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Here at County Animal Hospital we perform various orthopedic and neurologic surgeries.  When being evaluated for a lameness issue, it is important to determine if it is due to nerve damage or musculoskeletal inury.  The doctors here at County will spend a little extra time with you and your beloved pet so that an accurate diagnosis is made.  Radiographs (x-rays) are commonly used to help us deterimine the exact location or locations.  At County, we have digital x-ray so the images are much better than conventional film.   We commonly use bone models so you can "see" where your pet  "hurts."  Just a few of the orthopedic/neurologic procedures that we offer are listed here: ACL repair (TPLO, TTA, Tightrope, fibular head advancement, and lateral suture), medial and lateral patella luxation repair, femoral head and neck excision, fracture repair (internal and external), dorsal and hemilaminectomy, and joint arthrodesis. 

ACL rupture in dogs is the leading orthopedic injury in the United States.  Since there are several methods of repair, listed below are some basic history and information about TPLO and TTA.

Michael Vitucci MS, DVM has accreditations in AO ASIF (Association for the Study of Internal Fixation), External Skeletal Fixation, and Tibial Tuberosity Advancement (TTA).  He is also an active member of the Veterinary Orthopedic Society. 

Tibial Plateau Leveling Osteotomy (TPLO) 

In 1978, a new test for identifying rupture of the anterior cruciate ligament was described.
 
After using this test for several years, Dr. Barclay Slocum began to understand how the stifle really works. In 1982, Dr. Slocum described the cranial tibial thrust which is a dogs natural force created in the stifle. The cranial tibial thrust is responsible for rupture of the anterior cruciate ligament. Understanding how this force is created led to the design of a surgical procedure for controlling this force and its destructive side effects. A new version of the procedure, called Tibial Plateau Leveling Osteotomy has proven effective in returning dogs to full function.
 
Healing takes about two months for the bone and slightly longer for the soft tissues to heal. Because the plateau leveling permits the joint pain to subside, the major problem in this surgery has been related to excessive patient activity before bone healing is complete. Owners are advised that absolute restriction of activity is mandatory during the healing process. Most patients return to very light yard work at 2-3 months, light training at 4-5 months, full training at 5-6 months, and are functioning normally under field trial conditions at 6 months.
 
The surgery results over the past 10 years have been excellent. Even patients that had ruptured ligaments for periods up to 5 years have made marked improvement. Many of these cases have a longer period for regaining flexibility in the stifle. Dogs that have had a previous surgery (up to seven on the same stifle) still show improvement. Patients with poor conformation may not respond well to this surgery but those patients can also have their conformation corrected at the time of surgery. This surgery is not size dependent, it works on all stifles of all breeds with the described mechanism of injury.

TTA Surgery (Tibial Tuberosity Advancement)

TTA was developed by Dr. Slobodan Tepic of Zurich, Switzerland. Dr. Tepic is well known in medicine for developing the Zurich Cementless Total Hip Replacement, the state-of-the-art in canine hip replacement surgery. This procedure is also used for hip replacement in humans. 

TTA is a new-comer to the arena of procedures advocated to stabilize the cranial cruciate deficient knee in the canine. The theory of TTA arose out of a modification of the proposed model by Slocum, in that the net “joint reaction” is approximately parallel to the patellar tendon, and that if the patellar tendon is perpendicular to the tibial plateau (joint surface), the cruciate ligaments are not under any load. If we move the patellar tendon forward to the point that it is perpendicular to the tibial plateau in a standing angle, we relieve the load on the cranial cruciate ligament. The net result being that the patellar tendon takes over the load of the cranial cruciate ligament.  The result is a stable knee. Apparent advantages to TTA when compared to TPLO include;

1. Quicker recovery – as a result of less invasive surgical technique, less swelling, shorter surgical time, and improved postoperative stability. Many patients are walking better when they leave the hospital postoperatively.  Recent studies by A. Pozzi, show that dogs that have had a TTA have "more normal" joint forces than that of TPLO. 
 
2. Ease of procedure – less technically demanding procedures are less likely to have operator-dependent failures, resulting in better clinical results.
 
3. Good results with chronically arthritic knees – since TTA does not require a rolling of the tibial plateau (like TPLO), stability is easily achieved even in the most chronic knees.