Red Bank Veterinary Hospital

RBVH Articles:

New Surgical Options For Management Of Cruciate Tears

The department of surgery at RBVH is pleased to announce the addition of two surgical options for the treatment of cranial cruciate injuries in dogs: the Tibial Plateau Leveling Osteotomy (TPLO) and the Tibial Tuberosity Advancement (TTA).

TIBIAL PLATEAU LEVELING OSTEOTOMY

The TPLO procedure is well known and has been performed for many years The TPLO is designed to neutralize the cranial tibial thrust that is generated in the

cruciate deficient stifle by realignment of the weight bearing surface of the proximal tibial plateau. In most dogs, the tibial plateau is not level but is angled in a caudal direction. One of the functions of the cranial cruciate ligament, therefore, is to stabilize the stifle so that the femur does not “slip” backwards off the plateau (and thus allowing the tibia to “thrust” cranially) during weight bearing.

After careful measurements are performed from preoperative radiographs of the stifle and tibia, a curved osteotomy is performed on the proximal tibial with a special saw. The proximal portion of the tibial containing the tibial plateau is then rotated into a predetermined and more level position. The tibia is then secured with a special TPLO plate and screws. The TPLO very often allows an early return to weight bearing and minimizes post operative degenerative joint disease.

TIBIAL TUBEROSITY ADVANCEMENT

The TTA also is also designed to neutralize the cranial tibial thrust but by changing the direction of force of the patellar ligament so that it is perpendicular to the tibial plateau. Based on precise measurements made from pre-operative radiographs, the tibial tuberosity is separated from the body of the tibia by a bone saw and, by the insertion of a titanium cage or spacer, it is repositioned in a more cranial position and stabilized with a special plate. While this surgery is relatively new compared with the TPLO and other more traditional procedures, it has already shown great promise and is championed by many surgeons throughout the country.

In addition to the TPLO and TTA procedures will allow RBVH to offer more options for the surgical management of cruciate injuries. While both the TPLO and TTA procedures have been performed in dogs of all sizes, the surgeons at RBVH tend to believe them best suited for larger dogs (over 60 lbs).The more traditional lateral imbrication suture technique (often referred to as the DeAngelis technique) and the fibular head transposition are still offered and commonly performed at RBVH. These expanded options will allow us, working with the owner and the referring veterinarian, to select the procedure that is best suited for each case. If you have any questions regarding these procedures, or the management of cruciate injuries in general, please contact one of the surgical staff at RBVH.