Wednesday, September 03, 2008

T.T.A. SURGERY (Tibial Tuberosity Advancement) Part I

August 6, 2008: It was one of those mornings where I decided to make like I was in the Beijing Olympics. I just got one of those “wild hare” moments and started to haul ass! Off my deck and around the yard like one of those Sprinters I flew. With my ears pinned back and eyes wide with glee, my tongue flapped about and my Mom and Dad could see the exhilaration of the wind in my face. It was magical!

And then, “it” happened…that sharp tearing pain a dog feels when its Cranial Cruciate Ligament rips apart completely from the femur (thigh bone). It sent me screaming to the deck, straight to my parents in Tri-pod style. I guess I should have warmed up.

My Dad was hoping it was just a sprain. My Mom knew right away that, “this is bad…really bad”. By the following day my Mom couldn’t stand it anymore and took me to the local Veterinarian. The Vet walked in and felt up my leg a bit, kind of squeezing it around. Then she looked at Mom and said, “Oh Yeah…she blew out her knee real good”. Mom was right, it was bad! Now the Vet talked about various SURGERIES to repair my knee and big dollar signs. Mom looked down at me, stroked the side of my face and said to the Vet, “well, it has to be done…can’t have her like living like this”...


August 12, 2008: Woo-hoo we’re going bye-bye! Where? Who cares! Yehawwww…and, then we pull up into a place that has “smells” which I’m not so sure about but hey, I’m with my folks.

So we go in and meet Dr. Carlos Aragon. Nice guy with a gentle touch, who verifies that my CCL is kaput. He explains all kinds of things regarding size, breed, weight, age, activity level and so on and so forth. He uses a picture book and a model to show what the trouble is with my stifle (knee) and how he wants to fix it. Surgery is set for Thursday August 21, 2008. Then I said, "That's all fascinating people, but I'm more than happy that I get to leave with my folks...NOW"!

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The Problem and The Answer, According To Several Veterinary websites : Tibial Tuberosity Advancement (TTA SURGERY) - Possibly the BEST Surgery for your dog’s Knee...
The most common knee injury in the dog is rupture of the Cranial Cruciate Ligament (CCL), also frequently called the Anterior Cruciate Ligament (ACL). This injury can occur at any age and in any breed, but most frequently occurs in middle aged, overweight, medium to large breed dogs. This ligament frequently can suffer a partial tear, leading to slight instability of the knee. If this damage goes untreated, it most commonly leads to complete rupture and possibly damage to the medial meniscus of the knee. The meniscus acts as a cushion in the knee. Complete rupture results in front-to-back instability, commonly called Tibial Thrust, and internal rotation of the lower leg, commonly called Pivot Shift. Untreated legs usually become very arthritic and painful from the instability.


An injured Cruciate Ligament can only be corrected by surgery. There are numerous surgical corrections currently being performed. The most common are 1) External Capsular Repair, 2) Tibial Plateau Leveling Operation (TPLO), and 3) Tibial Tuberosity Advancement (TTA). This article will focus on the TTA, which is the newest procedure, and probably the best repair for most dogs. The forces within the knee are very complicated and change as the knee is rotated through its range of motion. In a normal standing position there is a tendancy for the lower end of the Femur to slide backwards on the tilted Tibial Plateau, this is called Tibial Thrust. This force can be corrected by either cutting the Tibial Plateau and rotating it into a more flat position (TPLO) or by counteracting this force by changing the angle of pull of the very strong Patellar Tendon by advancing the Tibial Tuberosity (TTA). It has been shown that the TPLO procedure can still allow rotational instability (Pivot Shift) and this may lead to the progression of arthritis as the dog ages. This Pivot Shift does not seem to be a problem with the TTA procedure because it results in more control of rotation by the large quadriceps muscle which pulls on the Patellar Tendon. The difference in the physics have been worked out quite well by the researchers. Anyone interested in the details can easily find them by doing an internet search on “TTA vs. TPLO”.


The normal Knee Joint (also know as the Stifle joint), has multiple structures which are important to its function. This drawing shows a view from the front with the muscles removed. It is important to note that the Patellar Tendon, a vital structure in the joint has been removed, so that you can see “behind” it. The Patellar Tendon is a thick, tough band that runs from the Patella (green dot) to the Tibial Tuberosity (red dot).

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Note From Tina ( aka "Mom"): I learned a lot more about the surgery from this website. I also noticed that many Veterinarian websites use the exact information as above...so I really don't know who should get the credit.

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