A ruptured ACL [anterior cruciate ligament] is every footballer/netballer/dog owner’s worst nightmare. ACL injuries are a common cause of sudden, non weight bearing, hind limb lameness in the dog and most require surgery. A functioning ACL prevents forward translocation and rotation of the tibia during weight bearing. Without one the knee joint quickly becomes inflamed, develops capsular thickening, degeneration and cartilage damage which inevitably leads to irreversible osteoarthritis, poor function and pain.
Surgical Holy Grail
A ruptured ACL is a significant injury with a prolonged rehabilitation period following surgery. Some footballers are back on the field in 6 but most take 12 months and canine recovery is similar. The holy grail of surgical treatment is a quick recovery followed by “near normal” long term function.
Once upon a time vets in regional practice could only offer an “extracapsular repair”. Here we tie, what is effectively, sterilised fishing line in a “figure 8” pattern outside of the joint in an attempt to mimic the function of the ligament. Results are at best OK in the short but poor in the long term. Newer treatment options use to require specialist referral but since 2012 Milton Village Vet has been quietly offering an advanced ACL repair called tibial tuberosity advancement [TTA]. The results are frankly mind blowing and comparable to studies showing TTA treated animals return to 90% of pre ACL injury function.
Tibial Tuberosity Advancement
TTA changes the geometry of the upper part of the tibia which restores dynamic stability in an ACL deficient knee. It does this by advancing the attachment point of the patellar tendon which neutralises the shearing forces generated during weight bearing. It is an elegant procedure that results in both a quick return to weight bearing and minimal osteoarthritis in the long term. We have performed the procedure on dogs as small as 10kg and as large as 48kg and [touch wood] complications have been minimal. Our experience agrees with large published case studies conclusions; that TTA is the ACL repair of choice for owners of active dogs who wish to maintain optimal athletic performance in the long term. Even better it is now available locally from an experienced, membership accredited, surgical team.