# TTA - Any bad reviews?



## Rich Schultheis (Aug 12, 2006)

So I've joined the club of CCL tears with my 2.5 year old. Spent a few days searching here and elsewhere and reading up on everything I could find on TTA and TPLO. My orthopedic surgeon seems to favor TTA right now. He believes he is seeing shorter and easier recovery and rehab with this technique, and prefers this type of modification to the knee structure to that done with the TPLO. Unfortunately it is a newer tecnnique and there is still less of a dataset of long term results that is available for TPLO. What I haven't found to this point in my search is any input from anyone that has seen complications, longterm problems, or any issues with the TTA. Anyone seeing any problems, short or long term yet?
Anyone here have the TTA done with a dog that has since been actively competing for a long period of time? How is long term durability looking? Thanks in advance for any input!


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## Misty Marsh (Aug 1, 2003)

Can't speak to the benifits of TTA, heard quicker recovery and that it's a good fix, but TPLO is proven long term. My input is that TPLO worked great for my hard going, young at the time dog and have not had a lame day since surgery. I did the re-hab to the tee and no abnormal anything to be had post-op.


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## jeff t. (Jul 24, 2003)

pondhopper said:


> So I've joined the club of CCL tears with my 2.5 year old. Spent a few days searching here and elsewhere and reading up on everything I could find on TTA and TPLO. My orthopedic surgeon seems to favor TTA right now. He believes he is seeing shorter and easier recovery and rehab with this technique, and prefers this type of modification to the knee structure to that done with the TPLO. Unfortunately it is a newer tecnnique and there is still less of a dataset of long term results that is available for TPLO. What I haven't found to this point in my search is any input from anyone that has seen complications, longterm problems, or any issues with the TTA. Anyone seeing any problems, short or long term yet?
> Anyone here have the TTA done with a dog that has since been actively competing for a long period of time? How is long term durability looking? Thanks in advance for any input!


At 2.5 years of age, I agree with your long term concerns. 
Lacking long term data, I'd be inclined to go with the proven method and would want to find a surgeon who is on board with that.


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## Breck (Jul 1, 2003)

From Dr Sherman Canapp of VOSM.com

Currently, there is no “best CCL procedure”, however there is a best technique for each individual patient. The TightRope, TTA, TPLO, and lateral suture/extracap are all very good procedures however, each have their limitations. When considering the preferred CCL technique for your dog one must consider variables such as age, size, activity level and desired return to sport, tibial plateau slope, etc. For example, it is not possible to adequately stabilize a stifle using the TightRope or TTA procedure for dogs with tibial plateau slopes greater than 28 degrees (some say 30). In addition, for very active dogs the TightRope material may be so strong that it could potentially “work away” at the bone leading to loosening through the bone tunnels over time. Should the dog have an infection or sensitivity to the implants it is almost impossible to remove the implants following a TTA (they are healed into the center of the bone). The lateral suture is not biomechanically as strong as the tightrope and over time may lead to stretching or complete failure. The TPLO has the least amount of limitations and has also been around longer than the TTA or tightrope (TPLO was first described in the early 1990s). The is no weight limitation, age limitation, tibial plateau slope limitation, and we expect all working and performance / sporting dogs to return to full function and activity.
Despite which knee surgery you choose, we recommend that the intra-articular work be performed through minimally invasive means. Another words, either arthroscopically or through a mini arthrotomy (small keyhole incision into the joint). Now-a-days most joint procedures performed in people and horses are performed through minimally invasive means, they should be in dogs as well. This allows for less post-op pain, less chance of complications, less infection, less inflammation, more cosmetic appearance, and a quicker return to function. 
The meniscus (shock absorbers within the stifle) also must be evaluated and probed (palpated). The meniscus add stability to the stifle and protect the cartilage. Because they are so important for function and protection we do not recommend performing a meniscal release (cutting the meniscus as some describe) at the time of surgery. The chance of a meniscal injury following the TPLO once the dog has returned to full function is very low (well less than 5-10 percent). Should this occur, it can be treated arthroscopically. Should a meniscal injury be noted at the time of the original surgery treatment is recommended. If it is missed or not treated the dog will show signs of intermittent lameness, poor overall function and there will be a progression of osteoarthritis. The most important step regardless of which procedure is performed is appropriate rehabilitation therapy, conditioning and retraining. Now-a-days physical therapy is standard of care following ACL repair in people, it should be for dogs as well. Rehabilitation therapy should be performed by a certified veterinary therapist (CCRP/CCRT) in a customized program should be created. This program should be tailored to fit the dog’s response to treatment and adjusted at each session (there should be no cookbook approach). Conditioning and retraining is imperative to allow for the dog to return to sport / work without causing injury to other areas of the body as well as redeveloping that competitive edge.




Hope that helps. I've had 3 TPLO's done on my dogs, all successful.

Bottom line with the TTA is if something goes wrong and they have to go back in to the repair it is necessary to actually break/splinter the bone to get there. Pretty scary the way it was described to me.


