EDITOR'S NOTE: SurgerySTAT is a collaborative column between the American College of Veterinary Surgeons (ACVS) and DVM Newsmagazine. In
December, Shawn Mattson, DVM, DVSc, BSc , Dipl. ACVS, discusses "Treating Subchondral Bone Cysts in the Fetlock Joint." Dr.
Mattson practices at Moore and Co. Veterinary Services, a full-service equine hospital in Calgary, Alberta, Canada. Dr. Mattson,
previously at the Ontario Veterinary College in Guelph, Ontario, has published scientific articles in the American Journal
of Veterinary Research and Veterinary Surgery related to research on orthopedic infections in horses.
To locate a diplomate,
ACVS has an on-line directory, which includes practice setting, species emphasis and research interests (
In the first article in this series, we provided a brief overview of the two surgical procedures that addressed the active,
abnormal biomechanics of the cranial cruciate ligament deficient stifle—Tibial Tuberosity Advancement and Tibial Plateau Leveling
The veterinary literature remains inconclusive regarding the best therapeutic option for the cranial cruciate deficient stifle;
or, perhaps interpreted a different way, the litera- ture supports multiple options. Two recently published literature reviews
were unable to clearly identify a superior surgical procedure due to variation in study design and commonly subjective data
comparisons. The principles of evidence-based medicine decision-making undoubtedly will be useful for answering this question
as we collect more data in a prospective and standardized manner. Until that conclusive moment arrives, decision-making must
continue with available evidence.
Image 1: Model replica of Tibial Tuberosity Advancement.
TTA and TPLO both appear to be excellent procedures for the treatment of cranial cruciate ligament injuries in medium and
large breed dogs. These procedures also may be considered in smaller, more active patients and those with bilateral disease.
They should be considered for those patients in whom other procedures have failed.
As an example of how we facilitate this decision for clients and patients who present to our practice, we recommend TTA as
our procedure of choice for most of these cases because we believe that this procedure is associated with a more rapid ability
to bear weight, a lower complication rate, a less painful convalescence and high owner satisfaction. We have been performing
the TTA successfully for four years. Our experience with the approximately 800 cases we have managed has been positive and
similar to the early reports in the veterinary literature. We highly recommend this procedure for medium- to giant-breed dogs
with cranial cruciate ligament disease and for any size patient who needs a rapid return to athletic condition.
Image 2: Model replica of Tibial Plateau Leveling Osteotomy.
Some dogs are not good TTA candidates due to an excessively steep tibial plateau angle, a coexisting patellar luxation or
excessive concavity to the tibial crest. In these cases, TPLO is an excellent alternative. We have been performing the TPLO
successfully for 11 years now. Our experience with more than 10,000 cases has been positive and similar to the clinical reviews
in the veterinary literature. We recommend this procedure for medium- to giant-breed dogs with cranial cruciate ligament disease
and for those patients who need to return to an athletic lifestyle.
Many factors enter into the decision-making process that revolves around a recommendation for medical care. Everything from
patient compliance to client financial concerns to the availability of surgical equipment and expertise will impact how a
case moves forward.
The interpretation of sound scientific data definitely will help us, but it will be only a piece of this complex puzzle.
It is at times frustrating for all involved to navigate these decisions, acknowledge these frustrations through open communication
and keep working toward the best treatment option for each patient and owner.
Drs. Rasmussen (right) and Levine are ACVS board-certified surgeons. Dr. Rasmussen is with the Veterinary Surgical Specialists
— a small-animal surgery specialty practice serving the Greater Twin Cities area of Minnesota. Dr. Levine is owner of Veterinary