Cruciate Ligament Repair Surgery: TTA and Lateral Tie
Lucerne Veterinary Hospital offers the services of Dr. Chris Miles. Dr. Miles brings extensive training and more than 30 years of experience in both soft tissue and orthopedic surgery to benefit her patients.
Offering Two Types of Cruciate Repair Surgeries
We are pleased to offer two types of cruciate repair surgeries:
- Tibial tuberosity advancement/TTA
- Lateral tie/lateral suture technique
Osteotomy surgeries, such as the tibial tuberosity advancement, have become the standard of care for repairing cruciate ligament injuries. This surgery requires specialized surgical training and is only offered at a few veterinary hospitals in Maine. We also offer the lateral suture technique for smaller or less active dogs.
Dr. Miles is one of the few veterinarians in Maine, and the only one in the region, who performs TTA surgery to treat cruciate ligament rupture in dogs. Depending on the dog’s conformation, this surgery is likely to have a significantly better success rate, with fewer complications than the lateral suture method.
You may wish to download and print our handout outlining our CCL Surgical Options.
Tibial Tuberosity Advancement/TTA Surgery
This newer technique for CCL repair was developed in Europe. It has gained popularity because of its excellent clinical performance and reduced rate of significant complications. Because of its superior strength, faster recovery, and better long-term joint function, TTA is best suited for larger dogs weighing more than 50 pounds and for active, athletic dogs.
With this technique, the tibial tuberosity (the front section of the tibia) is removed and advanced forward. This is performed using a specialized titanium plate and spacer cage, along with a bone graft, to stabilize the bone until it has healed.
Advantages of TTA
- Rapid recovery and return to full function (6–8 weeks)
- Stronger repair than lateral suture techniques, suitable for larger or more athletic dogs
- Reduced osteoarthritis development over the dog’s lifetime
- Clinical trials suggest better long-term clinical improvement, both in range of joint motion and weight bearing, and greater owner satisfaction over lateral tie techniques
- Minimal post-op rehabilitation required
Disadvantages of TTA
- More involved surgery requiring added technical expertise and specialized training on the part of the surgeon
- Post-op care and exercise restrictions are critical, since too much activity or a patient fall can cause serious complications at the surgical site
Lateral Tie/Lateral Suture Technique
This type of CCL repair is performed by placing a prosthesis, most commonly a monofilament nylon suture, outside the knee joint. The prosthesis extends from the back of the femur to the front of the tibia, mimicking the position of the natural CCL. This method is best for smaller dogs weighing less than 40 pounds, but can be used for larger dogs that are sedentary or elderly.
Advantages of Lateral Tie
- Simplest technique, performed in many hospitals
- Less expensive, generally less than $2,000
Disadvantages of Lateral Tie
- Implant failure and repeat surgery is needed in some patients, especially larger, more active dogs
- More osteoarthritis development
- Longer and more involved rehabilitation, from 4–6 months
- Unsuitable for dogs with excessive tibial slope
Tibial Plateau Leveling Osteotomy (TPLO)
With this technique, the tibial plateau (top of the bone) is rotated to change the forces on the CCL. This is performed by making a circular cut in the bone and using a specialized plate to hold the fragment in place until healed.
This technique is not performed at Lucerne Veterinary Hospital, but there are cases in which this procedure is more appropriate for the patient than the TTA surgery. If this is the case for your pet, we are pleased to refer you to a surgical specialist.