Orthopedic surgery focuses on surgical treatments for your pet’s bones and joints. We treat a wide-range of orthopedic conditions. One of the most common canine orthopedic disorders we treat is Cranial Cruciate Ligament (CCL) Injury or Rupture. After diagnosing your pet’s condition with the help of our digital radiology and laboratory testing, we offer state-of-the-art treatment options to improve your animal’s quality of life.
The cranial cruciate ligament is one of the major knee stabilizers in dogs and cats, and is commonly equaled to the ACL in humans. Just like humans, surgical intervention may be needed if your pet injuries or ruptures their CCL so your pet can return to normal activity.
TTA (Tibial Tuberosity Advancement) is one of the newer surgeries performed to repair a ruptured cruciate ligament (blown knee).
I was told that my pet has torn his cruciate. What does that mean?
The cranial cruciate ligament (CCL) is a strong, dense structure that connects the ends of two bones across a joint. Their main function is to stabilize the joint. The CCL plays a critical role in stabilizing the stifle (knee) against front-to-back forces, prevent internal rotation of the tibia bone and to limit hyperextension of the stifle. Once the cruciate ligament is torn, the femur slides down the sloped top portion of the tibia (tibial plateau), creating instability in the knee joint and pain.
What are the signs that my pet could have a cruciate injury?
What should I do if I think my pet might have injured his cruciate?
If you suspect a cruciate ligament injury then y our pet should be seen by a veterinarian.
How is a cruciate ligament injury or rupture diagnosed?
A physical examination will be performed checking the stability of the knee joint and evidence of any lameness or swelling. Since the injury is painful, sedation might be needed in order to perform this examination. Depending on the results of the examination, radiographs might be taken to look for any arthritic changes or displacement of the bones. Radiographs may show subtle changes in the cruciate ligament that may not be obvious on a physical examination.
My pet was diagnosed with a cruciate injury but now is improving. Should I still have the surgery done?
Most dogs with an injured cruciate ligament show lameness after the initial injury and then start to improve. While there might be some improvement over several days, there usually is a dramatic decline in limb function over time. Any joint with instability will develop arthritic changes. There is no benefit to the wait and see approach. Stabilization of the joint soon after the injury has occurred is recommended,
What is the difference between the TTA (Tibial Tuberosity Advancement), TPLO (Tibial Plateau Leveling Osteomy) and lateral suture technique?
The lateral suture technique is just what the name implies, strong sutures used in the stability of the joint. This type of surgery is generally performed in small breed dogs and cats.
The TPLO and TTA techniques are used in the medium to large breeds. The TTA is somewhat of a less invasive procedure and gives similar results to the TPLO. Dogs that receive the TTA procedure will recover quicker initially and use the limb quicker; however, by 4 months after surgery both procedures will have similar outcomes.
The TTA Procedure
The TTA procedure involves making a cut in the front part of the tibia bone (tibial tuberosity) and advancing this portion of bone forward in order to realign the patellar ligament so that the abnormal sliding movement within the knee joint is eliminated. A specialized bone spacer, plate and screws are used to secure the bone in place. Bone graft is collected from the top of the tibia and placed in the gap in the bone to stimulate healing.
How does the TTA Work?
Now this will seem complicated when you look at the forces that are applied to the knee, but let me try to explain. There are opposing forces that affect the stability of the knee. The forces that come from the patellar ligament (from the pull of the quadriceps muscles), Fq, oppose the other forces applied (Fn and Ft). Because the patellar ligament is angled greater than 90 degrees to the top of the tibial slope (dashed line), there is a resultant shear force that causes the tibia bone to slide forward with weight-bearing; this force is normally neutralized by the cranial cruciate ligament. However, then the cruciate ligament is torn, this force causes the knee to “give out” with every weight-bearing stride. After the TTA procedure has been completed, the angle of the patellar ligament approaches 90 degrees to the tibial slope and the opposing forces become cancelled, thus the tibia bone remains in place when weight is lace on the limb.
What do I need to do at home after surgery?
The homecare is an important part of your pet’s recovery. Following these guidelines will increase the changes of a successful surgery.
When does my pet need to return to the hospital?
You will need to return to the hospital at various times to have the healing process and the incision area checked. The first visit will occur 3-4 days after surgery to have the bandage removed and the incision area checked. The second visit is 2 weeks after surgery to have the staples removed and the incision checked. Eight weeks after surgery your pet will need to return for radiographs to check bone healing progress. By 16 weeks after surgery, most pets are fully weight bearing on the operated limb and exercise restrictions cam be lifted at this time.
Are there any complications involved?
As with any surgical procedure, complications can arise. There is the risk with the anesthesia. To decrease the chance of any anesthetic complications, pre-surgical blood work is performed and anesthesia is tailored to each individual patient. Patients are given antibiotics to minimize the chance of any surgical site infection. All surgical equipment is sterilized prior to use and surgery is performed in the surgery room where caps, masks and gowns are worn.
If your dog is receiving medications such as chemotherapy or steroids, the bone may not heal well, therefore it is imperative that you inform the surgeon prior to surgery that your dog is receiving these medications. Over activity in the postoperative period may also result in poor bone healing, loosening of the screws or breakage of the implant. In addition, if your dog falls, the tibia may fracture. Arthritis (bone spurs) is usually present at the time of diagnosis of a cruciate ligament rupture and likely will progress regardless of the surgical procedure performed. Glucosamine and Fatty Acids supplements are recommended for life to ease the discomfort and pain medications can be used as needed.