In dogs with ruptured cranial cruciate ligament, is TPLO superior to TTA in reducing postoperative radiographic osteoarthritis?

Authors

William Grech

Published in

Veterinary evidence. Volume 11. Issue 3. Epub Jul 10, 2026.

Abstract

In dogs with a naturally occurring ruptured cranial (anterior) cruciate ligament [P] does surgical treatment using tibial plateau levelling osteotomy (TPLO) [I] compared to a surgical repair using tibial tuberosity advancement (TTA) [C] result in a reduction in the risk of developing postoperative osteoarthritis? [O].
Treatment.
Three papers were reviewed. These were a prospective, randomised, non-controlled clinical trial; a prospective, randomised, controlled clinical trial; and a retrospective, non-controlled, blinded cohort study.
Weak.
The first clinical trial showed that TTA was associated with less osteoarthritis (OA) progression than TPLO at 6-month follow-up. However, the opposite was reported in the second clinical trial, where less OA was recorded following TPLO than TTA surgery. In both the first and second studies, the difference between groups was not significant. The third study reports a significant increase in OA score in TTA over TPLO group at end of follow-up period. Despite the third study claiming a noticeable difference in recorded OA between these two surgeries, evidence is presently scant.
At the time of writing of this Knowledge Summary there is minimal evidence to conclude either TTA or TPLO reduces the rate of postoperative osteoarthritis progression for dogs treated for naturally occurring cranial cruciate ligament rupture.
All three studies possess various limitations, such as a lack of controls, absent confidence intervals, lacking blinding, small sample sizes, presence of confounders, bias, and short follow-up, all of which limit the value of their conclusions. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient's circumstances and owners' values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

PMID:
42434438
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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