TTA vs. TPLO for Cruciate Injury

[EAO76]

TTA vs. TPLO for Cruciate Injury

My foster dog Rowdy is 3yrs old & has TWO blown knees so I have been researching the different surgeries. I actually am not one to rush into surgery because I had success with a more conservative management approach with my own dog when he had a ligament injury. But in Rowdy’s case we need to resolve this issue and don’t have months and months to spend “waiting to see”. In order for him to be adoptable he needs to be “fixed”. And we actually suspect that this may be the reason his family surrendered him to the rescue so we wouldnt want that to happen again.

So I have been spending the last few weeks researching and have gotten several opinions from different surgeons. We are very lucky that there are a lot of really experienced vetinarians in our area. The surgeon that I met with today said that with boxers in particular he had started to become very unoptimistic in regards to these ACL injuries & the TPLO procedure. He said in Boxers there seems to be a difference in the injury & the way that they heal. He said there is no literature/ studies about boxers in particular but he said if you talk to very experienced surgeons they all seem to notice something different about this breed. However in the last few years he has started to perform TTA procedure on boxers and he is extremely please with the results.

TTA is a newer procedure (since 2004 in the states) some lay people get confused between this procedure and an older procedure that is recommended for smaller breeds (because at one time there were only two options). For example in this post http://www.boxerworld.com/forums/dog-health-issues-questions/109899-torn-acl-tplo-vs-tta.html the replies were incorrect and most likely those who replied were not familiar with TTA (no fault of theirs; at the time TTA was very new).

Anyway I found it really refreshing to find a surgeon that talked straight with me and offered multiple solutions. I also liked when vets recognized that boxers are “just different” because it certainly seems that way to me! From all the things I have seen working in rescue from “boxer colitis”, to the heart problems, knee injuries, etc, etc this breed certainly seems special.

Anyway here is some info about TTA. Anyone considering knee surgery in their boxer should at least check it out so that they can be aware of ALL the options. We haven’t made a decision yet but I am glad to know there are other options beside the TPLO. The consensus is that the TTA is less invasive, quicker recovery, and reduced complications.

TPLO vs. TTA for Cranial Cruciate Ligament Repair | Dog Knee Injury

Surgery STAT: TTA vs. TPLO: Recovery time remains an important consideration - DVM

http://www.vssoc.com/documents/VSSTTAcards_000.pdf

If anyone has experiences with TTA I’d love to read them…

 

[darwinsmom]

What about the TPLO procedure and boxers did the surgeon find problematic?

Darwin had a TPLO on his left knee this summer. His bone healing took a bit longer than average, but this is not uncommon with older dogs (he was 7 years old at the time of surgery) and he battled some medical complications unrelated to the knee the first several weeks. But from the very beginning of recovery he was weight-bearing and trying to do more than he should. We are less than 2 weeks from the 6 month mark and Darwin appears completely back to normal. No limping and fully using the leg for the past 2.5 months.

My understanding is also that some dogs are not candidates for TTA because the angle of the tibial plateau is too high.

The orthodogs community emphasized that whatever the procedure, you want a surgeon who is experienced and has good results with that procedure. So if the surgeon you want feels more comfortable with a TTA and your dog is a candidate then that is good choice.

There are some other boxers on the orthodogs message board so you might want to try there as well.

Good luck
-Karlyn

http://pets.groups.yahoo.com/group/orthodogs/messages

 

[Loladog]

Lola had a TPLO Christmas of 2008 after a complete tear. We decided to have the surgery done right away after the torn ACL (she had surgery within just a few days) and the surgeon said that this made things easier because there wasn't time for scar tissue to develop.

Well, so far so good! Keeping her calm during the recovery period wasn't easy but we don't have any regrets. Although it seemed hard at the time, it's amazing how fast they recover and regain full use of the leg. The main thing now is to keep her at a good weight in order to minimize arthritis and the risk of her blowing out her other knee. She was a chubby couch potato who decided to chase a squirrel too fast when she tore her ACL in 2008.

