Dogs appear to be more comfortable in the first few post-operative days, as evidenced by early, strong weight-bearing. TPLO and TTA can be used in the most active (athletic) dogs of large size with good to excellent results. By continuing to use this site you consent to the use of cookies on your device as described in our cookie policy unless you have disabled them. Materials and Methods. Debating tplo vs lateral suture vs tightrope for 9 yr old 60 lb pit mix, see above, ccl knee, limp, yes, sue, no - Answered by a verified Dog Veterinarian. Proceedings of the 1st World Orthopaedic Veterinary Congress; Munich Germany, September 2002, p. 152. Pre-operative measurements are taken from lateral stifle radiographs (with joint extension) to determine appropriate basket and plate sizes. Unfortunately, dogs can’t tell us how they feel following a surgery. Thus, medial swelling of the proximal tibial region is more usually more prominent in TPLO-treated than in TTA-treated dogs. Patient selection is similar to the TPLO; specific indications in our hospital are dogs that have concurrent ACL injury with a luxating patella. Following a TTA or a TPLO surgery, our patients need to have strict crate restriction for a few weeks. A dog’s outcome, much like complications, is largely determined by the experience of the surgeon, the quality of post-operative care, and adherence to recommended rehabilitation (dog physical therapy) protocols. Welche Vorteile biete die TTA gegenüber der sog. The results of three studies and one large review suggest that the TPLO gives better objective* lameness outcomes with a lower risk of complications. TTA vs. TPLO. To account for the learning curve, the first 85 cases of TPLO done by the author (in a series of over 700) were compared with the first 85 cases of TTA. October 31, 2008. – Why TTA requires less rotation than TPLO. In our experience, the patient experience in the immediate post-operative period appears to be improved over other active and passive stabilization techniques such as TPLO and extracapsular lateral suture imbrication. I have a dog that I did a tplo on at 4yrs and a tightrope on the other leg at 7yrs. We could only find one study that directly compared TTA and TPLO, and it concluded that TPLO was superior to TTA in long-term outcomes. Tibial Tuberosity Advancement for Stabilization of the Canine Cranial Cruciate Ligament-Deficient Stifle Joint: Surgical Technique, Early Results, and Complications in 101 Dogs. However there is no consensus of data or consensus among surgeons as to whether the TPLO or the TTA is inherently superior. The gender distribution was 38 males and 36 females for TPLO and 36 males and 36 females for TTA. Conventional surgery aims to stabilize the injured joint without altering the dog's bone structure. Major complications include: post-operative patella luxation, tibia fracture, implant loosening, and meniscal injury (if initial meniscectomy/ meniscal release was not performed). The procedure involves a cranial tibial crest osteotomy, advancement of the tibial crest with an advancement cage (acting as a stabilizing wedge) and internal fixation of the crest with a thin, tensionband plate held in place with bone screws (Figures 1 & 2). J Cook. “I tell clients to do the procedure that your surgeon does,” said Dr. Bilicki, DVM, DACVS-SA, Diplomate American College of Veterinary Surgeons (ACVS). The TTA and TPLO share similar advantages and disadvantages. His surgical technique resulted in better results than previous surgeries. The TTA is surgically less invasive than the TPLO. By one month postoperatively, patients are strongly weight bearing and advancing in their at-home physical therapy. The surgeon will place a stainless-steel bone plate, which holds the two pieces of tibia together, until the osteotomy site heals after about eight to twelve weeks of recovery. Cost is variable by clinic but comparable between TTA and TPLO. Techniques no longer recommended in dogs, include: 1. The principles of evidence-based medicine decision-making will undoubtedly be useful for answering this question as we collect more data in a prospective and standardized manner3. Surgery alternatives. Vet Surg (2008) 37:111–125. The TTA advances the tuberosity and is kept in place by inserting a titanium cage that bone grows through. Key Points: CBLO and TPLO surgery both use a radial cut osteotomy to level the tibial plateau. TTA vs TPLO. They should be considered for those patients in whom other procedures have failed. The difference is that TPLO cuts a weight bearing bone, TTA cuts a … Again subjectively, some surgeons believe that TPLO is better for more active or athletic dogs. Depends on age, activity level, what you plan on doing with the dog afterwards ("normal pet" vs hunt, agility, something super active). Removal of implants from a TTA surgery can be much more difficult and have a higher risk of bone