Tibial Tuberosity Advancement (TTA)

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Cranial Cruciate Ligament

There are several surgical options commonly used to treat patients with cranial cruciate ligament (CrCL) injury. For some patients TTA surgery is the best surgical option. We perform all commonly done repairs for torn cranial cruciate ligament. Our doctor will advise you regarding which type of surgical repair is best for your pet.

Tibial tuberosity advancement (TTA) is an advanced surgical procedure performed on dogs to repair the cranial cruciate ligament (CrCL). Similar to an ACL in humans, this ligament supports the knee by preventing the femur from sliding against the tibia. This constant tension leaves the CrCL highly vulnerable to injury, resulting in one of the most common orthopedic injuries in dogs.

When the ligament is torn, the knee is almost completely destabilized, severely reducing mobility and leading to pain and inflammation. Dogs are unable to bear their full weight on the affected leg and will walk with a pronounced limp. If left untreated, this injury will lead to chronic pain, stiffness, limping, and arthritis in the joint.

How TTA Surgery Works

A TTA procedure works by changing the angle of pull of the patellar ligament at its attachment to the front of the tibia. A bone incision (osteotomy) is made in the front of the tibia allowing the bone area holding the attachment of the patellar ligament to be angled forward. This change in angle offsets the stifle joint laxity that develops when the cranial cruciate ligament is torn, allowing the joint to function normally without the cranial cruciate ligament being intact. Upon achieving the desired tibial tuberosity advancement the repair is stabilized with a stainless steel implant spacing device (called a cage based on its shape) and a bone plate anchored with screws. The surgery also utilizes a bone graft. By advancing the tibial tuberosity the articular surfaces of the femur and tibia interact normally, creating a load bearing stable joint.


Tibial tuberosity advancement is a major surgical procedure that requires an initial recovery period of 8 weeks to allow for bone healing at the osteotomy site. Patients require exercise restriction during this period. After this initial period patients are able to have gradually increasing amounts of exercise based on how they are doing. Our veterinarian will advise you about the amount of exercise your pet can have at various stages of healing. Pain relief medications are prescribed following the procedure to manage discomfort. Pets must wear a collar to prevent licking the incision for the first two weeks following surgery.

Your pet’s comfort is very important to us. We will send home a full and detailed list of instructions for care after surgery. It is not complicated. We will go over all of these directions with you. Your pet will be able to get up and down and go outside to go the bathroom after surgery. Patients need to be on a leash when going outside after surgery however to make sure they do not try to run before the osteotomy site is healed. Regular veterinary postoperative checkups including follow-up x-rays will monitor your pet’s recovery. The cost of your pet’s postoperative recheck examinations and postoperative x-rays are included in the price of TTA surgery. We want you to call us if you have any questions after your pet’s surgery at Bethany Family Pet Clinic.