Annie walking 4 weeks after TTA surgery

This is Annie, she had a torn right ACL (properly called Cranial cruiate ligament or CCL in dogs) a few months ago, she was limping and was in a lot of pain.  She had a Tibial Tuberosity Advancement or TTA done by CVSS to repair/stabilize her right knee, and this video 4 1/2 weeks after surgery shows that she is doing great.  We are so happy for her!

Click here to see her video walking on Youtube:

Understanding Cranial Cruciate Ligament injury (CCL,ACL)

In this post I will do my best to explain and simplify things that you need to know regarding a cruciate ligament injury and their consequences.

A cranial cruciate injury is the most common source of rear limb lameness in dogs.  The cranial cruciate ligament or CCL is also known as the Anterior cruciate ligament or ACL, but this is the term used in humans.  Many times veterinarians use this term since people are more familiar with it, and makes it easier to understand, however,  the proper name of this ligament in dogs is the Cranial Cruciate ligament or CCL.

This ligament is inside the knee joint (also called stifle joint). The knee is formed by 3 bones, the femur (or thighbone), the tibia (or shin bone) and the patella (or knee cap).  The sections of these bones that form the knee are surrounded by cartilage, and this is enclosed by a thick layer of tissue called the joint capsule.  Inside the capsule is fluid called joint fluid (synovial fluid).

If you look at the knee joint from the back you’ll see two ligaments that form a cross, these are the cruciate ligaments.  They are the caudal cruciate ligament and the cranial cruciate ligament. Injuries to the cranial cruciate ligament are very common, injuries to the caudal cruciate ligament are rare.

The function of the cranial cruciate ligament (CCL or ACL) is to keep the tibia from sliding forward under the femur (tibial thrust) as well as to prevent the internal rotation of the tibia. In other words, the function of the cruciate ligament is to maintain appropriate contact between the femur and the tibia and good alignment of these two bones during walking, running or standing.

Inside the knee joint, dogs as we do have something called meniscus. These are shock absorbers, they are at the top of the tibia, and the femur (thigh bone) sits on top of them.

When a dog has torn a CCL the femur will slide backwards on the tibia, and the tibia will move forward (tibial thrust, also called cranial tibial subluxation). The femur will move on top of the tibia and meniscus making pressure against areas of the joint that are not used to receiving this much weight bearing, causing damage of the cartilage and meniscus (commonly causing meniscal tears). All of these changes will cause joint swelling (inflammation) and pain.

Rupture of the cranial or anterior cruciate ligament (CCL or ACL) can be acute (sudden) or chronic (over a period of time) in nature. Acute injuries can be traumatic sports injuries in active dogs, and most commonly occurs due to over/hyperextension and internal rotation/twisting inwards of the knee (often occurring when a dog steps in a hole or any type of force stressing the ligament that exceeds its breaking strength while the pet is active). Proposed underlying causes for chronic disease of the CCL include age-related deterioration of the ligament, obesity, conformation abnormalities of the rear limb, and immune-mediated disease.

Partial or incomplete tears of the Cranial cruciate ligament (CCL, ACL) most of the time does not cause as much joint instability but can be as painful and requires same treatment as a complete tear/rupture.

I will talk about diagnosis for this injury on a separate post as well as the surgical treatments available such as Tibial Tuberosity Advancement or TTA, Tibial Plateu Leveling Osteotomy or TPLO, Extracapsular technique, Tight Rope, etc.

And please don’t hesitate to make any comments, or share this post, any input is always appreciated.

Marcos Haase, DVM

About

CVSS is a traveling surgical practice, that provides advanced surgical care to your pet(s) within your veterinarian’s hospital.

At CVSS we strive to arrive at the most beneficial resolution for your when surgery is needed. Our goal is to fix and reform problems when they arise so you and your pet can return to a normal active life. Your pet means a lot to you, and his or her well being means that much to us.

If you are interested in any information please contact us at: info@charlotteveterinarysurgery.com or call at (704)915-9900

or visit our Facebook page: http://www.facebook.com/pages/Charlotte-Veterinary-Surgical-Services-PLLC/287014321340286

Thank you so much for checking us out,

The CVSS team

Meet the surgeon…

Dr. Marcos Haase, is a fully licensed veterinarian in North and South Carolina, with 10 years experience in general practice and emergency and critical care, who offers TTA for advanced cranial cruciate ligament rupture repair, and titanium plating techniques as well as other veterinary surgical services in the Greater Charlotte area and South Carolina to surrounding general practices on-site. He utilizes top of the line Titanium Kyon Swiss Implants, and the ALPS advanced locking plating system.  His goal is excellence and compassionate care.

Prior to moving to Charlotte with his family, he was serving as the medical director of a 24 hour emergency and referral center in Winchester, VA. He often collaborated on patient care with board-certified surgeons at the same facility and continues to consult with specialists on cases to receive their imput frequently.

He has a great passion for orthopedics and has trained with the industry leader KYON in both TTA and ALPS plating procedures. He can also provide a wide range of other veterinary surgical service support to area hospitals including emergency surgeries such as splenectomies, Caesareans, GDV, liver lobectomies, nephrectomies, intestinal, and other soft tissue/orthopedic procedures. Dr. Haase is also bilingual and can do surgical consultations in Spanish for clients when desired. He is a member of the American Veterinary Medical Association, and  is a certified TTA surgeon and ALPS surgeon with Kyon.

His passion for surgery is equal only to his devotion for patient comfort, and is a strong advocate for progressive pain management utilizing a multi-modal approach stemming from his critical care and general practice background.  He also highly values client communication and close follow-up as hallmarks of  a good surgeon, with caring equal to skill as a necessity. Before any surgical case, he always values the importance of a full history, physical exam, and face to face consultation with the owner and general veterinarian to treat the whole patient and look at the bigger picture to keep patient care in the core of everything CVSS provides.