fracture, compared to the relatively easy removal of a TPLO plate. TPLO? A slower return to limb use after surgery often means more muscle loss due to disuse. Cranial cruciate ligament disease (CrCLD) is a chronic condition marked by the persistent degradation of a dog’s cranial cruciate ligament. Our experience with over 10,000 cases has been positive and similar to the clinical reviews in the veterinary literature6,7. However there is no consensus of data or consensus among surgeons as to whether the TPLO or the TTA is inherently superior. Postoperatively there are weekly visits for … I even did the rehab swimming at $75 a session, because I hoped this dog could get back into it and finish Senior. The biggest difference between the two procedures is that TTA moves the tibial tuberosity cranially to help use the quadriceps to neutralize cranial tibial thrust. Surgery complications aren’t common for either procedure, but according to Dr. Mark Beerenstrauch from Pet Health Hospital, DVM, “Complications can occur with any procedure, and vigilant post-operative exercise restriction, as well as following instructions for recommended rehabilitation and exercises will minimize these risks.”. Vet Surg (2007) 36:573–586. Online Access: GBP25.00 + VAT Buy online version. Joint Surgery in Canine Hind Limb: Recent, Contributions from the University of Zurich—PM Montavon & S Tepic. Beim Riss des vorderen Kreuzbandes verschieben sich Unter- und Oberschenkelknochen gegeneinander, wenn das Tier den Fuß auf den Boden setzt. NH Priddy et al. Some potential complications of TPLO and TTA surgery include the following: Infection of the implant is one of the more common complications associated with these procedures, although implant infection risk is low at 7.4%. TTA uses biomechanical principles to adjust the angle of the patellar tendon. Speaker: Michael Hamilton; TTA can have a potential advantage over TPLO in the immediate post-operative period, as dogs subjectively sometimes appear to be more comfortable and bear more weight because the TTA involves a less invasive osteotomy or cutting of the bone. Web resource for a brief TPLO explanation by the original developers: http://www.slocumenterprises.com/Articles/cranial_cruciate_ligament.htm Cranial Cruciate. TTA can have a potential advantage over TPLO in the immediate post-operative period, as dogs subjectively sometimes appear to be more comfortable and bear more weight because the TTA involves a less invasive osteotomy or cutting of the bone. Surgery went great, but he opened up the entire incision after the stitches came out WITH his cone on, not kidding…. Both TPLO and TTA will lead to significant improvements in the usage of the injured leg. Im Vergleich zu den beiden vorherigen Methoden TTA und TPLO ist die Methode deutlich weniger invasiv. Vet Surg (2007) 36:187–189. CL Aragon, SC Budsberg. explains how to do measurements for TTA and TPLO properly. This effectively neutralizes the tibial thrust, which occurs when a dog with cranial cruciate ligament disease bears weight on an affected joint. CBLO and TPLO surgery. Conventional surgical procedures are much less invasive and less expensive than TPLO or TTA. Auch das Auslösen der Schublade und die Innenrotation der Gliedmaße werden verhindert. BSAVA Library Pass Buy a pass. As an example of how we facilitate this decision for clients and patients who present to our practice, we recommend TTA as our procedure of choice for most of these cases due to the more rapid ability to bear weight, a lower complication rate, a less painful convalescence, and high owner satisfaction. No matter which one you choose, new or time-tested, understand that complications can occur with any of the procedures. The TPLO keeps the rotated bone segment in place using a plate. A cranial cruciate rupture in a dog won’t heal on its own, and as a result, most pets require a surgical repair. 10.22233/9781910443446.35.2. “They offer that surgical procedure because they’re good at it, and they like the results they achieve.”. Lara Rasmussen. The standard TTA and TPLO remain good procedures especially in the hands of an experienced veterinary surgeon, but in my view, MMP is currently the best CCL repair procedure for dogs over 38 pounds that have suffered CCL tears. Patients return to weight bearing rapidly and regain muscle mass quickly. Postoperatively there are weekly visits for 4 weeks. – geringere Invasivität (das Kniegelenk selbst bleibt während der OP geschlossen! Lazarveterinarysurgery.com TTA vs TPLO Surgery | KYON. We highly recommend this procedure for medium to giant breed dogs with cranial cruciate ligament disease and for any size patient who needs a rapid return to athletic condition. We packed up, prepared lunch, got ready for the children, and loaded everything into the van. Similar to the TPLO, the cut in the bone is stabilized by the use of a specifically designed bridging