TTO Surgery for Dogs


While still not very common in the US, the TTO is one technique available to repair a torn dog knee ACL ligament. The idea behind the TTO is to combine aspects of the TPLO and TTA to create a new angle within the injured knee joint. The goal of the TTO, or Triple Tibial Osteotomy, is to create a 90 degree angle between the tibial plateau and patellar tendon while the knee is extended.

During a TTO CCL surgery a veterinarian will make three cuts (where the “triple” comes from) into the dog’s tibia.  These three cuts into the tibia bone will allow the surgeon to then rotate the tibial plateau slightly (as they do in a TPLO), while moving the tibial tuberosity forward slightly (as is done in a TTA).  When the adjustments have been made, the veterinarian will screw a metal plate directly onto the bone to hold the new position.  After these cuts and bone angle changes are made the result is a 90 degree angle within the knee joint when the dog’s leg is in an extended position.

It is the opinion of some veterinarians that the TTO is the best dog knee ligament surgery because it, in effect, molds the bone into a new shape.  According to a study done in New Zealand, there is a very low incidence of implant failure associated with the TTO, with most patients experiencing good post operative results.   Another benefit of this procedure, according to veterinarians, is that the TTO technique is relatively easy to learn.  It does not require expensive instruments to perform, and the technique can be easily replicated on dogs of all sizes.

8 thoughts on “TTO Surgery for Dogs

  1. I did bunch of research on this method and I have to say I do feel that it takes the best from both TPLO and TTA. I quite like it and if I had to decide between the three, TTO would have been my choice.

  2. Hi
    Coco my 5 year old choc lab is on day 4post TTO surgery. She was referred by my vets when the lameness that seemed to appear suddenly could not be treated. She was admitted in the morning and was home for 9pm. We were lucky to have been given a copy of the X-rays and also a copy of the actual video of the exploratory into her knee joint. Only having seen this did I understand just what damage had occurred and the complexity of the very simple procedure. Coco is doing well although we are at a very early stage. She has to have total rest for 30 days, no climbing, no jumping, no chairs and no stairs…. She has to be taken to the toilet on a lead and the weight taken off her leg, we use the sling method so no weight is transferred..
    Days 30 -45 she can start with lead exercise. Day 1 – 3 x5 mins walk increasing by 2 mins each day. So on day 45 she can have 3 x 35
    Min walks.
    Day 45-60, she stays at 3 x 35 min walks.
    Day 60-90, increased walks off the lead on flatground only. NO ball or friznee games. And if allgoes well from day 90 she can start to rebuild the muscles in her leg byunrestricted exercise.
    Days 45 – 60

  3. I found a vet that does the “Hohn” technique. Is that the same as traditional surgery? They say it’s less invasive.

    1. Hi Maxine,

      I’d love to know more about the “Hohn” surgery. If the veterinarian you spoke with has any resources they could point you toward, I’d love to share them with the readers.

      I was able to find some information on the Hohn CCL surgery via UPenn’s website. Looks like it is, as Jana mentions, also known as a posterolateral capsulorrhaphy – it is an extracapsular type of repair (similar to the traditional repair) that utilizes a suturing technique around the joint to provide stability. I have yet to really dive into the research, but at first glance it looks as though the Hohn technique uses more sutures around the joint than does traditional repair, and the Hohn surgery also seems to involve some movement and suturing of muscles for additional stability.

      I’ll do more research this week and get a post together!

      1. Thank you for digging (with better results I did 🙂 ) This would make sense. Our vet used double the sutures than in traditional repair too, but didn’t call it anything special.

  4. Wow, thought I knew everything about ACL repairs/treatments … never heard of Hohn technique before. Seems that it is posterolateral capsulorrhaphy, but I can’t really find anything on that.

    We did extracapsular repair, that is less invasive than the TPLO/TTA/TTO. Worked great, one thing about it that it is more vulnerable during post-op.

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