My Kendra slipped and fell on a very icy day in my yard. She was running and hit an ice patch in the yard with a slight slope. At 180 lbs, she hit so hard that the gouge in the yard where she hit remained for a year. She tore both ACL’s to near complete tears. She couldn’t walk at all. It took me over an hour to slide and get her into the house. I thought at 3 yrs old, her life was over.

I took her to one Vet Clinic, they would only perform TPLO on one knee. Then after healing and therapy, they would do the other knee. This is not an option for a 180 lb Mastiff. Not a dog that can easily harness or towel walked – takes two people.

I brought her to Cornell University, where they had performed all of the options on various dogs, including bilateral TTA. Said their average was that most dogs could put pressure on their legs in about 5 days. It was one operation, one anesthesia, one physical therapy etc, etc. Half the cost of stretching out over two different TPLO’s. Further, less invasive. And, she ended up being able to put pressure on both legs with a harness in 3 days. Yes, a teaching hospital, yes, less expensive. Less effective….NO. More effective.

She went to physical therapy every week for months. I took her to TheraVet Acres in Webster. I wished I had known they would have done alot of the work right after surgery. I tried to do alot and it was over my head at times while also trying to work. They will take a dog post surgery and do the whole initial work. Gets the dog rolling even faster.

So now, Kendra is nearly 6 years old and she can outrun my other two Mastiffs and as a female against her two male buddies – she is much stronger. And she could take me out if she ran into me. Her latest evaluation shows an incredible recovery and immense muscle tone. So, no – you don’t have to lose a dog over this, and it definitely pays to get a second or third evaluation. I preferred to find a hospital that could be objective and evaluate the dog for various procedures and pick the best option for the dog, and liked the fact that they could do several of the procedures.

Kendra is a rock and I dare say she is even stronger now and possibly more fit than my two younger males.

Bilateral TTA and Physical Therapy – Kendra is a post from: Dog Knee Surgery and Ligament Injuries

Our 6 year old yellow lab tore her first ACL 2 years ago. After 4 months of limping and unsuccessful medications we had a traveling surgeon Do a TTA. She came home with 15 pages of instructions. It took months but she did finally regain all use of that leg.

Recently she tore The ACL in her other leg. We found a fantastic Vet in Faribault MN that does both TTA and TPLO. Lacey got a TTA like the first, but our experience was SO much better. We actually met the surgeon and felt a lot more informed. Lacey just got her staples out and is started on a rehab program. She is nearly normal already! Lacey is doing fantastic and we actually saved $1000 over the first surgery. It pays to do research and shop around. Our Vet did not refer us, we did our own homework.

TTA Surgery on Both Knees – Lacey is a post from: Dog Knee Surgery and Ligament Injuries

Beauregard (TTA SURGERY) tore his right CCL when he was about 8. The vet verified the CCL damage and sent us to a surgeon in the Phoenix area. Post surgery recovery was good with no limping or other signs of discomfort after about five to six weeks.

A year later he tore his left CCL going after a ball. Same story, same surgeon. This time, although he seems to be able to walk normally, he has a pronounced limp when he gets up from a prone position. The limp goes away as he continues to walk. The big problem is that he seems to be losing control of his back legs. Sometimes he will cross the two legs and nearly trip and fall. He gets around okay and even takes short walks but is almost 13 years old now and is much slower than he was before his surgeries.

I know he’s getting older but the apparent loss of control in his rear legs concerns me. It doesn’t seem to be getting any worse but I’m wondering what the cause is. His knees were recently x-rayed and the vet didn’t see any problems with the TTA repairs. Any ideas?

TTA on Both Knees – Beauregard is a post from: Dog Knee Surgery and Ligament Injuries

Help!  My dog is limping – Could it be a torn ligament?

This guide is a good starting place for anyone looking for more information on dog knee problems, specifically cruciate ligament injury in dogs.  This article will give an overview of dog knee injuries covering everything from symptoms to recovery.

What is a Cruciate Ligament Injury?

An injury to the CCL (also known as the cranial cruciate ligament and sometimes called the ACL) can cause lameness in dogs, and is one of the most common causes of rear leg lameness. The function of the cruciate ligament in dogs is to stop the femur (large bone at the top of the leg, above knee) and tibia (smaller bone at bottom of leg, below knee) from rubbing against one another. When the cranial cruciate ligament is torn or ruptured the leg loses stability because these bones are now free to move back and forth on top of one another, causing friction, inflammation, possible meniscal injury and eventually arthritis.