bone plate and screws. CBLO and TPLO surgery. The Tibial Tuberosity Advancement (TTA) is a procedure developed in Zurich, Switzerland in the early 2000s (1). Cranial cruciate ligament disease occurs for several reasons. Vet Surg (2005) 34:93–98. Surgery alternatives. Hundreds of thousands of dogs have been treated by TPLO and TTA surgery for cranial cruciate rupture. This is one significant advantage of TPLO over TTA. The surgical procedure involves a radial (semi-circular) osteotomy of the proximal tibia, rotation of this proximal tibial segment and internal fixation with a bone plate and screws (Figures 3 & 4). They are pretty much the same. TPLO and TTA offer some benefits over older procedures such as extracapsular repairs (ECLS), especially for larger or athletic dogs. Dr. Slocum noticed that some dogs had an abnormal slope of the knee (tibia), which put added pressure on the ligament and predisposed dogs to developing CrCLD. CrCLD eventually leads to a cruciate tear in a dog, and 50% of dogs with a ruptured ligament will tear the other ligament within the following six to twelve months. Peak vertical force of affected hind limbs at a walk and trot was 5% to 11% higher for dogs in the TPLO group versus those in the LFS group during the 12 months after surgery. A dog’s cranial cruciate ligament can be compared to a human’s anterior cruciate ligament, as it’s one of the primary ligaments supporting the stifle joint (knee). Prior to surgery, pre-operative measurements will be taken, using stifle radiographs (x-rays of the knee). Dogs undergoing TPLO or TTA tend to heal faster, resume normal activities quicker, and have a better range of motion in the knee. These procedures may also be considered in smaller, more active patients and those patients with bilateral disease. 4600 sounds high to me for a TPLO but it will vary depending on area, locally (west US) they go for 3k to 3500 at our teaching hospital. Consequently, more physical therapy is often required to regain the lost muscle mass in dogs that have the TPLO procedure. 3. Surgery STAT: TTA vs. TPLO: Recovery time remains an important consideration. TPLO is more common than TTA but TTA was only released into clinical practice in 2005 while TPLO has been around since the 1990's. Fibular head transposition procedure, which was former… On leash exercise can generally be started at 1-2 weeks post operatively. So far, this TPLO has the leg straighter than the TTA , which is twisted a bit after 5 years. Instead of fixing the ligament, Dr. Slocum decided it would be better to correct the abnormal slope. We had planned to go on a hike as a family, to Sedona Arizona on the West Fork Trail. – Why TTA requires less rotation than TPLO. Percent of function >1 year after surgery was 93.1% + 10.0% for TPLO, 92.7% + 19.3% for TR, and 89.2% + 11.6% for TTA. Force plate gait analysis was performed at 1 time point for the normal control group and preoperatively, and at 2 and 8 weeks and 6 and 12 months postoperatively for the treatment groups. Minor complications include: incisional infection/inflammation, seroma, and wound dehiscence. Outcomes-Based Patient Care in Veterinary Surgery:What Is An Outcome Measure? Torn Cranial Cruciate Ligament can only be corrected by surgery. However, TTA gives faster recoveries in the period shortly after surgery. Intracapsular reconstructive techniques, using fascia lata or other natural substitutes, due to documentation of decreased weight-bearing at objective recheck evaluations compared with normal dogs, and better results with other procedures1 2. TTA und TPLO beim Kreuzbandriss des Hundes Dieter Müller Problematik des Kreuzbandersatzes In der Kleintiermedizin werden vielfach humanmedizinische Operationstechniken angewandt, die auf den reinen Ersatz des lädierten Kreuzbandes abzielen (Faszia lata Transplantat, Flo-Technik, Tight Rope® etc). 12° or 20°? Surgical repair of the cranial cruciate ligament in the dog and cat using Tibial Tuberosity Advancement (TTA). • TTA patients begin using the leg more quickly than patients having a TPLO procedure, because with the TTA procedure, the tibia is cut only in a non-weight bearing area: The femur sits on top of the uncut portion of the tibia, not through a line cut across the shaft of the tibia, as in the TPLO procedure. Osteotomy (TPLO), lateral suture (also called fabellotibial suture/extracapsular repair or nylon suture technique or lateral imbrication technique) as well as recently Tibial Tuberosity Advancement (TTA). Final Words. Several surgical techniques for the condition have been developed including: The two most commonly recommend corrective surgeries are the TPLO and TTA procedures. TTA was associated with significantly (P <.03) higher rates of major complications and subsequent meniscal tears than TPLO and TR, and TPLO had significantly higher rates of major complications and meniscal tears than TR. We found