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.
My 11.5 year old 60lb (27kg) lab tore her CCL about 3 weeks ago. Her x-rays show some arthritis, but less than anticipated for her age. Her leg also has a clicking sound when you try to move it (suspected miniscis damage). She was never as active as other labs I see. She is very sweet and has always preferred socializing with people at the picnic bench to the dogs in the park. Maybe occasional bursts of running in the yard when showing off to neighbor dogs or a visitor, but most of her days are spent begging, jumping up on the couch and ~1m (1.5km) with a daily walk on a leash (until recent). She is stockier lab build but trim and otherwise healthy for her age.
My vet routinely brings in a contracted surgeon from the area for this who performs extracapsular repairs. He estimated that this surgeon had performed 30-40 in his office. He has watched her surgeries and described this vet as meticulous and had good things to say about the short/long term success of past patients. He said he would have her do the surgery on his own dog if needed. My vet is very trusted, established and experienced. This is a surgery that seems more complex than prior surgeries/treatments and available information seems conflicting.
Calling other schools and specialty vets in the Chicago area, they say they mostly prefer the TPLO (maybe because they are teaching schools and specialty vets). Acknowledging all surgery has risks, is it reasonable to be optimistic on an extracapsular repair for this type of dog?
Joan posted September 30th about her GSP. We have a 7 year old, very hyper GSP with a torn cruciate ligament and have been agonizing over what to do. Joan if you are still reading this website, I would like to know how things are going 4 months later. My email is lisarobinb@hotmail.com. Thanks, Lisa
Help! I don’t understand the anagrams used on this site to describe the different types of surgery for cruciate ligament repair. My 8 year old, mixed breed, 45 lb. friend tore such in her left hind leg on 12/16/09 and had surgery with a tightrope implant that I believe was screwed in. No cast, but a 8 week recuperation period. What letters apply to this surgery? Then, on 1/09/10, the right hind leg became ‘loose’ and vet stated she needed same surgery. I can’t imagine her recuping safely from 2 such invasive surgeries. I will call University of Missouri Vet School on Monday, 1/18 to see if she is candidate for the less invasive tight rope CCL surgery currently in clinical trials. In the meantime, can anyone advise me as to which surgery anagrams she did have in december/09? Also, I currently have a broken left leg, casn barely walk her on a leash, can’t lift her so am looking for the fastest recovery time. Thanks, Marsha
Janet posted 14th Jan 10, 11.5yr, 27kg lab.
Given your dog has good weight for her breed and considering her age, I would say that Extra-capsular repair would be indicated and probably a good choice.
There are several methods for Extra-capsular repair and I am not sure which one is intended for your dog. never the less, extra-capsular repair tend to be less invasive and no bone cutting is involved. One of the major issue I would look at when choosing type of surgery, is looking at the rate of healing and potential complications. Using this analysis I would be less inclined to to TPLO for an older dog.
For the more “chubby” dog I would consider osteotomy repair (TPLO) as in these dogs the extra-capsular implant tend not to last due to the greater load.
It is not to say that your dog can not have TPLO, but if your vet (the Doctor that examined your dog and knows her) feels she is a candidate for Extra-capsular repair than I would consider this as a god way to go about.
Hi Everyone
We just went thru a bilateral extracapsular stabilization on my 14 month old pit bull. She had a complete rupture of the right and 90% rupture on the left. She is doing great so far. We are 10 days post op and she is bearing weight, walking, full extension and partial flexion (this is what we are working on). My dogs surgery was approx 3000 with radiographs and all. If anyone has any questions I would be more than happy to help out. I am in NY and would highly recommend Dr Tim Robinson, he was excellent before and thus far after the surgery. She will be starting her rehab Thursday with the center also.
Hi Karrie,
Good to hear your dog is doing well after the surgery. My dog Pixie had the same problem, rupture of right knee ligament, I waited for 10 months doing the conservative managament , she was fine but now she started to limp more often and I am looking for a vet that performs the Tight rope surgery in NY. Could you give Dr Tim Robinson location info and if possible phone number.? I appreciate. Thank you! best for you and your dog.
