TTA knee ligament rupture surgery technique

เทคนิคการผ่าตัดเอ็นหัวเข่าขาดแบบTTA

A ruptured knee ligament is a condition that any dog can experience. The causes of a ruptured knee ligament are divided into two types: acute and chronic.

1. Acute type: Often caused by an accident, such as a dog falling into a hole, causing the hind leg to twist inward, causing the knee ligament to be pulled too much until it tears.

2. Chronic type: Dogs often have a history of degenerative joint disease from a dislocated patella over a long period of time, which leads to subsequent rupture of the knee ligament. In most dogs, around 80%, this is usually chronic.

This image shows the location of the knee ligament, which normally holds the tibia in place and prevents it from moving forward. If it is torn, the tibia is free to move forward, causing the knee to be unstable when the dog walks. Source: Cranial cruciate ligament injury, http://www.vmsg.com

To diagnose a ruptured knee ligament, your veterinarian will assess the forward movement of the tibia, which is not normally pushed forward by dogs.

For X-ray, the changes of the knee joint will be clearly seen in cases of chronic injury because the characteristics of osteoarthritis and bone spurs will be seen in both side-lying and supine positions.

Diagnosing rupture of the cranial cruciate ligament, http://www.ncbi.nlm.nih.gov

If the dog is not treated or treated incorrectly, the dog will not be able to walk smoothly and will not put weight on that knee because it hurts. Over time, the dog will become disabled due to the atrophied leg muscles.

An x-ray shows the appearance of bone spurs around the knee joint of a dog with chronic knee ligament rupture.

To effectively treat a torn knee ligament, even though there are initial treatments such as pain medication, weight loss, and exercise restriction, veterinarians often recommend surgery because it is a direct solution, allowing the dog to put weight on the leg again, reducing pain and reducing muscle atrophy in the leg in the future. Early diagnosis and prompt treatment will help the surgical results be good.

There are several surgical methods to repair a torn ACL, but here we will present the following: Tibial tuberosity advancement, or TTA for short. It is a new surgical technique based on the principles of physics to reduce the angle of the back of the tibia (tibial plateau) by cutting the front of the tibia (tibial tuberosity), which is the attachment point of the patellar ligament, and moving it to the front so that the patellar tendon is perpendicular to the back of the tibia, as shown in the figure.

Figure A shows the preoperative appearance of the knee. The tibial plateau is not perpendicular to the patellar ligament, causing a physical rupture to the front (two black arrows). When the dog walks, the tibia displaces forward. The knee becomes instable and painful, and the dog does not use the leg normally. Figure B shows the postoperative appearance of the knee. When the tibial tuberosity is cut and moved anteriorly so that the patellar ligament is perpendicular to the tibial plateau, no rupture occurs. Therefore, the tibia does not displace forward when walking. Source: Randy, JB 2009. In: Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement?, Veterinary Surgery 38

The advantage of TTA technique is that it gives satisfactory treatment results in the long term. The device is durable and strong, suitable for supporting the weight of large dogs and dogs that are cheerful, playful, and like to run or jump.

However, this technique requires a surgeon with expertise to perform it. Since TTA is a relatively new technique, the success after surgery depends in part on the experience and expertise of the veterinarian. Post-operative care is similar to general bone surgery: the dog must receive pain-reducing and anti-inflammatory drugs in the beginning. The area must be restricted for 2-4 weeks after surgery, including weight control, especially in obese dogs.

If your dog has not used his leg for a long time before surgery, causing the leg muscles to atrophy, veterinarians will often recommend starting a physical therapy program 6 weeks after surgery to help your dog regain normal weight bearing on his leg more quickly.

After the tibia is moved forward so that the patellar tendon is perpendicular to the back of the tibia, a special bone plate is used only to correct a torn knee ligament using the TTA technique.

Photo of None's knee about 2 weeks after surgery.

Taling Chan Animal Hospital used this TTA technique to treat None, a 10-year-old mixed breed dog whose knee ligament was torn due to long-term osteoarthritis. His patella moved inward. The results showed that None was able to walk normally within just one month after TTA surgery. 

Video clip of Nong No Ne before and after surgery

en_USEnglish