out yesterday that Rukus (our 6 yo black lab) ruptured the CCL in his right leg. In our experience, patients recover with better long-term results than traditional passive stabilization techniques, such as extracapsular lateral suture imbrication. Some dogs are not good TTA candidates due to an excessively steep tibial plateau angle, a coexisting patellar luxation, or excessive concavity to the tibial crest. We had planned to go on a hike as a family, to Sedona Arizona on the West Fork Trail. Which Surgical Method Is Best for My Dog’s Cruciate Ligament Rupture? Stephen H. Levine, DVM, MS, Diplomate ACVS, Joint Surgery in Canine Hind Limb: Recent, Request Referral to Direct Veterinary Surgery-Como Park Hospital, Request Referral to Direct Veterinary Surgery-Lakeland Veterinary Clinic, Request Referral to Direct Veterinary Surgery-Northwest Animal Hospital, Request Referral to Direct Veterinary Surgery-ZimmVet Hospital. TTA and TPLO both appear to be excellent procedures for the treatment of cranial cruciate ligament injuries in medium and large breed dogs. TPLO and TTA are the most commonly used geometry altering techniques for cruciate deficient stifles in dogs. At the last minute, we decided to take our American mastiff Freyja with us on the trip. Inaugural-Dissertation zur Erlangung der tiermedizinischen Doktorwürde der Tierärztlichen Fakultät der Ludwig-Maximilians-Universität München von Monika Höpfl aus Landshut München 2011 When the cruciate tears, it’s like a human’s ACL tear in a dog, painful and debilitating. S LaFaver et al. dogcollarsharnessesandleashes. Study Design Full-weight bearing, however, has been shown to be better with a TPLO at six months of age. Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. It is at times frustrating for all involved to navigate these decisions; acknowledge these frustrations through open communication and keep working toward the best treatment option for each patient and owner. But as the research shows, extra-cap procedures, in the hands of a skilled practitioner that has done 100’s of them, can also be a very effective procedure in all cases. Dadurch kommt es zu Schmerzen, … A good size is a crate in which your pet can stand up and turn around comfortably. “While studies have not been able to clearly determine which procedure is superior, it has been demonstrated that both procedures have improved outcomes with post-surgical rehabilitation,” said Dr. Jessica Pizzillo, DVM, CCRP. What’s the difference? Implant complications, consisting of infections or screw loosening, are seen in small percent of cases and are managed with appropriate antibiotics and implant removal after healing. This procedure was developed in Zurich, Switzerland in the early 2000s. The main disadvantage of the TPLO and the TTA lies in the necessity of performing an osteotomy (cutting the bone to achieve biomechanical stability of the knee). Welche Vorteile … We have been performing the TTA successfully for four years now. Two recently published literature reviews 3,4 were unable to clearly identify a superior surgical procedure due to variation in study-design and commonly subjective data comparisons. TPLO is more common than TTA but TTA was only released into clinical practice in 2005 while TPLO … 5. That being said, there may be particular situations in which one may be better suited to correct concurrent problems (i.e. It generally believed, however, that the more active and larger the pet, the better they will do, in both the short and long term, with a TPLO or TTA. Here's how the TTA compares to the TPLO procedure: The TTA is less invasive but does not address dogs with very steep tibial plateau angles or very large/very small dogs) The TTA is the newest surgical procedure for management of cranial cruciate deficiency in the dog. Similar to the TPLO, the cut in the bone is stabilized by the use of a specifically designed bridging bone plate and screws. Recently published literature reviews, however, were unable to clearly identify a superior surgical procedure, and studies have shown that TPLO and TTA achieve the same level of function by 12 months after the surgery. J Am Vet Med Assoc (2003) 222:1726–1732. The goal of a TPLO surgery is to reduce the angle of the tibia’s slope. The TPLO procedure was developed by Dr. Barclay Slocum in the 1980s. Over the past 50 years, surgical treatment of CrCLR has evolved through a number of procedures, many now obsolete. Therefore, swelling on the inside of the knee tends to be more pronounced in TPLO-treated dogs then TTA-treated dogs. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease J Am Vet Med Assoc. We packed up, prepared lunch, got ready for the children, and loaded everything into the van. When the disease advances or eventually turns into a full tear, a dog will show signs of lameness or suddenly hold up their leg.
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