During activities with a healthy dog ACL ligament there will be tension on the ligament, preventing the femur from pressing into the tibia, creating a sliding motion for fluid movement. If your dog is walking or running with a cruciate ligament tear there will be no tension on the CCL, allowing the bones to unnaturally move together, causing pain, lameness and an aversion to using the leg. The best way to think of this would be to envision the ligament like a rubber band, but instead of holding the bones together, the rubber band is in place to prevent the bones from coming into contact. When the rubber band is snapped, there is no longer a gliding joint in the knee and there is contact between the bones.

Acute vs. Chronic Causes of Cruciate Ligament Injury

Acute injury is generally associated with trauma. If the CCL (also referred to as ACL because of it’s similar function to the human ACL) is injured acutely it will most often be due to improper rotation of the knee and hyper extension. This can occur in many different ways such as a dog taking a misstep off a curb, stepping into a divot, jumping or becoming stuck, using a jerking motion to free him/herself.

Chronic injury of the canine ACL is generally associated with disease, age related degenerative changes of the ligament, excess weight (obesity) and conformation of the knee joint (certain large breed dogs are more prone to these types of injuries due to the way their back legs are formed). In the case of chronic injury of the cruciate ligament, there is very little that can be done to prevent the injury from taking place.

Size Matters

Small and large dogs fair differently with the same type of ACL injury. Studies have shown that dogs weighing less than about 25 pounds can experience a full recovery from ligament damage without surgery. This is not true in dogs above the 25 pound threshold. While dogs over 25 pounds may appear to be improving with conservative methods, these larger dogs rarely return to their full function without any issue. This is not to say that there has never been a case of a medium to large sized dog recovering from a torn CCL with only conservative management, but does demonstrate that smaller dogs have an easier time fully recovering using the conservative approaches.

Symtoms of a torn, ruptured or injured CCL will vary from dog to dog, and depending on whether the injury was acute or chronic in nature. Some dogs with a fully torn cruciate may only exhibit mild lameness, while others with a tear may not bear any weight on the leg at all. This again varies based on the type of dog, their size and whether other structures within the knee (particularly the meniscus) were also damaged. Below are some of the most common symptoms associated with a dog knee ligament injury.

Symptoms of a Dog ACL Tear:

1. Decreased range of motion.
2. Hind leg extended straight when sitting down (this is known as the sit sign).
3. Crackling noise of bones rubbing against each other – the medical term for this is Crepitus.
4. Dog exhibits signs of pain when knee (stifle) joint is touched.
5. Exercise intolerance.
6. Limited range of motion or mobility.
7. Stiffness, limping or unwillingness to use the leg after exercise.
8. Knee joint is swollen and/or hot to the touch.
9. Thick, tight, hard and/or firm feel to knee.
10. When standing will only place weight on the toe instead of using entire foot (called toe-touching). An early sign of toe-touching is to only have weight on one side of the body when standing.

There are other conditions with symptoms similar to a dog ACL injury such as: arthritis, knee sprain, meniscal injury, hip dysplasia, patellar fracture, patellar luxation, myelopathies, lyme disease and others. Please schedule an appointment with your vet if your dog shows any of the CCL tear symptoms listed above.

What if my dog’s CCL is never repaired?

This, again, depends on their size, breed and a number of other factors. Some dogs without a CCL may do just fine, while others may use the ability to use their leg. One truth for any dog without a supporting knee ligament is the fact that they will be more succeptible to injuring other structures within the knee, particularly the meniscus. The role of the mensicus in the knee is to act as a cushion, and absorb shocks. Damage to the meniscus is serious and typically leads to arthritic change and lameness.

What to Expect During Your First Veterinary Visit for a Suspected CCL Injury

Consultation and Review of Symptoms

Your veterinarian will review your dog’s symptoms and time of onset.  Going through a detailed history will allow your vet to determine if conditions with similar symptoms may be ruled out at this time.

Physical Exam

Walking Gait

Your veterinarian will want to watch your dog walk and run to see how they are balancing their weight and using the affected leg.