I have a 3 1/2 black lab who had a TPLO done on her left knee 2 yrs ago. She now needs one done on her R knee. Our Vet recommended this traveling surgeon who has done a few hundred to 1000 TTA. Which was not given as on opiton the first time around. Since the surgeon is a traveling surgeon there is no way to really “look him up” but our VEt and another custome but have recommneded him. He says either option is okay but due to dogs wt and age she is 85 lbs is opting more for the TPLO. I amm leaning more towards the TAA. How do i know which way to go? Also reading other people’s post, alot say their dog had to be in a kennel for months after surgery, our did not and recovered just fine why are so many going into kennels?
I posted a comment a couple of days ago on my girl Kendra. She injured her front leg and the day before going to the specialists, tore both hind ligaments. She is a 3yr old, 170 lb., very active Mastiff. One Specialist recommended TPLO; one leg at a time. We went to Cornell University yesterday for a second opinion. I would do the same for myself, so I felt she deserved it also. We have had great success with highly specialized issues in the past. They perform all four procedures, hence, we felt they would be objective on the best solution for her. They have recommended, because she has bilateral tears…and a bad front leg, that we do bileateral TTA. They have recently done 5 or 6 bilateral TTA’s and the dogs were able to walk out the door in 4-5 days. She will then stay there for 4-5 days post op. The cost is around $5000 for both. This ends up cheaper than TPLO….we had quotes of $7000 to $8000 for both legs and we would only be able to do one leg at a time, doubling the recovery period. It takes two of us to hold her up and walk her and this is incredibly difficult at her weight. I worry that she will sustain further injury by waiting with conservative management in the dead of winter. Her surgery was supposed to be today, but she has been bumped to tomorrow morning. In the meantime, we called a 3rd Vet, Dr. Rene van Ee (Kenmore, NY…near Buffalo). He has been doing extracapsulation (fishing wire style) surgery for years. He comes highly recommended. He performed this surgery on our friends 195 lb. Mastiff about ten years ago. He had a second surgery done a few years later. This Mastiff lived to 13 1/2 yrs of age. Our friends took extra precautions with lead walking for 6 months. I would have strongly considered Dr van Ee, and this type of surgery, except he wasn’t available for two more weeks and Kendra really can’t wait. Their Mastiff, due to his weight, had to put some weight on the leg post op and he still fully recovered. This procedure may have been more difficult for Kendra as she is having trouble putting weight on 3 legs. We are also looking into the option of having her stay a few extra days for a longer period of rehab. I will update
Dr Robinson is located in Syracuse NY 315-446-7933
Best of luck to you!
Kendra had bilateral TTA this past Friday. It turns out that both knees had near complete tears. There was no meniscus damage, thankfully. We visited Saturday evening and as we sat in the waiting room, we saw her being gurneyed outside. We watched through the windows as they unloaded her and two people sling walked her. I more appeared that she was walking them. I couldn’t believe my eyes. She could actually walk better than prior surgery, this, one day after surgery. Wow. Kendra’s biggest challenge is ahead of her, that and she isn’t eating much. I am cooking her food and trying different things she may like for now. On Monday, we went to drop off more cooked food and they said she was good enough to take home. 3 Days after both legs had TTA?! We were a bit shocked, but after the 3 hour one way trips…we were taking her with us. As she still has pain in the one front leg from arthritis, it takes two to walk her. I am applying heat to the edema 3x per day and meds 2x per day. I am massaging her muscles a couple of times per day also. I am going to look into something for the front leg…she needs to be able to help herself more with that leg for now, eventually, she will be able to rely more on her hind legs. She will be walked 5-10 min per day, for 2 or 3x per day for a few weeks, then we are strongly considering taking her for the 10 day physical therapy plan at Cornell. Our surgical cost for both legs, was the price of one TPLO. From what I have seen thus far, I have made the right choice. One wound is ready for the bandage to come off already. More to follow, the work begins.