Orthopedic Services

Anterior Cruciate Repair Anterior Cruciate Ligament (ACL) rupture is the most common orthopedic problem in dogs. Canine ACL rupture almost always leads to progressive osteoarthritis and is almost always debilitating if left untreated. The underlying cause of ACL rupture is biomechanical stress caused by a downward sloping tibial plateau and its relationship to the patellar tendon. Stifle joint stability is achieved when the tibial plateau is perpendicular to the patellar tendon. The diagnosis of ACL rupture ranges from simple to complex. Palpation to identify instability is accurate in complete acute tears. Approximately 50% of all dogs have partial or chronic tears without obvious instability. Palpation, radiography and/or arthroscopy lead to an accurate diagnosis in nearly all cases. Almost all dogs with ACL tears sit to the side. Choosing which ACL Repair Technique is best for your pet:

  • The TTA produces less postoperative discomfort, reddening and swelling than other ACL repair techniques including TPLO.
  • Dogs that undergo TTA recover sooner than with other ACL repair techniques including TPLO.
  • The TTA osteotomy (bone cut) is made in a non-weight bearing area of the tibia, while the TPLO osteotomy is weight bearing.
  • Dogs with crooked legs and/or an extreme tibial plateau slope may be better suited for TPLO.
  • Dr. Freedman will be happy to discuss the pros and cons of each surgery and help you make an informed decision.


How many veterinarians perform the TTA surgery?  Worldwide, there are 400 surgeons that perform this specialized surgery.

How many TTA surgeries have been performed at this time? To date, there have been approximately 50,000 TTA procedures performed worldwide.

Does my pet have to spend the night in the hospital?  Yes. They will be admitted for 2-3 days and released when the doctor feels it’s appropriate.

Will this have a negative effect on the opposite leg? No. Both of the current ACL repair techniques (TTA and TPLO) provide the best possible outcome with no negative affect on the opposite leg.

Will the opposite knee have the same problem? Forty percent of all dogs with ACL rupture on one side will have the problem on the opposite side. The most effective ways to decrease this percentage are early surgical repair to allow for even weight distribution and weight loss in obese dogs.

Is TTA only for large dogs? No. Small breed dogs also have an excellent outcome following TTA.

Is the postoperative period more difficult following TTA than following older techniques? Absolutely not. Because the TTA involves an osteotomy in a non-weight bearing portion of the bone, patients are very comfortable and recover more quickly than with all older techniques including TPLO.

Will my pet experience pain in the postoperative period? Minimal. All dogs undergoing TTA here are given a morphine epidural. Most clients feel their pet’s discomfort level is quite tolerable.

How long does it take for healing? The osteotomy takes 6 – 8 weeks to heal. During this time your pet can have a reasonable amount of leash activity.

Life After TTA

Dr. Freedman has been doing knee surgery for over 25 years. The TTA procedure was developed about 14 years ago, and for the past 10 years, Dr. Freedman has done over 800 cases. Owners have come from Florida, Illinois, Baltimore and Va Beach to have Dr. Freedman operate on their dogs’ knees. The success rate has been above 95%. Dr Freedman has been invited to train other veterinarians in the procedure as well, and was invited to the join the first Masters meeting that Kyon, the company that developed the TTA procedure, held in Boston in 2011.

Keep in mind, each pet’s rehab treatment plan will not be the same. Dr. Freedman will determine what is needed and for how long, for each pet. Every pet is different and may react in a different way to each surgery and exercise plan.




PennHIP stands for the University of Pennsylvania Hip Improvement Program.

What is PennHIP? 

PennHIP is a multifaceted radiographic technology (x-ray) for hip evaluation. The technique assesses the quality of the canine hip and quantitatively measures canine hip joint laxity. The pennhip method of evaluation is more accurate than the current standard in its ability to predict the onset of osteoarthritis. Osteoarthritis, also known as degenerative joint disease (DJD), is the hallmark of canine hip dysplasia (CHD).

AVHCC is certified to perform pennhip radiographs. This is a way to determine if your dog has hip dysplasia, earlier in life than traditional ofa processes. By catching the disease earlier in life, we can offer a surgical process that has a good chance of correcting the condition, a procedure called juvenile pelvic symphysiodesis, or “jps”.

The Problem:
Canine Hip Dysplasia

– The most commonly inherited orthopedic disease

-Afflicts more than 50% of dogs within some breeds

– Leads to hip arthritis causing pain, stiffness, and a diminished quality of life

– Affects large breed dogs more severely than smaller breed dogs

-Has no medical or surgical cure

The Solution:

1. Early, accurate hip screening by a local pennhip veterinarian, specially trained and certified to perform the pennhip procedure.

2. Benefits of pennhip interpretation

a. For breeding dogs – breed those with tightest hips

b. For CHD-susceptible pet dogs – your pennhip veterinarian can prescribe palliative measures.

If you are purchasing a dog from a breeder, be sure to ask them if any of their dogs have had hip dysplasia. Also ask if their dogs are pennhip certified.

For more information about pennhip you can visit www.pennhip.org or you can call our office and we would be happy to send you information about PennHIP.