TPLO vs. TTA for Cranial Cruciate Ligament Repair
TPLO, or tibial plateau leveling osteotomy, and TTA, or tibial tuberosity advancement, are two very new and biomechanically similar surgical techniques. Both the TPLO and TTA create stability within the dog stifle by altering the angle of the knee and using implants to hold the knee in place while the joint heals in its new position. The TTA procedure is actually a modified version of the TPLO procedure, using the removal of bone of the tibia to allow the restructuring of the stifle’s angle, which is subsequently held in place by metal implants.
So which is better, TPLO or TTA?
Well, if your veterinary surgeon has no experience performing TTA’s, as it was only introduced to US surgeons starting in 2004 so many vets do not, you will want to opt for the procedure with which your vet can demonstrate proficiency and results. Many veterinary surgeons perform both TPLO’s and extracapsular imbrication techniques, but there are not many who perform all three. If you have the option of choosing between a surgeon that does a TPLO and a TTA, and have an active, large breed dog that would not do well with a traditonal, or extracapsular imbrication, repair, you will want to weigh all the characteristics of both procedures.
Which is less invasive?
The TTA is surgically less invasive than the TPLO. The amount of stifle angle shifting that takes place during a TTA is minimal when compared to that of a TPLO, where the tibia (the weight bearing part of the knee joint) is surgically cut and altered. In the TTA the osteotomy is made into the tibial tuberosity (not a weight bearing part of the knee joint), not the tibial plateau itself, giving dogs a greater ease in healing, recovery and overall success of the procedure.
Which has a shorter recovery time?
The TTA, because it is a surgically less invasive process, has a shorter recovery time than the TPLO. While most TTA and TPLO dogs are able to begin weight bearing within the first 24 to 48 hours postop, TTA dogs continue to improve with time, whereas TPLO dogs often demonstrate a more gradual healing process taking place over months instead of weeks.
Which has less risks of complications?
What does each procedure cost?
The least expensive method of cranial cruciate ligament (or CrCL) repair is always going to be the extra capsular imbrication method, as it does not require the use of any implants or an osteotomy procedure, and you can expect to pay between $700-$1100 to have a traditional repair done. This procedure can be a great option for many dogs, and I encourage all owners to read more about its risks and benefits when considering surgery for a CCL rupture.
When comparing the TTA and TPLO, the TTA is less expensive, and this is due to the simpler nature of the procedure as well as the fact that it does not require as much equipment, despite the fact that titanium costs more than stainless steel. A typical price for a TTA will run between $1500-$2000 vs. a TPLO ranging between $2200-$2700, which usually includes all of the pre-operative testing, postop medications and post-op visits for suture removal, bandage removal (if applicable) and radiography.
May 27th, 2008 at 10:10 am
Hello. I have a question about TTA and TPLO. Is there “an estimated” cost $ for each of these? I have seen and been quoted different costs. Thank you very much.
May 28th, 2008 at 2:04 pm
Hi Matt,
The estimated cost for a TTA is $1500-$2000, and $2200 and above for TPLO procedures (I have heard cases of TPLO’s being around $3000). Different estimates are common and are related to a number of different factors including:
1) Size of the Dog - the smaller the dog, the lower the price. This has to do with the fact that smaller dogs require less anesthesia, medication, sutures and equipment.
2) Where the Surgery is Being Performed - your local veterinarian is going to charge less than having the procedure done at an orthopedic surgery center with 24/7 staff.
3) What is Included - usually estimates include other exams/tests in addition to the surgery itself; be sure to find out exactly what will be done for the estimate you are given.
June 17th, 2008 at 6:43 am
Hi; I have a 4.5 yr old female German Shepherd. She had the TPLO on the one side last August, and just last week the TTA on the other side. The TPLO side was a result of stress from the original tear on opposite side at 9 months. FOr over two years she used the [yet to be done] TPLO side too much… thereby instead of doing one surgery early on, we were forced to do two, with the worse side having surgery first.
Had I done the original surgery when she was younger I might have avoided the second ACL tear. I felt she was too young as her bones/structure had not completely developed… this was seconded by the surgeon, however, I waited another year which by then she had torn the other side. I was hoping limited movement, stress ont he leg, providing Chondrotin supplements, etc., were ‘working’.
I was very wrong.
The second tear was far worse than the original, she had no muscle mass on that side and hence was done first. She had become some what of an artist hiding how she was hurting since the hurt must have beenn familiar to the one at 9 months.
I followed her down the stairs one day and instead of seeing the ‘tribbling’ down the stairs with all 4 paws, I saw ‘ker-plop’, ‘ker-plop’, ‘ker-plop’ all the way down… she was carrying the worse leg.
Cost: TPLO was $3200 [include radiography, physical therapy which is needed if you love your dog]; TTA was $3800.