Mission of CVSS

Our mission is to provide support for general practices in the Charlotte and SC area who would like to provide a broader range of veterinary surgical options for patients on-site, and to reach patients who for various reasons must decline a referral to a board-certified surgeon as an industry gold-standard but still deserve quality care. With this unique concept of bringing the surgeon to the patient, continuity of care alongside the primary doctor as well as reducing patient anxiety due to familiar hospital settings are additional benefits.

Compassionate care, excellence, integrity, and client communication are hallmarks of what CVSS stands for.  Every patient is unique, and individual in their medical needs. CVSS looks at every case individually, and offers support and services to maximize patient benefits and strengthen the bond of the owner, patient, and primary veterinarian in a familiar setting. CVSS wants to support the Greater Charlotte area by offering a novel option between referral and in-house current capabilities

Luna’s testimony

In the beginning of October of 2011 I began noticing that Luna, our 3 year Old English Bulldog, was limping significantly on her rear right leg. I took her into our veterinary clinic to have her examined and was told, at first, that there may be a possibility of a torn cruciate ligament in her leg. A close friend of mine had to have her Labrador Retriever’s cruciate repaired the previous year; therefore I knew how serious this was and I also knew we had very limited options.

The next week I scheduled a sedated examine with Dr. Haase so that we could confirm that her cruciate was indeed torn. When Dr. Haase called me with the results I was shocked to learn that not only was her right cruciate injured but so was her left. Once we had gotten the confirmation we wanted to schedule surgery right away. Dr. Haase spent a significant amount of time with me going over each of the different cruciate repair procedures. So with his help and knowing the type of active lifestyle that I wanted Luna to be able to go back to, I decided on getting a TTA.

After the surgery was performed, Luna stayed at the clinic for two days. Within those two days Dr. Haase personally cared for and monitored her; because this time is so very crucial in making sure that recovery is successful. The fact that he spent so much time with her did not go unnoticed by us as owners. I was relieved to know that he truly cared about Luna and that Luna did not just seem like another patient to him. I received regular phone calls and updates throughout the first 48 hours which also helped put my mind at ease.

One thing I must say about cruciate repair is that the recovery is not an easy one. Luna was monitored almost constantly and there is a very rigorous and intense physical therapy regime that must be maintained in order to make sure the surgery is successful. Luna is a bit hyperactive sometimes so for anyone who is planning on having this surgery done on a hyperactive dog, you need to prepare yourself for what is to come throughout recovery. Sometimes our furry friends seem or think they are able to do much more than they really should in order for a proper recovery. This was probably our biggest challenge with Luna.

Luna seemed to feel like she was 100% again within the first two weeks or so. It was difficult to keep her from trying to run or jump from the moment we brought her home; so we kept her in her own little room where she was able to heal without injuring herself. This allowed for her to have some space and not be confined to a crate for 6-8 weeks.

Throughout the entire process Dr. Haase has not only been helpful but also been compassionate; which I believe is essential for any animal and their owner during this procedure and the recovery since both are quite intense.

Dr. Haase was available whenever I had questions or concerns. He never seemed to be inconvenienced by our phone calls or questions and was always more than helpful and accommodating. He would even periodically call just to check on Luna which made us feel like he genuinely cared for her well being and recovery. Dr. Haase even made a home visit at one point to check on Luna’s progress because she was much calmer in her home setting than at the clinic.

I could not be happier with not only the outcome of Luna’s surgery but also the way in which she was cared for and treated by Dr. Haase. I would recommend Dr. Haase to anyone who is planning on having the surgery, or any surgery for that matter, performed. Because this procedure is so intense, it is important to have it performed by a Doctor that cares about your animal as much as you do.

We have been so satisfied with the results of the surgery and with the way in which Dr. Haase has cared for Luna, we plan on getting Luna’s left leg repaired in June of 2012 with Dr. Haase as well.

Mallory R, Luna’s owner

ALPS Plating Systems

CVSS utilizes swiss titanium Kyon implants, and the ALPS (Advanced Locking Plate System) developed for advanced fracture repair  is preferred for three main biologic benefits:

• Reduced damage to vascular supply of the bone by minimizing contact with the periosteum

• Increased resistance to infection

• Accelerated wound healing

Titanium is a preferred standard in human medicine as well, based on the closer bio-compatability to bone over other lesser expensive implant types.  CVSS depends on these premium implants to aid in the healing of more complex fractures many times in combination with bone grafts.

Tibial Tuberosity Advancement

What is a TTA?

TTA stands for tibial tuberosity advancement, and is one of the techniques available for stabilization of cranial cruciate ligament deficiency in dogs. This technique was invented by Dr. Slobodan Tepic and Dr. Pierre Montabon in Zurich, and was launched by Kyon in 2004 following three years of clinical testing.

TTA involves an osteotomy of the non-weightbearing portion of the tibia. This section of the bone called the tibial tuberosity is moved forward so that the patellar ligament is aligned on a 90 degree angle with the tibial plateau. By doing this, you change the angle of the forces applied to the knee during stride which gives stabilization to the joint.

Implants used to keep the tibial tuberosity in place (as seen in this radiograph of a CVSS patient), includes a cage which is placed on the end of the osteotomy closer to the joint and is secured by two titanium screws to keep the space between the tibial tuberosity and the tibia. Also, a tension band plate secures the tibial tuberosity to the tibia and is secured by an an pronged implant called a fork and additional cortical screws.