At Luxstowe Vets we have been performing cruciate surgery for 30 years. In 2011 we introduced the TTA technique and updated this to the TTAR in 2015.
The cruciate ligament is a band of fibrous tissue that attaches the femur to the tibia. This prevents the tibia from shifting forward relative to the femur. It also helps to prevent the stifle (knee) from over extending or rotating.
Cruciate ligament disease is different in dogs compared to people. In dogs it usually degenerates over time like a fraying rope, whereas in people it is usually the result of an injury. This is the main reason why the treatment is different for dogs and humans.
We do not know the precise cause of cruciate ligament injury, but genetic factors play a significant role. Certain breeds such as Labradors, Rottweilers, Boxers, West Highland White Terriers and Springer Spaniels seem to be predisposed. There are other important factors, such as obesity, confirmation and inflammatory joint conditions.
Limping is the commonest clinical sign of cruciate injury. This may occur suddenly or can be more progressive and intermittent. It is important to note, that even in the early stages of cruciate injury, osteoarthritis is already present in the joint. The rupture of the cruciate ligament changes the mechanics of the joint and causes bony surfaces to rub against each other. This mechanical deficency can also lead to damage of other structures within the joint, particularly the cushioning structure known as the meniscus.
Diagnosis of cruciate injury is usually based on an examination by an experienced surgeon. This will include manipulation and palpation of the limb and show laxity in the joint using specific manipulations. Other tests including radiography and exploratory surgery of the joint may be necessary.
Conservative or non surgical management of these patients is rarely successful and often takes months before an improvement is seen. Dogs weighing under 15kg and cats have a better chance, but a complete recovery is rare. The methods used in non sugical management are weight management, physiotherapy, exercise modification and anti-inflammatory pain killers.
Prosthetic ligament replacement techniques have been used for many years. The main technique used now is the placement of a nylon suture. This is known as a fabello-tibial tuberosity suture. They have a varying degree of sucess and are unpredictable during the early stages of recovery. They also have mechanical limitations in larger and very athletic dogs. Post surgery recovery time is longer than other surgical methods and dogs may take longer to return to normal exercise.
The other surgical methods change the geometry of the stifle joint making the cruciate ligament redundant. There are several methods available, but they all involve reshaping the top of the tibia (shin bone) using a cut and fixing it into a new position. The techniques we offer at Luxstowe Vets are known as a TTA (Tibial tuberosity advancement) and a TTAR (Tibial tuberosity advancement rapid). The two techniques are similar, except the TTAR uses less implants and an artificial bone graft. This results in the surgery being faster, thus reducing the length of the anaesthetic. This can be very beneficial in older or medically compromised patients. Both the TTA and TTAR provide a very reliable return to normal function, with over 90% of dogs able to return to their usual activities.
Complications are rare with these surgeries when they are performed by experienced surgeons. The two most common problems are infection and mechanical complications. Infections are treated using antibiotics. Occasionally surgical irrigation of the area may be necessary. In very rare cases, the implants may need to be removed once the bone has healed. Mechanical complications are usually due to the dog being allowed to exercise too much before the bone has completely healed. This is usually treated with strict rest. Very occasionally surgical revision may be necessary.
Post operative radiograph of a TTAR
Post operative radiograph of a TTA
After surgery the vet will advise you of the post operative care your dog will require. You will usually need to return to the practice for a re examination after 48 hours. We will provide you with an exercise plan for gradually increasing your dogs activity levels. An X-ray will be taken 6 weeks after surgery to ensure the bone has healed correctly.