While this may seem excessive given varying clinics/vets around the country, go with some one who is experienced. If the Dr had said its going to cost $10K I am not Ms Moneybags, but I would have paid it == I wanted him to perform the surgery after knowing he had already performed some 2000…
You do get what you pay for, whether your own Dr [who may have graduated bottom of the class at med school, worthwhile to investigate before you sign up to let him open you up] or pay more for someone who is highly skilled and graduated top of the class.
Research is recommended; go with someone who only does orthopedic surgery. He/she is then a specialist and has performed many of these surgeries prior to having your pet go under the knife with this person…. going with someone who is a generalist, would be like asking your general physician to perform brain surgery rather than a brain surgeon or having your general physician perform open heart sugery rather than a thoracic surgeon who specializes in heart surgery, hmm?
Just something to consider.
First surgery: success at 4 months, knowing she is the alpha of three I restricted her for up to 5months. She was a real dog again, and I saw for the first time since she was a pup, the ’sphinx’ sitting for a treat.. I know she had healed and healed well.
Second surgery: waited only 2 more months to make sure the leg was strong enough to carry the other for recovery and of course, let the dog be a dern dog - romp play.
The ‘ker-plop’ versus the tribbling returned 10 days prior, and off to the surgeon we were once again.
June 25th, 2008 at 6:29 pm
I have read your web page and would like to share some info on the subject of cost comparing tta and tplo. I have spent the last year learning about this problem and the procedures to correct it. My very large breed dog has partially ruptured her cruciate ligament in both legs. I have been all over the north east visiting vets and Tplo is like $3000-$4000 and the tta is the same. For one leg …both is going to be like $8000. The reason I am leery on going ahead with TPLO vs TTA surgery is because a family member had the same issues with their dog and she recovered good from the first surgery but the second one the poor baby just isn’t the same. She had the TPLO done on both legs a few years ago 2002 and 2004.
June 29th, 2008 at 4:29 am
We have a 4 year old female Irish Wolfhound x Great Dane who we opted to have the TTA done (after putting it off for nearly two years) after MUCH research. At first, we figured that her stiffness was due to her arthritis and over use after we adopted another dog two years ago but quickly realised in April that it was not the case anymore.
We live in Australia and knew that she could not make it through another Winter and upon seeing the specialist (which by the way was the most recommended surgeon in the area for this procedure) we opted to do the surgery at a cost of $3,222 PER knee.
She is five weeks post surgery with her left knee scheduled for next week. Immediately after her first surgery, she was trying to run - proving that the level of pain prior to the surgery was immense! It only reassured us that we made the right decision and it is wonderful to see her full of life again - although it is a challenge to keep her on all four feet…even when she is on a lead!!
I do recommend that if you have this done you DO have a clinic with 24/7 care AND, if only a surgery centre, it is affiliated with a vet for emergencies. We have had several visits to the vet over the past five weeks due to our dog “killing” the tip of her tail from hitting it on the crate & needing it cut off. I think we now own stock in both the Surgical Center & Vet!!
Oh yeah…and be sure you are ready for the emotional roller coaster you will go on with seeing your dog in a crate for SIX long weeks!! Something we had no idea would have such a huge impact on us. Tip for you all - line the crate with non slip padding so your dog doesn’t end up in the vet with an unexpected $500 surgery to fix her tail when she beats it to death with the excitement of seeing you!!
Do your homework, check out websites and ask other people for tips PRIOR to making this huge decision. You get what you pay for and NOT all surgeons are capable of doing this procedure. If you are serious about having it done, investing the money and time then I recommend you see a surgeon who specialises in TTA procedures.
July 19th, 2008 at 6:44 am
My dog a 55lb Chow mix started favoring his left rear leg about 3 weeks ago. Our Vet examined him and recommended surgery which he said he can perform. He is recomending TTA.
I am feeling like I should have this done immediately so that he doesn’t injure his knee more. It seems like other people have waited months or years
How do I know my Vet will do a good job? He told me he has done TTA 10 times. His price quote was $2,600
My dog is very active and I don’t know how we will keep his inactive for several weeks at the very least
I’m trying to talk to other vets to get opinions
August 16th, 2008 at 11:14 pm
Linda-
Do NOT let a surgeon who has only performed a surgery 10 times operate on your dog. Go to the closest University Vet School and have the procedure done. I had top notch care last week on my 65 lb. Black Lab and she’s doing great so far. In all, we spent around $2000 total on her surgery and pre-op radiographs. My surgeon has done the procedure close to 100 times in the past year. This is not simple surgery. Make sure you have someone who knows what they are doing. Don’t let someone practice on your dog. Good luck.
August 27th, 2008 at 2:35 pm
Hello,
Thank you very much for this great website resource. It is greatly appreciated.
I have been reading about a new procedure called Tightrope CCL. Does anyone have any opinions on this or know of any surgeons who are performing it yet? Any information/experiences would be helpful.
