Orthopedic surgery involves bones, joints, muscles, tendons, and ligaments. Fractured bones and torn ligaments are some of the most common injuries seen by the veterinary surgeon. In many cases, there are multiple injuries to the pet often as the result of trauma. Advanced techniques including the use of steel plates and screws or elaborate bone pin and clamp systems are required to adequately stabilize these injuries so that the pet can heal normally.

The surgeon also sees more subtle, chronic injuries that can be difficult to diagnose and frustrating to the pet owner. Sporting dogs, like human athletes, may acquire these injuries that though not debilitating, decrease their performance in the sport. Often, however, these sporting dogs are stoic and do not show their pain easily. A thorough orthopedic exam, radiographs (x-rays), and specialized procedures may be required to make the diagnosis in these complex cases.

Our state of-the-art surgery suite is equipped with modern anesthesia machines, heated surgery tables, and patient monitoring devices. We have invested in specialized equipment to aid in quick and successful resolutions for many orthopedic conditions.

Safety for all anesthetic and surgical patients is of primary importance to the staff at AVCG. We have instituted the highest standards of pre-operative care to ensure favorable outcomes for all patients. Along with the diagnostic tests performed by your Veterinarian, we always perform specific tests to evaluate the health of your pet prior to anesthetic induction.

These include:

  • Digital Thoracic Radiographs (X-rays)
  • Pre-operative ECG with Boarded Cardiologist telemedicine interpretation
  • Venous Blood Gases
  • Coagulation Panel (cPT and cPTT)
  • Additionally all patients are supported intra-operatively with intravenous fluids appropriate for the pet’s condition.


Lateral Fabellar Cruciate Stabilization (Extracapsular Suture Stabilization)

This is a traditional surgical treatment that has been performed for decades. The concept of this procedure is to replace the function of an incompetent cranial cruciate ligament with a heavy monofilament nylon placed along a similar orientation to the original cruciate ligament, but outside of the joint (the actual ligament is inside the joint). The suture needs to stabilize the tibia (“shin-bone”) relative to the femur (“thigh bone”), while allowing normal knee movement, until organized scar tissue can form and assume the stabilizing role. These techniques tend to have a little bit too much “give” for larger breeds and active dogs, but seem to work reasonably well in small breeds and inactive dogs when performed by an experienced surgeon. Postoperative care at home is very critical and involves strict activity restriction for ~ 4 months. Premature and excessive activity risks complete or partial failure of the stabilizing suture that can render the surgery a complete or partial failure.

Tibial Tuberosity Advancement – Rapid (TTA –R)

TTA-R is the most promising surgery for rapid recovery and repair of a torn cruciate. While older techniques like TTA standard or TPLO can be quite difficult and take a long surgery time, a surgery with TTA-R is less invasive and quicker. As a major difference to other techniques, TTA-R uses the non-Maquet-Hole-Technique. This brings the advantage of reducing the number of needed instruments and auxiliary implants, which makes this technique much more stable and quicker.

tta-rapid2TTA RAPID implants are made of titanium and are a combination of a plate and a cage with an open mesh construction. This combination enables high stability and fast bone growth “through” the sponge construction. The implant is manufactured with titanium due to its known properties which minimize the risk of infections.

Another advantage is the high flexibility of TTA RAPID. In the past surgeons had to switch their techniques depending on the weight and the size of a dog. While TTA standard worked better with dogs less than 30kg TPLO worked better with dogs over 20kg. But the new TTA-R implants work with a 5kg-dog as well as with a 90kg-dog.


Triple Tibial Osteotomy (TTO)

In some cases the Tibial Plateau Angle is too steep and the TTA Rapid is not a viable option. In those cases the TTO has been chosen as the best procedure to address the dynamics of cruciate instability. Incorporating the plateau leveling of the TPLO as well as the tibial crest advancement of the TTA along with primary bone to bone healing, the TTO provides the most stable repair for cranial cruciate instability. Developed in Australia, the TTO is the newest technique for addressing this common and debilitating injury.

With triple tibial osteotomy (TTO) a small closing wedge osteotomy is performed and this simultaneously advances the tibial crest while leveling the tibial plateau. (see figures to the left).

Frequently Asked Questions

What is the Cranial Cruciate Ligament?


Why did my dog rupture this ligament?


Why does my dog need surgery?


Why do different surgeons recommend different procedures?


What surgeries are currently being done?

At present, there are four surgical procedures being advocated. Lateral Suture Procedures, TightRope (a variation of the lateral suture procedure, TPLO, and TTA. These will be discussed below.

What are the pros and cons of the Lateral Suture Procedure?


What are the pros and cons to the TPLO procedure?


What are the pros and cons of the TTA Procedure?



There are several answers to this question, First, it is not universally accepted that one procedure is better than another. It appears that the TTA procedure will be the best procedure available, but we will know for sure twenty years from now! The second reason is possibly a matter of training. The TPLO procedure was a patented procedure. To be certified, the surgeon had to take special classes given by the company who owns the patent. The surgery requires the purchase of very specialized equipment, and consequently, a fair amount of investment has been made on the part of the surgeon. It is quite hard to give up a procedure that you have invested time and money in, particularly when the jury may still be out on the eventual winner of this “contest” between surgeries. A third reason is that most of the TPLO surgeons report “good” results. The fact the TTA research looks better than the TPLO does not mean that the TPLO surgery is wrong. Similarly, surgeons doing many of the older procedures for cruciate repair also reported good results. As I have mentioned, twenty years from now , the results will be more evident.

Is the TTA procedure only for large breed dogs?


How is the bone cut and the necessary plates different between the TTA and the TPLO procedure?

In the TPLO procedure the cut is made in the weight bearing area of the tibia and consequently requires a larger thicker plate for its stabilization. In the TTA procedure the cut is made in a non-weight bearing area of the bone. In the TTA procedure, all of the implants (that are used by this surgeon) are made of space age Titanium. The implants are consequently thinner, lighter, and stronger than stainless steel.




There are several things that may help. Obesity is often blamed as a contributing factor. So, if your dog is overweight, then a proper diet program may help. If you are not sure if your dog is overweight, ask your doctor. Most veterinarians will give your dog a “body condition score” and explain what that means. Your doctor will also give you suggestions to help your dog lose weight. Many dogs act like “weekend cowboys.” They rest all week and on the weekends, when the parents are home, they over exercise in the back yard, possibly leading to joint damage. The same thing frequently happens to people. It is important that our muscles be trained for the activities that we plan to do. It is important also to stretch our muscles before vigorous workouts. Talk to your doctor about how you can help train your dog, rather than just turn him or her loose.