TPLO and TTA—A Comparison Of Surgical Options For The Treatment Of Anterior Cruciate Ligament Rupture In Dogs

Anterior cruciate ligament rupture is a very common problem in dogs with the knee. Anterior cruciate ligament disease (CrCLD) is the leading cause of lameness in dogs, and meniscal injuries are also common in dogs with CrCLD. For most dogs, surgery is usually the best treatment because it is the only way to permanently resolve the instability of the knee. The two most commonly used surgical procedures are the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity anterior translation (TTA).

1. TTA



TTA surgery simulates the tension of the anterior cruciate ligament on the joint capsule by moving the tibial cage forward and pulling the straight knee ligament forward. Since the straight knee ligament is connected to the quadriceps above and the tibial cage below, its tension is located exactly in the center of the knee joint. By moving the straight knee ligament forward, the tension of the anterior cruciate ligament on the knee joint can be simulated. TTA surgery does not reconstruct the geometric structure of the knee joint, does not change the original biomechanics of the knee joint, and does not directly use implants to pull the bones to simulate the tension of the anterior cruciate ligament. Instead, it cleverly uses the original structure of the straight knee ligament to maintain the stability of the joint. The advantages of this surgery are its stability and success rate. The advantages are:

1. It can reduce the risk of infection.
2. Reduce the trauma of the tibial tuberosity.
3. Quickly combine the implant with the bone, reducing the operation time.

The surgical difficulties of TTA are as follows:

1. Complexity and unpredictability of the surgical process: The TTA surgical process is relatively complex, with many steps, unpredictability and non-repeatability. This increases the difficulty of the operation and requires doctors to have high skills and experience. In addition, the operation time is long, usually taking 25 to 45 minutes to complete, which also increases the uncertainty and challenges during the operation.

2. Complexity of implant placement: Implant placement is a technical challenge. Due to the complexity of implant placement, it is easy to make mistakes, especially when the animal is small, the operation is more difficult. This requires doctors to have not only superb skills, but also a deep understanding and preparation of the surgical process.

3. Long learning curve: For novice doctors, it takes a long time and a lot of practice to reach an ideal level of surgical skills. Doctors usually need to complete 60 to 160 cases before they can reach a relatively ideal level of surgery, which shows that the learning curve of TTA surgery is long and the challenge for new doctors is greater.


2. TPLO

TPLO: ‌Tibial plateau leveling surgery, ‌by adjusting the position of the tibia, ‌to restore the stability of the knee joint, ‌thereby reducing the joint instability caused by anterior cruciate ligament rupture. ‌Advantages include: ‌

1. Effective treatment of joint instability caused by anterior cruciate ligament rupture. ‌

2. Reduces the risk of reoperation due to re-rupture of the ligament. ‌

3. Pets recover normal motor function faster. ‌

4. Surgery can be personalized for planned treatment.

TPLO focuses on preoperative planning, which requires accurate measurement of TPA angle, selection of appropriate oscillating saw osteotomy, accurate calculation of osteotomy distance and position, mastery of the anatomical structure around the osteotomy during the operation, protection of surrounding tissues, blood vessels and ligaments to prevent injury, and attention to pain management and anti-infection treatment after surgery. If these can be done well, the operation will generally be successful.


If TPLO makes the tibial plateau face the bone stress point, TTA is just the opposite, it makes the stress point face the tibial plateau. These two surgeries have their similarities, so they have achieved different degrees of success.

Judging from the final recovery effects of a large number of domestic and foreign cases, both surgeries have proven to be very mature surgical techniques. Currently, various studies have not proven which surgical technique has more advantages, and which technique should be chosen. More considerations are the selection of cases, the preferences of surgical veterinarians, etc.