What is Tibial Tuberosity Advancement?

The knee joint of a dog is stabilized by tissue known as the 'cranial cruciate ligament', which connects the femur and tibia together across the middle of the joint. When this ligament becomes damaged, however, it can allow the knee to move out of its proper alignment, causing pain for the animal and limiting the limb's ability to move and bear weight. In order to remedy this, the vet may choose to surgically intervene and reposition the 'tibial tuberosity' ligament (which helps connect the patella to the rest of the knee) further forward on the tibia. This will neutralize much of the lateral force applied to the cranial cruciate, giving it a chance to recover and heal.

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Tibial Tuberosity Advancement Procedure in Dogs

Before the operation can begin, the dog will have a patch of fur shaved off its knee and the skin thoroughly cleaned to prevent infection. They will also need to be anesthetized prior to starting the procedure. To begin, the surgeon will make an incision along the side of the animal's knee joint, revealing the tissue below. They will then carefully remove the tibial tuberosity ligament from the tibia itself and use a saw to remove the tibial tubercle (the frontal mass of the upper tibia), allowing it to yaw forward. In the newfound space between the tubercle and the rest of the tibia, the surgeon will install a metal spacer, which will help maintain the distance between the two parts. A bone graft will be applied to the space between the tubercle and the tibia, further bolstering the strength of the new joint. The bone shavings for this graft will often be harvested from another spot on the dog's body, such as the hip. The next step is for the vet to attach the tibial tuberosity back to the tibia with a metal plate, which will hold the ligament further forward than usual. The incision will then be closed back up and the skin will be disinfected again. 

Efficacy of Tibial Tuberosity Advancement in Dogs

The tibial tuberosity advancement is a very effective technique for treating serious long-term damage to the cranial cruciate ligament. By changing the position of both the tibial tubercle and the tuberosity itself, the vet can provide a permanent solution to the pain and debilitation that a dog with such an injury would be feeling. Despite the procedure's effectiveness, some owners may see it as too invasive and may wish to explore other options. The only other long-term solution available is a 'tibial plateau-levelling osteotomy', which involves cutting through the tibia and repositioning it to change its angle of movement, thereby taking pressure off the cranial cruciate. One of the advantages of the osteotomy is the relatively fast recovery time afterwards, though the knee will lack stability compared to one that that has undergone a tibial tuberosity advancement.

Tibial Tuberosity Advancement Recovery in Dogs

Following the procedure, the dog will require several weeks to fully heal and get used to moving freely again. With older animals, this process may take longer. Due to the fact that the knee will be held together with metal fixtures, the dog will be able to walk almost immediately after the operation, however, it is best to restrict its levels of exercise for a few weeks in order to allow the incision to heal and the bone graft to take hold. The vet will most likely want to schedule some follow-up appointments in order to make sure the dog is healing properly and is not experiencing any discomfort, although providing the animal with regular doses of antibiotics and painkillers should ensure this.

Cost of Tibial Tuberosity Advancement in Dogs

Major joint surgery is a complex procedure, requiring a large amount of time and technical skill in order to execute correctly. Because of this, the majority of owners can expect the surgery to have a price of between $3,500 and $4,500. This price may vary depending on things such as the availability of qualified surgeons in the local area and the age of the dog in question. A tibial plateau-levelling osteotomy on the other hand, can be expected to cost roughly the same amount, though some vets may be able to perform the procedure for several hundred dollars less.

Dog Tibial Tuberosity Advancement Considerations

While the tibial tuberosity advancement is a great way to resolve the problems caused by damage to the cranial cruciate, some owners might be concerned about the potential implications of such a major surgery. The main worry that is frequently raised is the question of if the dog will end up suffering from impaired joint movement following the surgery. Whilst it is easy to imagine that restructuring the knee could impair the animal's ability to move, the majority of dogs will in fact make a fast recovery that results in them being able to resume a very active lifestyle again. This is because of the additional joint stability that will be provided by the tuberosity advancement, allowing the dog to run and jump for long periods without experiencing the pain that would otherwise be caused by ongoing damage to the cranial cruciate.

Tibial Tuberosity Advancement Prevention in Dogs

The advancement surgery will most often be precipitated by some kind of injury to the dog's knee, which will result in additional strain being put on the cruciate. Because of this, it is important for owners to allow their animal plenty of time to rest and recover after injuries instead of making them exercise (this is especially true of working dogs, who may be under more pressure to resume high levels of activity). It may also be advisable for owners to seek veterinary advice if their dog displays signs of sustained discomfort, thereby allowing them to catch any developing problem in its infancy instead of letting it progress to a stage where surgery is required.