Edward
September 9th, 2008 at 4:52 pm
Hi Edward - You can find some info on Tightrope CCL Repair here - http://dogkneeinjury.com/2008/tightrope-ccl-procedure/
The surgery is still undergoing clinical trials, and the only surgeons performing it are involved in the trial. The results so far look very promising though, and we should be hearing more and more about the procedure as the months go on.
November 4th, 2008 at 3:26 pm
Hi, I’m from Brazil and my sister’s labrador retriever, a male aproximately 14 months old, just under went TTA procedure a couple weeks ago and the vet who performed the procedure told us the dog would have to rest and “lay low” for a week before getting back to it’s normal life. After following all the steps indicated by the vet, the dog is limping (I’m not sure about this word in english so I better describe what I mean by it… When the dog steps on the ground it fails to step regularly just as it does with the other 3 legs). She is really worried about it and asked me for help, so I’ve decided to look for some help out of the country, after all, before this procedure got to Brazil, it was already being performed there on the US.
I’m preety much looking for help of anyone who had or knows about a similar situation and could give me some tips on what to do now.
I can also email the pictures of the X-rays taken from Bob’s leg to someone who understands enough to emmit some opinion.
My email is antoniog_pereira@yahoo.com.br. If you can help me, please email me.
Thank you all so much.
December 9th, 2008 at 1:26 pm
Hello, My nine year old mut had a TPLO several years when six, and she has been active with zero setbacks. Feb ‘08, she received a TTA on her other leg. Our understanding was the vet was very experienced w/ TTA, and it seem a better choice especially since she had severe arthritis. Two weeks ago she began limping on her TTA leg. Now we are being told it is either arthritis or a meniscus tear. It is advised she have exploritory surgery.
Does a TTA lead to a higher change of meniscus tearing than a TPLO? What are your thoughts?
Thank you for your concideration, Lorna
(FYI: my dog is large and we keep her a thin 55 lbs. In addition, she is very stoic and doesn’t show pain unless it’s really bad)
December 9th, 2008 at 2:11 pm
My Dog is a 2.5 year old yellow lab, she gets her tta surgery done Tuesday at U of Penn. Then she gets the other knee done 8 weeks later. I think that I have coverded every aspect as far as researching the surgerys TTA, Tightrope, and TPLO. But did anyone have any problems with there dogs depression after sitting in a crate for 4 months or did there dogs temperment change.
Thanks in advance. Oh the cost was $4000.00 Per knee
December 12th, 2008 at 11:15 am
My 4 year old German Shepherd had TTA surgery 5 months ago. He was crated for about 6 weeks the he was allowed to roam a small room during the day while I was at work. Yes, there was a temperment change in him during the time that we crated him. I spoke to the surgeon and asked if he could spend some quiet time with me in the living room on the floor. He was given the ok for small amounts of time as long as I didn’t allow him to make sudden movements like running, jumping or lurching up on the couch. He had to be tethered to my side. His leg healed perfectly! It’s a very long healing process but I feel it’s worth it. Unfortunately, he just tore the other knee and we are headed down the road for surgery #2 in a month. It costs me a little over $3000 for each knee.
December 22nd, 2008 at 11:05 am
Our English Mastiff was 8 in June when we has the TTA done. The cost in NJ was $4700, really over 5k when you include the final xrays and test to insure the TTA was needed. We were warned that 40% of dogs do the same ot the other leg.
Just this week it happened and another surgery is needed. We were debating on the TPLO because we were told it was cheaper? After reading up on both I think we need to stick to the TTA.
It was amazing how this 160 lb dog walked the day after surgery. Dont get me wrong, its a tough stressfull time for all, especially the first few weeks.
January 2nd, 2009 at 2:02 am
Hello from Estonia!
I have a Lab-girl, 1,5 years old and she tore her right CCL in October 2008. I don`t know about others (countries, clinics :)) but in our case it took over two months to make it to the surgery. For the first 3 weeks she was held on a traditional repair with confinement and anti-inflammatory medication. that didn`t work, so we scheduled the TTA operation, which took about a month of waiting. Now almost 6 weeks has passed from the surgery. It seems, that she is feeling very good, the limp is practically gone and sometimes we have a really hard time to keep her from “dancing” and speeding up in our small apartment. We are still keeping her in a crate during night and while we are at work. When we are at home we let her out to our living room and we covered practically every room with the carpet so she wouldn`t fall because of the slippery floors.
During first 4 weeks we had quite many “oops” situations: climbing over barriers, jumping to the door etc. So after one bigger “accident” we thought it would be best to go and check her leg in x-ray (the 6 weeks check-up was too far away). It was almost 4 weeks after surgery and the doctor said looking at the x-ray picture that the bone was healed. it was actually surprising since I´ve read all over the internet that it takes much longer (or have I misunderstood something :S). The doctor said there is no harm in her (the dog) taking the stairs on her own (we live on a second floor) and she has been doing that ever since (after 4 weeks post-op). Also we are taking 10-15 min walks twice a day. It will soon be 6 weeks post-op and I totally agree with the previous (Bryan): it is really a very stressful time for ALL.