Palpation of the Joint

Your veterinarian will touch your dog’s knee to assess the joint looking for signs of:

• Swelling or Inflammation
• Loss of Muscle Tone
• Pain or Soreness
• Range of Motion
• Popping of the Joint
• Fluid Accumulation

Drawer Sign Test

During the drawer test the veterinarian with stabilize your dog’s femur with one hand while manipulating the tibia with the other. If the tibia moves forward, known as a positive drawer because of the way the bone moves similar to a drawer being opened, the ligament is ruptured.   A negative drawer sign does not necessarily mean your canine does not have a cranial cruciate injury, and false negatives can happen if your pet is tense, if the injury is old and if there is arthritis.

Tibial Compression Exam

Another test, similar to the eliciting the drawer sign, is the tibial compression test. During this exam your veterinary physician will stabilize the dog’s femur with one hand, while flexing the ankle with the other. In dogs with a ruptured cranial cruciate ligament, the tibia will display forward motion upon flexion of the ankle joint.  Again, a negative tibial compression exam does not rule out a cruciate ligament injury, and many factors can contribute to a false negative result.

How to Test a Dog for a Knee Ligament Injury

X-Rays for CCL Injuries

Radiographs are usually taken, not to diagnose a cruciate ligament injury (soft tissue damage is not clearly visible on x-ray), but to rule out other diseases such as cancer and hip dysplasia. An xray will confirm the presence of fluid in the joint as well as arthritis, which will help to confirm the diagnosis of a cruciate ligament injury.

Ultrasound for CCL Injuries

Ultrasound may be used to positively diagnose a CCL injury. Unfortunately a minority of medical clinics are equipped to do ultrasound, and many veterinarians rely on the results of the consultation with you, physical exam and ruling out any other conditions by x-ray to make the diagnosis of a CCL injury.

My Dog Has Received a Positive Diagnosis of a CCL Injury – What Are My Treatment Options?

There are two major avenues for treating a dog knee ligament injury – conservative management or dog knee surgery.

What Is Conservative Management?

Conservative management is a non-surgical option for treating cranial cruciate ligament (CCL) injuries in dogs. Depending on the size of your dog, the severity of the injury, presence of other damage (particularly to the meniscus – remember, this is the part of the knee that acts as a shock absorber) and the duration of time since the onset CM may be a good option for your dog. As mentioned above, dogs weighing less than 25 pounds tend to have better outcomes using conservative techniques than larger dogs.

A variety of techniques can be used if you choose Conservative Management (CM) for your pet.

Conservative Management Includes:

“Standard” Conservative Management

• Rest – Your dog should remain inactive during the recovery period, abstaining from rough play, prolonged exercise or any movement that may cause any pressure or unwanted movement within the knee joint.
• Weight Control (and reduction if necessary) – One way to reduce stress on the joint is to keep your dog’s weight under control, and if possible, underweight is better during the recovery process.
• Anti Inflammatory Medications – There are a number of Holistic (ex – Yucca Root) and Prescription (ex – Rimadyl) medications available that can help to make your pet more comfortable as the knee heals.

“Optional” Conservative Management

• Dog Knee Brace – There are a variety of dog knee braces available including the orthopets canine stifle brace and atrac dynamic brace.
• Veterinary Acupuncture – Acupuncture for dogs is available, and can help to de-stress your pet as their body heals.
• Veterinary Chiropractic - A chiropractor can work with your dog to make sure your pet is free from any subluxations or other blockages.
• Physical Therapy for Dogs – Working with a certified canine physical therapist can help to ensure your dog maintains muscle tone and range of motion in the leg following their injury.

What Are The Different Types of Surgery for Dog ACL Injuries?

Dog Knee Surgery Options:

TPLO Surgery (tibial plateau leveling osteotomy)

This surgery adjusts the slope of the tibial plateau (preventing unwanted forward motion) by cutting and rotating the top of the tibia, and keeping it in position with a bone plate (which can be removed after healing).

TTA Surgery (tibial tuberosity advancement)

The TTA surgery also focuses on changing the angles of the bones within the knee joint. In a TTA the tibia is cut and moved forward to create stability. The new position of the bone is held into place with a bone plate (which can be removed after healing).

TTO Surgery (triple tibial osteotomy)

The TTO is a combintation of the TPLO and TTA techniques. It moves the tibial crest forward, as a TTA does, and also adjusts the tibial plateau to 90 degrees, as the TPLO does.