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## Rich Schultheis (Aug 12, 2006)

Great read thanks for including that


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## Janet Kimbrough (Aug 14, 2003)

One of my dogs has had to have TPLO's on both knees (9 months apart). With the second one, my ortho said he would get in there and do the one he felt was best for the situation, either TTA or TPLO. He ended up doing a TPLO and said "he was made for the TPLO procedure."

He is and has been back running hunt tests. Age is the only thing that is slowing him down and not his knee surgeries.

Good luck.

Janet Kimbrough


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## JusticeDog (Jul 3, 2003)

Breck said:


> From Dr Sherman Canapp of VOSM.com
> 
> 
> 
> ...


 
is this the guy that did your dogs TPLOs? What kind of work has your dogs returned to? ie: running AA stakes since then?


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## Breck (Jul 1, 2003)

Sue,
For 2 TPLO's I used Dr Spodnick in Raleigh and rehabed at Vethab and Dr Sherman. Since Dr Shermans passing I searched for a good surgeon that also had rehab capability. Recently found Dr Canapp. He has only done my most recent dogs surgery and 8 weeks of rehab, he is 10 weeks post op now. A little more rehab and he will be good to go full bore again I'm sure but I've washed him out anyway and won't be doing much with him unless I get bored. Could though. He had his first one done at age 1 and was able to train and compete no problem. Only a Q dog though but won one. 
Other dog had an FCE in her spine affecting one rear leg and she ended up tearing the cruciate in the other. Spod did that one and Dr Sherman rehabbed. Because of her paralysis I ended up bringing her home off my pros truck and semi retired her with light training and trialing. Ended up winning an Am this spring to finish her AFC. 
From my experience using a good surgeon who has done 1000 or more TPLO's plus doing serious rehab will get your dog back to trialing no sweat.


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## tbyars (Mar 29, 2005)

I have a hard charging female that had the TTA surgery at 14 months. A year later she is still as a hard charger as she was with no signs of problems. Whether you have TTA or TPLO, I recommend you follow a schedule for you re-hab. Took mine to weekly sessions in the water tank treadmill, walking, etc. The rehab is as key as the surgery IMHO.
Tim


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## Rich Schultheis (Aug 12, 2006)

Thanks for all the information so far, keep it coming. For clarification, my surgeon reccommended either the TTA or the TPLO, and gave me the option to choose which one we go with. He just mentioned some of the things he's been seeing with the TTAs he's completed in comparison with the TPLO.


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## JusticeDog (Jul 3, 2003)

Breck said:


> From my experience using a good surgeon who has done 1000 or more TPLO's plus doing serious rehab will get your dog back to trialing no sweat.


I would agree.... my philosophy for humans as well. Just trying to keep track of who that would be... in case I ever need it..... and with my luck, I will.


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## Rich Schultheis (Aug 12, 2006)

I've decided to go with the TPLO, although it seems like the TTA shows promise, I am willing to put more time into our rehab for a procedure that has a more extensive dataset on longterm durability. Cache goes in on Friday, going to be a loooooong 6 months +, getting my walking shoes and floaties ready now....


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## Howard N (Jan 3, 2003)

pondhopper said:


> I've decided to go with the TPLO, although it seems like the TTA shows promise, I am willing to put more time into our rehab for a procedure that has a more extensive dataset on longterm durability. Cache goes in on Friday, going to be a loooooong 6 months +, getting my walking shoes and floaties ready now....


My bitch Missy had a TPLO on May 3. I did the underwater treadmill twice a week and rehabbed her with walks and swims like the rehab doc said. They had me put her back in training on June 28, 8 weeks post op. I took her to the Lardy workshop for 4 days July 8-12. She won an open and came in 2nd in the amateur, July 16-18. TPLO's are not a career ender and they're not out of training for more than a winter vacation. I don't believe your dog has to be out anywhere close to 6 months.


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## kimsmith (Mar 30, 2003)

I've got a MH female that is 6 now and we had TTA done on one knee at age 2. She was running hunt test a month or 2 and has never had any problems. I was told TPLO had to be perfect and TTA had room for error. I was also told that TTA didn't require as much down time and I'll have to agree, but this is the only dog I had done.


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## Rich Schultheis (Aug 12, 2006)

Cache had TPLO Friday. It was a full tear but the meniscus was in good condition, so hoping for a somewhat smooth rehab. Was a long weekend and airing is still going to be quite the challenge for a while but by sunday looked better than he did pre-op. (by the time of the surgery he was down to a slight limp) He is already trying to use the leg normally when airing every chance he can. Unfortunately he has the energy and the drive of two dogs and the intelligance of 1/2 a dog so it will be a challenge these first few weeks. I think his tibial angle was something like 26/27 pre-op so maybe there is a chance the other knee won't go, right away anyway, but looking into insurace this week, seems like the smart thing to do.


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