Radiograph of Milo's right stifle prior to surgery

Dr. Mark Romain has had special surgery training for a procedure called Tibial Tuberosity Advancement, or TTA. This surgery is performed on dogs who have sustained a cranial cruciate ligament injury (the “ACL” in people). Recently, Dr. Romain performed bilateral TTA on a beagle named Milo. This means both of Milo’s cruciate ligaments were injured, so he had the procedure done on both stifles at the same time.

The cranial cruciate ligament plays a crucial role in making sure the tibia bone does not slip out and forward from the stifle joint. ACL rupture in dogs is one of the most common causes of hindlimb lameness, and it almost always requires surgical correction.

Veterinarians can diagnose ACL rupture in dogs with a physical exam and radiographs (xrays). While stabilizing the femur in one hand, the other hand manipulates the tibia, and if the tibia slides forward like a drawer, this is indicative of cruciate ligament injury.

Radiograph of Milo's right stifle after surgery

The goal of TTA surgery is to limit this tibial thrust, which can be quite painful. Surgery begins by inspecting the stifle joint and removing the damaged cruciate ligament. The goal is to transfer the load of the joint from the patellar ligament to the quadriceps muscle. To achieve this, the veterinary surgeon makes a cut into the tibial tuberosity (bone). The tibial tuberosity is advanced into a position perpendicular to the tibial plateau, thus removing the load from the ruptured cruciate ligament. To keep this newly positioned tibial tuberosity in place, a titanium implant is secured to the bone, and a spacer and bone graft material is placed into the cleft between the bones. This helps stabilize the joint.

Post-operative care involves:

• Limited exercise
• 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.

Milo had TTA surgery on both stifles, which is why he has bandages on both legs. This is taken the day after his surgery.

Milo’s surgery included an epidural to numb his hind limbs for 12-24 hours post-op, and he received a continuous IV infusion of hydromorphone, lidocaine, and ketamine (referred to as an HLK CRI in vet talk) for the next 48 hours to help control pain and provide optimum pain management.

At Olathe Animal Hospital, we recommend having your male puppy or kitten neutered at 6 months of age. Neutering involves removing both testicles. Although routine, it is a major procedure, which is why we take extra precautions to ensure your puppy’s safety and smooth recovery.

There are many health and behavioral benefits to having your puppy neutered, including:

• Significantly reduced chance of prostate infections and prostate cancer
• Eliminates possibility of testicular cancer
• Decreased risk of being hit by car (un-uneutered males have the highest incidence of vehicular trauma as they are constantly on the look-out for females in heat)

His personality will not change, and he will not get “fat” (unless you over-feed him!).

At Olathe Animal Hospital, we recommend having your puppy or kitten spayed at 6 months of age. A “spay” is an ovariohysterectomy (removing both ovaries and uterus). Although routine, it is a major procedure, which is why we take extra precautions to ensure your pet’s safety and smooth recovery.

There are many health benefits to having your puppy or kitten spayed, including:

• Significantly reduced chance of developing breast cancer later in life (if spayed before the first heat cycle)
• She won’t develop pyometra, a potentially fatal infection of the uterus
• No possibility of uterine or ovarian cancer

Her personality will not change, and she will not get “fat” (unless you over-feed her!). She does not need to have a litter. In fact, each pregnancy puts her at risk of complications.

It is important for you to know that not all veterinary hospitals approach surgery in the same way.  Advancements in veterinary medicine have allowed surgical procedures to be much safer than ever before.  You can rest assured that your pet will be provided the highest quality of care including pre-anesthetic testing (blood work), advanced monitoring from nurses, pain management, body temperature control, and the safest gas anesthesia.

When your pet is admitted to our hospital for surgery, several steps are taken before the actual surgery.  First, your pet’s attending doctor will do an examination to determine if there are any current issues that would prevent us from proceeding with surgery.  We normally will have run a blood panel prior to the day of the procedure.  If not, we will draw blood to run the panel in our lab on the morning of the procedure.  This important step tells us if the liver, kidneys, blood count, etc., are within normal limits.  If all is well, a nurse will administer pre-medications to reduce pain, calm your pet and reduce the amount of anesthesia needed.  Later, a short acting drug is given to allow your pet to fall asleep.  At that point, a breathing (tracheal) tube will be placed and a gas anesthesia/oxygen mix will be administered directly into the lungs. Isoflurane gas anesthesia is also used in human hospitals and is one of the safest on the market. Monitors will be attached to your pet showing heart rate, blood pressure, carbon dioxide exhaled and oxygen saturation.  Anesthesia can be adjusted accordingly, and the monitors also indicate if the pet is having any difficulties during the procedure before serious problems occur.

Our surgeries are performed in a sterile surgery suite with the doctors and nurses masked and gowned, and your pet’s surgery site is prepped and scrubbed.  Your pet is constantly monitored by an attending nurse during the procedure and when the surgery is complete, the gas anesthesia is turned off and only oxygen is administered.  Because the gas anesthetic is delivered directly to the lungs and exhaled rapidly, your pet will wake up fairly quickly with a nurse present.  At that point the breathing tube is removed, and the pet will be breathing on its own. Heating pads, warm air blankets and, in some cases, incubators are used to keep your pet warm and comfortable during and after the surgery.

Your pet continues to be monitored by our trained staff during the recovery period, and your pet can usually be released later the same day!  Owners are often amazed that their pet walks out to greet them on their own with little indication that they have been under general anesthesia. Your pet will even be sent home with a pain medication to maintain comfort levels at home!

Be assured that the health of your pet is our highest concern and we will do everything possible to maintain that health.

We are proud to be accredited by The American Animal Hospital Association (AAHA) and only 17% of the small animal practices throughout the United States can claim this distinction.