is secured to the bone, and a spacer is placed into the area between the bones. Performing the surgery helps stabilize the joint.

2 mo recheck

Two months after surgery the bone has healed


Post-operative care involves:

  • Physical therapy
  • Restriction of play
  • Care of the surgical site
  • Administration of medications
  • Suture removal

Follow-up radiographs are usually taken 2 months after the surgery to ensure proper healing.

All TTA patients receive an epidural to numb the hind limbs for 12-24 hours post-op and a continuous IV infusion of hydromorphone, lidocaine, and ketamine (referred to as an HLK CRI) for the next 48 hours to help control pain and provide optimum pain management.

We have recently bundled the TTA surgery into one package price.  Including anesthesia, epidural, HLK CRI, surgery, monitoring, post-op care, laser treatments, two weeks of pain medication, a progress exam two weeks after surgery, and the x-rays two months later.  The total cost is $2,600.



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