The aim of surgical repair is to Stabilise the joint Provide an outcome of pain free function to pre-injury levels wherever possible Limit the development of future arthritis (degenerative joint disease) There are several ways this can be achieved. Selection of technique depends on what is best for your dog’s size, age and condition. Traditional cruciate surgery techniques  These procedures aim to replace the function of the cruciate and passively stabilize the stifle joint. These involve placing a synthetic ligament on the outside of the joint capsule (“extra-capsular”) to replicate the role of the missing cruciate ligament. This procedure essentially replaces the old ligament without realigning the joint. This is often termed a bandaid procedure, as there is still a risk of premature repeat rupture of the new ligament and subsequent instability. This procedure should only be performed in dogs under 10kg.There are several specific techniques such as De Angelis and ISO toggle techniques. Conventional techniques Aim to produce dynamic stability of the stifle, using the muscles to stabilize the joint, essentially replicating the level tibial surface of the human stifle. We change the way the joint works so the cruciate ligament is no longer required to stabilise the joint. Various techniques described as TPLOs (Tibial Plateau Leveling Ostectomies) and TTAs (Tibial Tuberosity Advancement) are available. These are generally indicated in larger patients as the only option for surgical repair. They are also the preferred option for all patients as the outcome is far superior to the extra-capsular procedures. At TRVC we offer both a DeAngelis (extra-capsular repair) and a TTA (Tibial Tuberosity Advancement). DeAngelis/Extra-Capsular Repair (Lateral Suture) The joint is stabilised by 2 appropriately sized monofilament or nylon type suture placed around the outside of the joint but under the skin. This suture mimics the path of the ACL. We think of this procedure as a bandaid as it fails to address the underlying issue of tibial thrust. Effective recovery for this procedure relies on the body creating fibrous or scar tissue across and around the knee joint. It is critical this scar tissue forms before the suture is stretched. So in essence there is a race between the body forming scar tissue and the suture stretching out. For smaller dogs and cats we usually win this race but larger dogs will often stretch the repair before enough scar tissue forms to stabilise the joint. Research has shown the suture will break completely anywhere between 2 and 12 months after surgery depending on the size of the dog and the level of activity. Even though there have been many patients with very good outcomes after external capsular repair, the number of dogs that do not stabilise adequately is too high to consider it a reliable treatment for this injury. Our preferred surgical option for the repair of a ruptured ACL is the Tibial Transposition Advancement procedure. This is the only option for dogs 15kg and over but also the preferred option for all our patients based on minimising arthritis later in life, quicker recovery and most importantly they can’t rupture it again. TTA and TPLO – Overview  TPLO (Tibial Plateau Levelling Osteotomy) and TTA (Tibial Tuberosity Advancement) are two biomechanically similar surgical techniques used to treat medium and large dogs (more than 15-20kg) with a torn ACL. Both the TPLO and TTA create stability within the dog stifle by altering the forces in the knee. They both involve making a surgical cut in the tibia (shin bone) and using implants to hold the bone in place while it heals in a new position. The new position allows knee stability to be provided by other knee structures, without the need to create a new ACL or repair the old one. The TTA procedure is essentially a modified version of the TPLO procedure, using a different location for the bone cut that is less invasive. Both of these procedures have an advantage over external capsular repair because they neutralise Tibial Thrust. This means that during normal weight bearing the femur is not being forced off of the back of the tibia. Both TTA and TPLO are great procedures that have a very high rate of success and will in >95% of cases return the patient to normal or near-normal function and once fully recovered there is no chance of repeat failure. At Toorak Rd Veterinary Clinic Dr Wilson prefers the TTA because there is a quicker return to normal activity following surgery, fewer complications, and a less invasive bone cut (osteotomy). The recovery from this procedure is exceptional with most dogs, big and small, walking 1-2km by 2 weeks post-operative. The TTA uses titanium implants, which carry less risk of infection and rejection and offer superior biocompatibility over the stainless steel implants used in TPLO. Also, because TTA is a quicker procedure to perform, there is less time spent in the operating room, which means lower chance for infection or anaesthesia-related complications. In the TTA, the osteotomy (bone cut) is made in the tibial tuberosity, which is not a weight bearing part of the leg. This appears to make TTA patients more comfortable earlier following surgery compared to the osteotomy for the TPLO made in the weight bearing portion of the bone. The TTA has the added advantage of being modified to treat patella luxation if required, occasionally seen with torn ACL in dogs.