ACL Surgery Information - TTA va TPLO surgery

The most common knee injury in the dog is rupture of the Cranial Cruciate Ligament (CCL), also frequently referred to as the Anterior Cruciate Ligament (ACL). This injury can occur at any age and in any breed, but most frequently occurs in middle aged, overweight, medium to large breed dogs. This ligament frequently can suffer a partial tear, leading to slight instability of the knee. If this damage goes untreated, it most commonly leads to complete rupture and possibly damage to the medial meniscus of the knee. The meniscus acts as a cushion in the knee. Complete rupture results in front-to-back instability, commonly called Tibial Thrust, and internal rotation of the lower leg, commonly called Pivot Shift. Untreated legs usually become very arthritic and painful from the instability.

An injured Cruciate Ligament can only be corrected by surgery. There are numerous surgical corrections currently being performed. The most common are 1) External Capsular Repair, 2) TightRope Procedure (a variation of the External Capsular Repair), 3) Tibial Plateau Leveling Operation (TPLO), and 4) Tibial Tuberosity Advancement (TTA).

The forces within the knee are very complicated and change as the knee is rotated through its range of motion. In a normal standing position there is a tendancy for the lower end of the Femur to slide backwards on the tilted Tibial Plateau, this is called Tibial Thrust. This force can be corrected by either cutting the Tibial Plateau and rotating it into a more flat position (TPLO) or by counteracting this force by changing the angle of pull of the very strong Patellar Tendon by advancing the Tibial Tuberosity (TTA).

Some researchers think that the TPLO procedure can still allow rotational instability (Pivot Shift) and this may lead to the progression of arthritis as the dog ages. This Pivot Shift does not seem to be a problem with the TTA procedure because it results in more control of rotation by the large quadriceps muscle which pulls on the Patellar Tendon.

Anyone interested in the details can easily find them by doing an internet search on “TTA vs. TPLO”.

Water Treadmill Therapy - underwater video

Here's a video of what it looks like under the water when the dog is walking on the treadmill. You can see all the legs working independently and he's unable to hop or skip and avoid using the back leg that had the surgery.

Warm water provides an ideal way to work the leg without putting undue stress on the knee (stifle) joint. Range of motion and strengthening can both be accomplished with less risk of re-injury through swimming. The warmth of the water itself helps relax stiff muscles. Underwater treadmills are also an excellent way to encourage your dog to gait properly and weight-bear on the affected leg, either post-surgery or in lieu of surgery.

Water Treadmill Therapy

Well, it's five weeks since the surgery and Niko is still limping quite alot. Apparently the meniscal tear has the ability to possibly make him lame if we don't take his recovery very slow. The TPLO surgery combined with the meniscus tear is what makes his recovery so slow. He was walking the other day and stepped off a curb at an angle and his leg gave out and he hurt himself. Even the simple task of walking him slow is difficult. You have to make sure that he walk up and down a curb at a 90 degree angle so as to avoid his placing his feet wrong.

Yesterday at physical therapy VOSM (the surgery center) checked to make sure that he didn't re-injure himself and that the pins weren't jarred lose. Fortunately, nothing serious happened and he was ready to try his water treadmill therapy.

It was pretty cool as the water quickly frilled the treadmill booth and when they turned on the treadmill he had to keep up with the speed or his rear end would hit the back wall. All in all, I think he loved it.

TPLO X-rays at 4 weeks

Healing is going very well and Niko is responding well to his physical therapy. However, it amazes me that we still have to keep him on the leash at all times, he can be alone with the other dog and we have to continue blocking off the stairs as well as the couches. It's not easy walking him because he sometimes refuses to move forward and I have to use lots of treats to get him to walk. He'd much rather run so he can hike up the bad leg and I have to constantly slow him down to a walk to force him to use all 4 legs.

Here are some x-rays of the plate and pins from the TPLO surgery. In the x-ray to the right here you can see where they cut the bone and it still has the vertical crack from the incision. That's what we are waiting to be filled in by bone

before he can do anything. We're still talking 12-14 weeks recovery time before the bone fills in.

The leg is a bit atrophied and I'm going to have to reall focus on more exercises to build up his muscles. We don't want the bone to heal and then have the leg be too weak to stand on.

Next week we start the under-water treadmill.

TPLO surgery recovery at 3 weeks

Niko is doing extremely well at 3 weeks. I took him back to the surgery center to have them check his progress. He's started to walk faster now, although I have to slow him down so he walks instead of runs. When he picks up his pace, he tends to run on three legs, so walking is very important because it forces him to use all 4 legs. He's allowed to go up and down one or two steps and I can increase his walk time from 5 minutes to 10-15 minutes.

I took a video of the physical therapy that they suggested be done twice a day after the surgery.

These are special exercises to help restore optimal movement to his knee joint. First, have your dog lay on his side, with the affected leg on top. To perform flexion, grasp the leg just above the knee and just below the ankle (hock). Holding the thigh steady, gently push the lower leg up toward the thigh, so that the upper and lower legs are fully touching. For extension, grasp the leg just above the knee and just behind the hock. Keeping the thigh steady, gently push the hock until the leg is straight. Perform both motions for 2 sets of 10 repetitions. Be careful never to force the leg, and never push past your dog's comfort zone.

Day 12 after TPLO surgery

Ahhhhh. Life is the new normal, and everything is ok. I was terrified of the changes we were going to have to endure with Niko's surgery. Don't let him climb on the couch, he has to wear the cone 24/7, can't allow him and the other dog alone together, no walking up or down stairs, have to put rubber mats on all of the wood flooring and kitchen areas, can't let him go outside except for a few minutes at a time, has to be monitored constantly to make sure he's not doing something destructive to his injured area... on and on and on.

I 'm happy to report that the "other dog" loves the crate when we are gone. Niko could care less about the cone and just lifts his head when it's time to put it on, he's not interested in going up or down the stairs and the mats all over the floor provide a variety of sleeping areas for him.

The staples come out on Monday in two days and we'll move into the physical therapy stage of recovery. It really hasn't been too bad at all. His incision is almost totally healed and his hair is growing back and he's occasionally starting to use his leg to stand on and sometimes to walk on.

I have to admit that preparing the house was the best thing I did. When he came home from the surgery center, everything was ready and all I had to do was give him lots of love and attention - that part was easy.

Day 6 after TPLO

Ok - so I'm dense. Niko was doing so well and he was healing like a champ. He didn't mind the cone and was into his new schedule. Everything was going great until we started to get a little lax on the cone thing.

We first started taking the cone off to give him a break when we were sitting right there. Then we left the cone off while we were in the other room for a few minutes. Then we left the cone off for a little longer period of time. He never was bothered or even interested in his stiches....

Always, always listen to the Doctor !!! I left the cone off and walked away, when I came back into the room, Niko was licking away. I nearly fainted. They warned us that this would happen. Thank goodness he didn't remove any staples. But the area is all red and raw from his licking and now I'm going to have to watch it for infection like a hawk. I'm sooooo stupid ! Everything was going so well, and we got careless. The amazing thing is that the Doctor could not have been more explicit about this particular instruction.

Rule #1.... Never leave the dog unattended without his cone on. Grrrrrr !