TPLO or TTA

It has been 5 weeks since the first onset of Riley's crucial ligament injury. We have been doing a stricter conservative mangagement (CM) program for him for the past 3 weeks. So far, it has worked for us and we have a nice routine. Ten minutes of controlled on-leash walking in the morning, one short potty walk in the afternoon, and extra brushing or belly rubs in the evening. He is closely monitored for descending stairs and carried up the main steep staircase. Plus, no jumping in or out of the car. Riley is bearing weight on his leg and is generally in a better mood.

Today was our visit to Dr. Trout at Angell Memorial. First of all, the hospital is beautiful. I think it looks better than Boston City Hospital. There were several dogs and cats there, all waiting to be called in. We didn't have to wait long. Dr. Trout came out with two interns following close behind and greeted Riley. I found Dr. Trout very humble, very thorough, and has a great bedside manner. We tried to ask every question we could think of, but I knew there were still questions I was forgetting to ask. Several surgical options were explained to us: traditional repair, TPLO, and TTA. The conventional, surgical treatment involves sewing a strong surgical suture around the knee joint to restore normal position and stability of the femur on the tibia. The suture provides support and performs a similar function as the cruciate ligament.

He then showed us a pretty impressive mechanical model of how a Tibia Plateau Leveling Osteotomy (TPLO) could help stablize his knee. This procedure levels the slope of the tibial plateau so the cruciate ligament isn’t necessary to keep the femur from sliding down the plateau of the tibia. Surgery involves cutting and rotating the top of the tibia, then screwing a bone plate into place so the bone will heal in its new position. Okay, that last part was medical jargon I found on this website: http://www.woodhavenlabs.com/ccl-injuries.html.

Finally, he talked about a Tibia Tuberosity Advancement (TTA): Similar to TPLO surgery, TTA stabilizes the knee joint by changing the geometry and physics of the knee and enabling it to work without a cruciate ligament. TTA surgery may be less invasive and quicker than TPLO surgery. Again, that jargon was from the website.

As a surgeon, Dr. Trout performed his job well. We walked out of there thinking surgery was the obvious option for Riley. He told us he'd expect Riley to be able to eventually return to all previously normal activity, given time and proper increments of exercise of course. As I left the hospital, I felt relieved. I felt hopeful and happy my baby boy was going to be all fixed up. But the surgeon left the decision up to us to decide between a TPLO or TTA. He felt comfortable with either surgery for Riley. But the fact is that the TPLO has been around a lot longer and Dr. Trout has done a lot of them. The TTA is newer but seems slightly less invasive and recovery may be a bit easier.

It seems surgery is the way to go. 30-40% of dogs that tear a ligament in one knee end up tearing the other too. I hope this never happens to him, but if it does, I'd like to know that he has a stablized, strong knee to rely on.

Surgery is set for October 23rd. We admit him first thing in the morning, he stays over night, and we pick him up the next day. Here we go.