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 dog’s? 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 sheer 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 dog’s? 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.
TTA vs. TPLO Comparison
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
TTA is less invasive, surgically simpler;
TTA is less versatile (angular corrections impossible), but also less prone to unintended angulations.