 

[EAO76]

This vet was telling me that some of his patients had TPLO done on one knee and then later had TTA on the other and they consistently report a faster recovery with the TTA. He also sees less post op complications w/ TTA vs TPLO. Also the complications that happen with TPLO often result in the need for a second surgery but that almost never happens with TTA. From what I understand TTA is a new & improved procedure. It was developed to combat / address some of the possible negatives to the TPLO procedure.

At this time TPLO is probably still considered the “gold standard” in the vet industry however there is strong shift happening and recently more & more surgeons are leaning towards the TTA. Of course just like anything else there are pro & cons but the two main reasons that you don’t hear a lot about the TTA procedure is because #1 Some surgeons (especially older ones) get comfortable and are reluctant to change. And #2 it’s expensive for practices to switch to another procedure. If a practice has the instruments/tools, hardware, etc for TPLO then it’s a huge expense to switch over to TTA. They must spend a lot of money on all new equipment. This is why you see TTA offered more often in larger /wealthier practices vs. smaller ones.

In regards to Boxers specifically this vet feels like boxers don’t seem to improve as well long term after the TPLO compared to other breeds. He said most of them do fine but that compared to most other breeds he sees a difference with boxers.

He doesn’t have anything against TPLO he thinks its fine. He is an ortho specialist and has performed MANY of TPLO procedures. He has seen it help a lot of dogs. However now that he has the experience of doing both procedures he feels like the TTA is a superior surgery in general but even more so when it comes to boxers. The example he gave was if someone lived 100miles from the nearest vet that did TTA and they had another breed he would tell them just to stay local and have the TPLO done but if they owned a boxer he would tell them to make the drive to have the TTA done.

Here is some more info that I found:

COMPARISON OF COMMONLY USED PROCEDURES TO TREAT CRANIAL CRUCIATE LIGAMENT RUPTURE :

GENERAL INFO:
TTA - simpler procedure and less invasive than the TPLO
TPLO-Technically more complex, more potential for error
Extracapsular/Intracapsular Stabilization (E/I Stabilization) - Less invasive

COST:
TTA - higher than E/I stabilization due to specialized instrumentation and implants. Implants cost more than the TPLO
TPLO - Higher than the E/I stabilization due to specialized instrumentations and implants.
E/I stabilization- Least expensive since specialized instruments and implants are not required.

Complication rate:
TTA-low, since procedure is straight forward
TPLO-Varies with skill and experience of surgeon. Catastrophic failure may occur.
E/I stabilization- Low, since relative simple procedure

Post Operative meniscal injury:
TTA-less likely than after a TPLO because TTA does not change the stifle range of motion
TPLO-TPLO result in increased stifle flexion which may injure the medial meniscus
E/I stabilization-Meniscal injury may occur if the stifle becomes unstable from inadequate periarticular fibrosis of stretching of autografts

Progression of degeneratine joint disease:
TTA-TTA decreases forces between the patella and femur and between the femur and tibia which may minimize progression of DJD
TPLO- TPLO increases forces between the femur and patella and between the femur and the tibia resulting in patellar tendonitis and potential pregression of DJD
E/I stabilization- DJD progresses

Creation of postoperative limb malalignment:
TTA- no unintended geometry changes
TPLO-can correct preoperative limb malalignment but also have the potential of creating unintended deformity
E/I stabilization- No unintended geometry changes

Implant material:
TTA- titanium, which is more biocompatible than stainless steel
TPLO-Stainless steel
E/I stabilization-Stainless steel, if suture anchors, crimb clamps or bone staples are used

Treatment of concurrent medial patellar luxation:
TTA- allows lateral transposition of the tibial tuberosity
TPLO-Tibial tuberosity is not readily transposed
E/I stabilization-can transpose tibial tuberosity

 

[Murp.mm]

Ms. Ali had ACL surgery in June past. She had the Tightrope repair. To have any other type done I would have had to send her out of the province (as we're an island) to another part of Canada and so I decided that since a lot of dogs have had this done I would go with it and a girl I knew had her husky done the same way and he did great. Unfortunately for Ms. Ali 3 1/2 months after her first surgery she torn her meniscus and had to have it removed as well. After surgery the vet explained to me that the meniscus was all twisted and I'm sure it was due to the fact that I didn't keep her still enough after the first surgery. But she's doing so much better now and it's been 12 weeks this week. I honestly don't think she will ever be the same but compared to how she was I'm pleased. Maybe boxers are different in how they are made. She's been on high doses of glucosamine and she's on Omega 3 but now she's got a UTI and has been having some stomach issues so today I took her off everything until she's finished with the antibiotics for the UTI and then I'll slowly reintroduce them again. Don't know if they're having any negative effect as far as the stomach problems (occasional vomiting) but I know the antiobiotics are strong and can cause it too. Good luck with your decision which ever way you go. It's not an easy one either way.

