TTA vs. TPLO

? TTA moves the joint force to meet the tibial plateau; TPLO moves the plateau to meet the joint force;

? TPLO increases internal joint forces; TTA reduces them;
   
? By logical extension, but without clinical evidence at this time, TTA may show less long-term joint
  degeneration;

? TTA is less invasive, surgically simpler;

? TTA is less versatile (angular corrections impossible), but also less prone to unintended angulations.

TPLO Surgery

While our canine friends are quite similar to humans in many ways, as we all know, they do differ in very dramatic ways. There is, however, one similarity, that you might not be familiar with, and we will be discussing it today in this article. Tibial plateau leveling osteotomy surgery, also known as TPLO surgery, is a procedure for dogs who have suffered from an injury to their cranial cruciate ligament, which, as you may or may not know, is one of the four key ligaments in the knee. If you?ve ever suffered from a knee injury or if you know someone who has, you will be familiar with the anterior cruciate ligament, or, as we often hear it called, the ACL. The ACL is the same as the cranial cruciate ligament which, when injured in dogs requires TPLO surgery to stabilize what is known as the stifle joint.

If a dog suffers from a tear of the cranial cruciate ligament (or, if it were you, your ACL), the knee joint becomes extremely unstable, and can result in worsening of health issues if not treated. In addition to limited mobility of the knee (and subsequently the entire body due to the interconnectedness of dogs), many dogs can suffer from painful arthritis if it is not treated, with the best method of treatment being TPLO surgery.

The actual surgical procedure involved with TPLO is very successful, and does not require long recovery times like some other surgeries involve. The surgery requires part of the tibia that attaches to the stifle (the stifle is trying to be stabilized in this surgery), to be cut, and then it is rotated. Drawing from its name, Tibial plateau levelling osteotomy, one can deduce that the tibia will be levelled at approximately 5 degrees. This is done by a rotation of the cut portion of the tibia.
The increase in angle allows the femur to stay firmly in place without sliding down the tibial plateau, thus increasing stability of the stifle joint.

In addition to being a fairly simple procedure, the dogs that undergo TPLO surgery very often go back to being just as healthy and active as they were before the surgery. Some dogs might even become more active, as they were suffering from degenerative issues before, but these can be alleviated by undergoing TPLO surgery. Statistics show that over 90% of dogs will go back to living an athletic, lively, and energetic lifestyle after the surgery. While that is very high for a surgery, all hope is not gone for the other 10%.

Dogs who do not recover as well from TPLO surgery can have additional procedures done in case the original tibial plateau levelling osteotomy surgery does not go as planned. Some dogs will require surgery, but some may require simple lifestyle changes, or physiotherapy-esque exercises to regain a healthy knee. Some dogs will also require ?pain-killers?, although most dogs do not require this for a long period of time. Only a small percentage of the 10% of dogs will require long term usage of such pain relieving drugs.

TTA Surgery

Tibial tuberosity advancement surgery, or, as it is more often known as, TTA surgery, is a procedure performed on dogs, although it can be performed on cats as well, it is primarily for dogs. Similar to the TPLO surgery the TTA surgery involves the cranial cruciate ligament, which is very similar to the ACL (anterior cruciate ligament) which is often injured in active humans.

A dog that will require TTA surgery will have an unstable knee joint (the stifle joint), whereas a healthy dog will have a stable stifle joint. When the stifle joint is healthy and functioning properly, the tibia and the femur are held at a constant ratio; that is, the tibia cannot slide towards the femur.

Of all injuries that dogs sustain, injuries to the cranial cruciate ligament are among the most common injuries, and unfortunately, they almost always cause severely limited mobility in the affected dog. Yet another problem with injuries to the cranial cruciate ligament is that approximately 30% of dogs will injure more than one limb at the same time, resulting in more severe health complications and when left untreated, the injuries will continue to worsen. Such injuries include arthritis, osteoarthritis, and damage to the meniscus, causing more pain for the dog.

Tibial tuberosity advancement surgery is a procedure that corrects the issues with the dogs? cranial cruciate ligament. The surgery strives to change the angle at which the ligament of the patella rests, and if done properly, this will reduce the amount of shear force inflicted upon the dog (or cat) during anything weight bearing. Since cats and dogs are very active animals, and must remain active for proper health, it is clear how this would be an issue if weight bearing causes the animal pain. The animal is left with two options, suffer the pain caused by the cranial cruciate ligament deficiency, and continue to live with good health, but this is somewhat of a paradox. While the dog is increasing his or her health, the dog is also decreasing it by worsening the injury, and causing itself immense amounts of pain, which as we all know, is neither good for dogs nor humans.

Alternatively, the dog could just live a sedentary lifestyle, eliminating any weight bearing activities, but once again, in a paradoxical sense, this is counterproductive to the dogs? overall health. Yes, the dog is not suffering from immediate pain due to the cranial cruciate ligament deficiency, but without TTA surgery, the dog will not be able to remain active enough to have a healthy life. Without TTA surgery, the dog is giving up long-term health for short-term comfort.

The actual TTA surgery is a very non-invasive surgery, and advancements are being made by numerous biomedical companies to further the advancement of this already efficient procedure. The TTA surgery is less intrusive upon the animal than the tibial plateau level osteotomy (TPLO), and the tibial wedge osteotomy (TWO). This is largely due to the fact that all of the aforementioned surgeries, save TTA surgery, disturb the tibia?s loading axis.

Please note that not every patient could be a candidate for TTA and that is why we do preoperative planning.