TPLO vs. TTA vs. ZLig vs. Suture Strip – 6 Methods

Zlig / Petlig method^®

Medium-sized dog with straight, long legs However, in our experience, they are excellent candidates for ZLig surgery – see also our own study 1 and a long-term study from 2012-2021 2.

But also small, lively dogs with lower body weight and bilateral cruciate ligament rupture They are ideally suited for a Zlig method modified by us – the so-called Petlig method.^®. The advantage here is that both cruciate ligaments can be replaced simultaneously in one operation, thus reducing the risk of anesthesia and ensuring that the strain after the operation is not one-sided.

TPLO

TPLO We recommend this procedure for large or giant breed dogs with cranial cruciate ligament disease and for patients who wish to return to an active lifestyle. Breeds with a steep tibial plateau or inherent lateral instability should also only be operated on using the TPLO method. These include, for example, Old English Bulldogs, Dobermans, some Labrador Retrievers, and Rottweilers.

The reason is simply that their physiognomy is inherently problematic – and if a cruciate ligament tear occurs at a relatively young age (<5 years), our experience is that even the best artificial cruciate ligament cannot be better than the original natural one.

TPLO vs. TTA

Two published literature reviews^3,4 failed to identify a clearly superior surgical procedure due to differing study designs and often subjective data comparisons. The principles of evidence-based decision-making in medicine will undoubtedly be helpful in answering this question once we collect more data prospectively and in a standardized manner.

Until then, decision-making should be based on the available data. Both TTA and TPLO appear to be good procedures for treating cranial cruciate ligament injuries in medium and large breed dogs.

These procedures can also be considered for smaller, more active patients and for patients with bilateral disease.

TPLO / TTA should always be considered for patients for whom other procedures have failed.

Some dogs are too steep angle of the tibial plateau, Patients with concurrent patellar luxation or excessive concavity of the tibial ridge are not good candidates for TTA or ZLig. In these cases, TPLO represents an excellent and often the only alternative.

Dr. Monika Höpfl also provides a comprehensive comparison between the two methods in her 2011 dissertation – Source 5.

Other alternative methods to TPLO vs. TTA vs. ZLig vs. suture strips

More affordable and proven methods for small dog breeds are

• Lateral thread rein (according to Floh, De Angelis)
• Capsule and fascia tightening
• Tight rope (Arthrex)

Decision-making TPLO vs. TTA vs. ZLig vs. Fadenzügel

Many factors play a role in the decision-making process regarding a medical treatment recommendation.

Everything from patient compliance and client financial concerns to the availability of surgical equipment and expertise influences the course of a case. Evaluating robust scientific data will help, but it will only be one piece of this complex puzzle. Making these decisions can sometimes be frustrating for everyone involved.

Recognize and name these frustrations through open communication with your veterinarian and openly express your concerns!

References: TPLO vs. TTA vs. ZLig vs. Thread reins

1 Own study on the topic of Zlig: https://tierarzt-karlsruhe-durlach.de/wp-content/uploads/2021/12/Arndt-HR18-korr2.pdf

2 Veterinary Clinic La Cardelle, 84 Chemin dit de Cannes 06530 LE TIGNET, FRANCE: https://vetlig-global.com/wp-content/uploads/2022/04/PROSPECTIVE-STUDY-UPDATE-JANUARY-2022.pdf

3 SE Kim et al. Tibial Osteotomies for Cranial Cruciate Ligament Insufficiency in Dogs. Vet Surg (2008) 37:111–125.

4 CL Aragon, SC Budsberg. Applications of Evidence-Based Medicine: Cranial Cruciate Ligament Injury Repair in the Dog. Vet Surg (2005) 34:93–98.

5 Monika Höpfl, Munich, 2011, https://edoc.ub.uni-muenchen.de/13298/1/Hoepfl_Monika.pdf