Tightrope Surgery

Tightrope CCL is an extra capsular technique using the lateral suture stabilization (LSS) procedure in conjunction with a material called FiberTape to provide bone to bone stabilization.

Extra Capsular Suture (traditional repair, extracapsular imbrication)

This is referred to as a traditional repair because this was once the conventional treatment for CCL tears. The extra capsular suture uses a strong leader line suture in a figure eight pattern around the knee to provide stability and keep the knee in a normal position.

Fibular Head Transposition (fibular head transfer)

The fibular head transfer surgery utilizes another ligament in the knee, the lateral collateral ligament, to take the place of the CCL. In this surgery the fibula is rotated so that the lateral collateral ligament can perform the function of the CCL.

Dog CCL Surgery Recovery

Depending on where the ligament surgery was performed, your dog may stay overnight to be monitored and receive pain medications following the procedure. TPLO surgery recovery can be different from TTA surgery recovery, so it’s important to follow the recommendations of your vet during the post operative period. Your dog’s sutures will be removed within a week or two of the procedure, and follow up appointments are typically done at 2 weeks, 4 weeks, 8 weeks and 12 weeks. Again, depending on the type of surgery done, radiographs may be done during these follow up appointments.

During the 6-14 week period following surgery it is very important to severely limit your pet’s activities. For approximately three months following dog knee ligament surgery your pet should be confined to a crate, small room or enclosed area when you are not able to be with your pet. You will probably want to make use of a dog cone collar – Elizabethan collars or Pro collars are my favorite. Make sure to post operative doggy proof your house and make sure they have no opportunity to slip, slide, jump up onto furniture, climb up stairs or engage in any activity that may damage the healing knee.

While outside you should accompany your dog for bathroom breaks, and they should always be controlled on a leash – you never know when a post operative dog may get the urge to chase a squirrel! You may increase the length of walks during the recovery period under the recommendation of your veterinarian and judging by how well your dog is recovering. I strongly recommend not letting your dog off leash at all during the first few months following surgery just to be on the safe side. Your veterinarian will most likely encourage you to have your pet use the injured limb immediately following surgery, but do not overdo it. Physical therapy during this time can also be very beneficial, and swimming is a great way to ensure your dog gets to use their leg (helping to maintain strength and muscle mass) without engaging in any activities that may be harmful to the knee.

Cruciate Ligament Injury in Dogs is a post from: Dog Knee Surgery and Ligament Injuries

How much will a TTA surgery for my dog cost?  How much should I expect to spend on a TTA repair?

TTA is the abbreviation for tibial tuberosity advancement.  The TTA is among the newer techniques (Tightrope repair is the newest surgical procedure for CCL repairs) for cranial cruciate ligament repair of the canine stifle, making its appearance roughly 10 years ago.  Biomechanically speaking, the procedure is very similar to the TPLO, but without many of the risks. 

The TTA is, in fact, a simpler procedure for veterinary surgeons to perform than the TPLO, and works to correct the injured stifle without over correcting the angle.  Basically during a TTA surgery the veterinarian will make an incision in the bone and move the tibia slightly forward.  The vet will then place a titanium implant on the joint, changing the angle of the knee joint and providing stability.

Below is the cost estimate I received for my dog to have TTA surgery.

1)  My dog in an American Bulldog weighing roughly 90 pounds (normal weight), and is 5 years old.

2)  He is in good health with no pre-existing conditions that would complicate anesthesia or surgery.

3)  This estimate, although some of the information has been blacked out to protect privacy, is from a speciality veterinary clinic with veterinary surgeons who specialize in cranial cruciate ligament repair surgeries in dogs.

4)  I live in Southern California, and this estimate is from a veterinary office in that area.

I received a low cost estimate for the TTA of $2800.00 and a high end cost estimate for the TTA of $3200.00.

This TTA cost estimate included:

- Surgical fees
- Post operative x-rays
- Post operative medications, including pain control meds during the surgery and to take home
- 4 post operative visits, including x-rays

What is the Cost of TTA Surgery for CCL Repair in Dogs? is a post from: Dog Knee Surgery and Ligament Injuries

Jake had traditional repair 7/28/10. This was Jake’s second surgery, as he had TTA (Tibial Tuberosity Advancement) in February of 2009. Prior to both surgeries we tried conservative management, but needed surgery both times.