P.S. Thanks for all the valuable infor. The websites are great.

 

[EAO76]

That is interesting that she had the tightrope. I read a lot of good things about that procedure too. I liked the idea of tightrope since it’s done mostly arthroscopically and is considered to be one of the least invasive surgical approaches to canine cruciate injury repair (much less invasive than both TPLO & TTA). But none of the surgeons that I met with felt like that was a good option for Rowdy. I am glad Ms. Ali is feeling better!

 

[darwinsmom]

I've come across several recent anecdotal reports of bone tunneling with the tightrope procedure - basically a widening of the hole that that the tightrope material passes through. It is a serious complication that has required a second surgery.

-Karlyn

 

[EAO76]

I've come across several recent anecdotal reports of bone tunneling with the tightrope procedure - basically a widening of the hole that that the tightrope material passes through. It is a serious complication that has required a second surgery.

-Karlyn

Thanks for the info. This is why I am leaning towards the TTA. It seems like some of the complications that come along with other procedures result in the need for a 2nd surgery. The surgeon told me that he rarely ever has to go in a second time with the TTA procedure.

 

[darwinsmom]

Although the TTA and TPLO are bone-cutting procedures and therefore more invasive, the restrictions and length of the recovery period is bascially the same for all procedures. I think most of us initially feel less-invasive is better but maybe not, especially for very energetic dogs. Good luck to you and Rowdy.

-Karlyn

 

[ebazos]

Natural Healing Versus TTA

Hello! I am in a dilemma. My 6 year old Vincenzo has had both knees injured for about a year now. He does not limp..he can run, jump, play.. but when he does sharp turns he collapses. He will not sit anymore either. He only sits with his legs kicked out to the side.

A year ago we were debating surgery, but came across this website:
Torn Dog Ligament-- Is Surgery Really Needed?

On this site there is AMPLE research about ACL tears and ligament injuries. The author did not have a boxer but another large breed dog and decided that natural healing and RESTRICTION were the best methods for healing. So this is what we have done for a year.

We did not Vincenzo go up stairs without lifting his rear legs with a harness (or helping jim somehow). We no longer played fetch and threw balls and encouraged jumping. We iced his knees hen he limped, we massaged him and for the past 5 months we have done underwater treadmill therapy and swimming. He has significantly improved. He has full motion in legs and walks normal. His legs seem stable, but every so often he will hurt himself again and limp for a day or two. For example if he runs too much and overdoes it he becomes stiff and has a hard time getting up. But then a few days pass and he seems normal. He is very caution not to take sharp turns when playing with other dogs. He has no trouble sprinting... it is really only sitting and turning fast and jumping.

So here is our dilemma....
The other day we were playing ball and he leaped so high into the air (Boxer energy!!) when he landed I heard a pop and he would not put his leg on the ground. I thought it was an emergency, but after some massage he started to feel better and we walked it off. He is fine again. This episode led me to make another vet visit with the fanciest orthopedic surgeon in NYC.

Of course they recommended the TTA right away. They told me that he will develop arthritis the longer we wait and the older his becomes the longer the recovery. I am SO skeptical about this surgery though because It is So invasive and I don't understand why he needs a metal plate when his body has naturally found a way through restriction and therapy to stabalize his knee. On Tiggerpoz website he mentions that the surger will cause arthritis down the road. But the surgeon says that if we don't do it arthritis will develop.
I am really having a tough time deciding what is best. He seems perfect now...but the surgeron suggests that if we wait he will eventually one day go limp in a leg and then we will have to do surgery. I don't think I beleive this.

Any advice?
Please read this site though...
Torn Dog Ligament-- Is Surgery Really Needed?

best, Erin 7 Vincenzo