ACL Surgical Repair Including the TTA-2

Due to the high incidence of the problem and the clinical success of surgical techniques, surgical repair of the cranial cruciate ligament is one of the most common small animal orthopedic procedures.

Lateral Suture

The lateral suture method involves placing a nylon material on the outside of the knee in a similar orientation to the injured cranial cruciate ligament.  This stabilizes the joint and allows fibrous tissue to develop which provides long term stabilization after the nylon degrades. The majority of dogs recover back to 80-85% of normal within 6 months and may improve further by 1 year.  However, smaller dogs are better candidates for this procedure compared to larger dogs, active dogs, or working dogs

Tibial Tuberosity Advancement (TTA/TTA-2)

The Tibial Tuberosity Advancement (TTA) technique was developed in 2004 in efforts to improve the outcome of surgically repaired cruciate injuries and reduce the severity of osteoarthritis (arthritis) that follows.  The procedure is designed to surgically change the biomechanics of the knee joint to compensate for the deficient cruciate, and therefore help return the pet to full function. The TTA is accomplished through an osteotomy (cutting off a section of the bone) of the tibia and by moving the attachment of the straight patella tendon forward using cages, screws and bone plates. Compared to other repair methods, the TTA offers a lower complication rate and excellent recovery.

In 2014, after 2 years of testing began to explore the next step in the TTA evolution, the TTA-2 became commercially available. TTA-2 involves an incomplete osteotomy (cutting partially through the bone) of a portion of the tibia. The patellar ligament is moved forward without the need for screws or bone plates like the TTA. The TTA-2 surgical technique uses less implant material yet is just as strong and effective as the TTA and eliminates stress risers created by the plate, fork, and screws used in the TTA.  In addition, the TTA-2 reduces surgical trauma by preserving bony attachments and blood supply, reduces the risk of infection and surgery time, accelerates incorporation of the implant into the bone, and thus provides surgeons and their patients with noticeable benefits.

Benefits of TTA-2

  • Rapid recovery: full weight bearing within 2 weeks for most cases
  • Good prognosis for return to full athletic activity and reduction of lameness
  • Protection of articular cartilage through rapid return of normal joint range of motion
  • Decreased progression of arthritis over time
  • Less invasive than TTA and TPLO
  • Lower complication rate

Typical recovery for pets undergoing this procedure is limited activity for 8-10 weeks, but most are full weight bearing within 2 weeks.  Pet’s receiving this repair have a good to excellent prognosis for returning to full athletic activity. Additionally, associated osteoarthritis (arthritis) formation within the knee joint is lower with the TTA-2 compared to other repair techniques.  Dogs of all sizes, breeds, and ages can benefit from the TTA-2.