Traditional Repair – Post Op

We are currently Day 4 after the Traditional Repair, and it has been remarkably smooth. Jake is a large mini poodle (32 lbs.) and was always on the large side of his breed and is more of a small standard size. He is almost 13 y.o. so I was concerned about going into surgery, since the anesthesia seemed to escalate his aging after the first surgery, the TTA.

Honestly, I have read so many horror stories about the recovery period, etc., I was skeptical. Jake had surgery Wednesday, he came home Wednesday night with a soft cast, some Tramadol and Previcox.  He was a little uncomfortable that night, but slept. Day 2 was similar, and although the cast was cumbersome he was putting weight on the leg. Cast came off 2 days after surgery and he has been walking on the leg. Pain meds continue (but 1/2 tablet Tramadol 3X day) and he is doing great.

TTA – Post Op

Comparing to the TTA, which I decided to do after about 6 weeks of conservative management, this was a piece of cake. Jake did, however, stay overnight with the TTA, and came home the following day, with cast and meds, and was putting weight on it (also) almost immediately, but lots of toe-touching.

TTA vs. TPLO

I did extensive research and interviewed various surgeons prior to the first surgery, and opted for the TTA over the TPLO once I heard if there was a complication with a TPLO, it was not able to be “fixed”, but the TTA could be re-done, if needed. I believe it has to do with how the joint is re stabilized — the TTA uses a non-weight bearing bone, and the TPLO reconstructs the angle on the weight bearing leg, so if there is a problem, there is a real problem. One vet confidentially told me that sometimes the leg needs to be amputated (now, this vet preferred a TTA, but upon some checking, it may be true). IF you decide to go with a TPLO procedure, be sure to ask the vet the “what if’s” in case there is a problem a few weeks out and you need to have a “redo”.

Recovery

In any event, Jake is doing well, and at almost 13, he should be as good as new.

I will add that his cruciate ligament was fully ruptured on the first leg (meniscus was ok), and the partially ruptured on the second leg — although he could not put any weight on the 2nd leg, so I had no option. We believe it is a genetic predisposition in Jake’s case, as opposed to an “injury” due to his age. Also, there was no real accident, just normal dog stuff. I am happy to share any of my knowledge I have gained over the last 2 years.

TTA and Traditional Repair Cost

By the way, the TTA cost was around $2400, plus physical therapy, x-rays etc. (another $1,000 or so); the traditional repair which I opted for this time due to the fact it would be easier on him, was around $1300. I reside in the Chicago area.

Traditional Repair and TTA Surgery – Jake is a post from: Dog Knee Surgery and Ligament Injuries

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.

TPLO vs. TTA for Cranial Cruciate Ligament Repair is a post from: Dog Knee Surgery and Ligament Injuries

TTA is the abbreviation for tibial tuberosity advancement.  The TTA is among the newer techniques for cranial cruciate ligament repair of the canine stifle, making its appearance roughly 10 years ago. The TTA technique was developed in 2002 at the University of Zurich, and, biomechanically speaking, the procedure is very similar to the TPLO, without carrying many of the risks. In fact, the TTA is a simpler procedure for veterinary surgeons to perform than the tibial plateau leveling osteotomy, or TPLO, and works to correct the injured stifle without over correcting the angle – as TPLO often does.

During the procedure an incision about 4 to 6 inches will be made along the dog’s stifle to provide the surgeon access to the knee tissues. The torn/ruptured cranial cruciate ligament, or CCL, is completely removed and the mensicus is examined. The veterinary surgeon will determine at the time of surgery the extent to which the mensicus has sustained damage and will work to remove the injured tissue. The doctor will take care to only remove meniscal tissue that is damaged, as dogs with some intact, healthy meniscus tend to do better long-term than dogs receiving a complete mensicectomy.

A transverse osteotomy is then performed just behind the tibial tuberosity (a non weight bearing part of the knee), which creates a groove in the bone, allowing the tibia to be advanced to its new position. The tibial tuberosity is then advanced to achieve a perpendicular relationship between the tibial plateau slope and patellar tendon, resulting in a stable joint. Examination of the stifle with a-ray radiography prior to surgery will make sure the surgeon has the proper size implants available for the procedure, and the advanced tibial tuberosity is held in place with titanium implants. Lastly, a bone graft is placed into the area of the osteotomy to stimulate healing and the incision is closed with sutures.

TTA Surgical Procedure is a post from: Dog Knee Surgery and Ligament Injuries