Jeong, Jaemin et al. “Subsequent meniscal tears following tibial tuberosity advancement and tibial plateau leveling osteotomy in dogs with cranial cruciate ligament deficiency: An in vivo experimental study.” Veterinary surgery : VS vol. 50,5 (2021): 966-974. doi:10.1111/vsu.13648
Key Point: Significant lower post-operative meniscal tears with TPLO as compared to TTA.
In previous blog posts I have discussed Cranial Cruciate Ligament (CCL) ruptures, with particular interest on addressing these patients early in their disease process to attain optimal outcomes (see Dr. Petrovsky’s blog post here). Of particular interest in CCL disease, is the meniscus, two cartilaginous cushions that live between the bones in the knee and protect the cartilage from wear and tear. When meniscal tears occur, there is associated pain and osteoarthritis development. This is most commonly because of a torn CCL in the dog.
If you have done any googling, or discussion with your primary veterinarian, there are endless options and considerations your veterinary surgeon will discuss with you when it comes time to making decisions for your pet. These involve intended dog function/work, lifestyle, age, breed, cost, complications, and many more! One consideration we have is protecting the meniscus if it is not yet damaged, this will prolong the joint health.
The two most common surgeries performed on large breed dogs with CCL disease is a Tibial Plateau Leveling Osteotomy (TPLO) and a Tibial Tuberosity Advancement (TTA), and they both aim to stabilize the knee. Previous reports indicate the TTA is inferior to protecting the meniscus but definitive direct comparisons have not been performed. Dr. Jeong and colleagues in 2021 out of Chungnam National University in South Korea evaluated the effects of these surgeries in dogs and their short-term protection of the meniscus. They found out, there was a significant difference in meniscal tears between the two surgeries – the TPLO operated knees had a tear rate of 6.7%, whereas the TTA-operated knees had a tear rate of 73%! Additionally they found increased short-term osteoarthritis in the TTA-operated knees compared to the TPLO-operated knees. This is both shocking, but also informative – and although no study is perfect, this was a well-designed evaluation.
This helps us at Arizona Canine Orthopedics and Sports Medicine with our decision-making process so that we can best guide out clients to obtain the most optimal patient outcomes. Please find out further information here: CrCL Tear.
Gross appearance of the medial and lateral menisci of TTA (A) and TPLO (B) at 32 weeks postoperatively. Complete disruption of structures was found at the medial meniscus in TTA. M, medial meniscus; Cr, cranial. Credit Dr. Jeong et al VS 2021.
Brian Petrovsky, DVM
Practice Limited to Surgery
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Distal Femoral Osteotomy for Comprehensive Treatment of Medial Patella Luxation
Three-Dimensional Printed Patient Specific Guides for Acute Correction of Deformities
Comparison of Arthroscopy and Arthrotomy for Diagnosis of Medial Meniscal Pathology
Second Look Arthroscopic Findings After Tibial Plateau Leveling Osteotomy