TTA - Allegheny Veterinary Associates

Allegheny Veterinary Associates,PC
TTA Frequently Asked Que stions
1.
My dog has been diagnosed with a torn
cranial cruciate ligament, what does that
mean?
The cranial cruciate ligament
(CCL) is one of 2 ligaments that
stabilize the knee from within
the joint. The cruciate ligaments
work together to prevent the femur (thigh bone) and tibia (shin
bone) from sliding back and forth
against each other. Your dog has
torn one of these ligaments and
this causes the joint to be unstable and painful. Tearing can be
partial or complete and is the
most common orthopedic injury
in veterinary medicine.
2.
Why or how did my dog’s cruciate ligament tear?
The top of the tibia is known
as the tibial plateau. The
tibial plateau may be sloped
toward the back of the leg.
During weight bearing, the
femur tends to slide backward
against the tibial plateau
pushing the tibia forward
(tibial thrust). The CCL functions to prevent this sliding
and is therefore under constant tension when weight
bearing. Also, the steeper the
slope of the tibial plateau the more stress on the
CCL. This biomechanical stress produces shear
forces within the CCL leading to tearing and rupture.
4.
Why is surgery required and what could
happen if I don’t do surgery?
Surgery is required to halt further damage to the
knee and gi ve your pet as much pain free use of the
limb as possible.
Inflammatory mediators are released into the joint
when damage and instability are present within the
joint. Without surgical correction this will undoubtedly lead to irreversible osteoarthritis.
Also, when a pet uses a limb with a ruptured or even
weakened CCL the femur slides backwards with nothing to prevent this movement. This action can damage the meniscus (a thick fibrous cushion between the
femur and tibia).
Furthermore, your pet’s wei ght will likely be shifted
to the unaffected limb placing even more stress on the
intact CCL. This can lead to undue wear and tear on
the other knee.
Surgery attempts to reduce these progressive and
painful consequences of ruptured CCL.
5.
I’ve heard about the TPLO and Lateral Suture procedure s, why don’t you recommend
these procedure s?
We do recommend these procedures in certain situations. TPLO is recommended for dogs with excessively severe tibial slope and in situations when TTA
is not feasible due to limb deformities and previous
surgeries. We also recommend lateral suture procedures for smaller dogs and in cases where financial
constraints do not allow for a more sophisticated procedure.
Allegheny Veterinary Associates,PC
3. My dog was fine and then suddenly
couldn’t walk on one of the back legs. Is thi s
common with tears of the CCL?
9450 Perry Highway
Pittsburgh, PA 15237
Affected dogs are typically suddenly lame on one rear
limb. Many are so uncomfortable that they are reluctant to bear weight on the affected limb. While
other pets have a history of having an i ntermittent
lameness that suddenly got worse.
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Allegheny Veterinary Associates,PC
TPLO and Lateral
Suture procedures
have proven their
merits and are
recommended when
they appear to be
more suitable than
TTA. However,
TTA provides a
better long-term
prognosis than
lateral suture for
larger dogs and has
potentially less
complications than
TPLO. In most
instances, TTA is
our procedure of choice.
6.
The tuberosity is then secured with
a spacer cage and specially designed
tension band plate. The osteotomy
usually heals within 8 weeks postop.
7.
Doe s my pet have to spend
the night in the hospital?
In most instances it is best to have
one to two overnight stays at the
clinic. During this period your pet
will be receiving intravenous medications to prevent infection and ease pain. Most patients can be discharged within 48 hours postoperatively and walk fairly comfortably out of the
clinic.
Tibial Fracture Fo llo wing
TPLO
8.
How does the TTA procedure work?
Current research shows that if the angle between the
tibial plateau and the patellar tendon can be moved to
900 then weight bearing forces will be redistributed so
that the CCL is not required to stabilize the joint.
In short, following the TTA procedure tibial thrust is
neutralized and the CCL is no longer necessary to
stabilize the joint.
Will this procedure have a negative affect
on the opposite limb? Will the opposite
knee have the same problem?
No. TTA repair has no negative effect on the opposite
limb. In fact, early repair and return to function will
lessen the stress on the opposite limb.
Somewhere around 30% to 50% of all dogs with CCL
rupture will develop the same problem in the other
limb. The most effective means to reduce the odds of
the other leg becoming injured is early surgical intervention of the affected limb.
9.
Is TTA only for large dogs?
Although TTA is most commonly used for dogs weighing between 30lbs and 120lbs it has been successfully
used in smaller dogs. Implants are made for dogs
from 10lbs to over 120lbs.
Allegheny Veterinary Associates,PC
The TTA involves an osteotomy (cut made in bone)
in the non-weight bearing portion of the tibia. The
tibial tuberosity is advanced to align the patellar
tendon perpendicular to the tibial plateau. This
creates a joint with virtually no tibial thrust and
eliminates the need for the CCL.
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Pittsburgh, PA 15237
412.635.VETS
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Allegheny Veterinary Associates,PC
10. How does the post-operative period compare to other techniques?
Because the TTA involves an osteotomy in a nonweight bearing portion of the tibia, patients are comfortable and recover more rapidly than with older
techniques including TPLO. Most patients are
weight bearing within 2 days.
11. Will my pet experience pain after the TTA
surgery?
pre-anesthetic blood work or antibiotics and pain
medications that exceed 10 days use. It also does not
include treatment for complications such as additional
surgery, bandages, self-inflicted trauma, etc.
While TTA is technically more sophisticated than previous procedures and requires expensive instruments
and implants, we are attempting to make it as affordable as possible so that pet owners won’t ha ve to settle for a less successful alternative.
Always remember to compare the value of the procedure and not j ust the cost when price shopping.
Some post-operative discomfort is unavoidable and
all pets respond differently to surgery. All pets undergoing TTA receive pain management before, during, and after surgery. It is our goal to prevent as
much pain and discomfort as possible rather than to
try to alleviate it once it occurs. The main reason for
the overni ght stay is pain prevention and abatement.
All pets receive intravenous pain medications while
at the clinic and receive oral medications at discharge. Most clients feel their pet’s discomfort level
is minimal.
TTA surgical procedures can be completed every
weekday except Thursday. Please call for an appointment if you would like to further inqui re about the
TTA procedure.
12. How long does it take for the limb to heal?
The osteotomy generally requires 8 weeks to fill in
with new bone. Duri ng this period your pet will be
allowed a reasonable amount of short-leash controlled activity.
13. What kind of follow-up can we expect?
You will need to schedule a recheck visit at 10 days
post-op to remove sutures or staples. Follow-up visits are required at 4 and 8 weeks post-op to assess
healing. At the 8 weeks visit x-rays will be taken to
evaluate bone healing.
14. How much does TTA surgery cost?
Our fee for the TTA procedure is between $2,200 and
$2,500 depending on implant size and the size of
your dog. This cost is a bit more than traditional
lateral suture procedures which run about $1,500,
but less expensive than TPLO fees which are around
$3,000.
Our fee includes surgery, pre and post-op x-rays,
pain medications, antibiotics, anesthesia, over night
stay, and 3 follow-up exams. It does not include
Allegheny Veterinary Associates,PC
9450 Perry Highway
Pittsburgh, PA 15237
412.635.VETS
www.alleghenyve t.com
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