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Our Goal is to Provide a Caring & Flexible Environment for Our Pets & Owners.
  From the Doctor...
My goal at Jewell Animal Hospital is to provide a warm, caring, and flexible environment for our pets and their owners. With an emphasis on great customer service and the latest medical, surgical, and pain management techniques, I want clients to walk away feeling that their companion animals received the best possible care and attention available anywhere in the city!
 
 

Jay Nordstrom, DVM 

Dr. Nordstrom received his veterinary degree at Michigan State University.

He has been practicing medicine for 17 years, and has a special interest in small animal surgery.  Dr. Nordstrom has over 15 years of experience in stifle (knee) repair, including anterior (cranial) cruciate injuries, meniscal cartilage injuries, and patellar luxations. 

Recently, Dr. Nordstrom has incorporated tibial tuberosity advancement (TTA) as an additional method of cruciate repair.  This method is state of the art, and is a great option in larger, more athletic dogs. It has provided these dogs with excellent results and shorter recovery periods. 

Dr. Nordstrom is currently available on site through Jewell Animal Hospital for these specialty surgical services. 

Personally, Dr. Nordstrom is married with two beautiful children.

He is an instrument rated private pilot, and enjoys time with his family, golfing, and fishing..

TTA (Tibial Tuberosity Advancement)for the treatment of cranial cruciate ligament injuries in the dog
Jeff Mayo, DVM

INTRODUCTION
Rupture of the cranial cruciate ligament (CrCL) in the stifle of the dog is probably the most common cause of hindlimb lameness seen in the general practice setting. Injury to the CrCL is thought to be due to a hyperextension injury of the knee with an internal rotation of the tibia. CrCL tears may be partial initially, complicating the diagnosis, but eventually most end up in complete tear due to the imbalance of forces that act on the joint resulting in cranial tibial thrust. This abnormal translation of the tibia relative to the femur may also result in additional injury to the medial meniscus, necessitating a partial or complete meniscectomy during surgery, further prolonging postoperative morbidity. Most practitioners opt for the modified retinacular imbrication technique utilizing heavy monofilament nylon as a repair method, or refer to surgeons capable of performing tibial plateau leveling osteotomy (TPLO), which is in a broad consensus, considered state of the art.

NEUTRALIZATION OF CRANIAL TIBIAL THRUST
Without neutralizing the cranial tibial thrust, any attempted reconstruction of the CrCL would simply fail as a result of the biomechanics of the knee. Slocum’s 1993 proposal was to modify the anatomy of the knee, i.e., eliminate the tibial plateau slope in such a way that all loading forces on the knee are transmitted perpendicularly from the femoral condyle to the tibial plateau, along the long axis of the tibia.

In 2000, Tepic and Montavon realized that the total joint force of the stifle is nearly parallel to the patellar ligament. They proposed that advancing the tibial tuberosity cranially would achieve the same results. Cranial advancement of the tibial tuberosity until the patellar ligament becomes perpendicular to the tibial plateau eliminates the shearing force produced in the CrCL deficient stifle.

RATIONALE FOR TTA
First, the total joint force of the stifle is approximately parallel to the patellar ligament. If the patellar ligament is perpendicular to the tibial plateau, there is no shear component of the total joint force, and the cruciate ligaments are not loaded. The angle between the patellar ligament and the tibial plateau changes with flexion and extension, and in fact the two are 90 degrees to each other when the stifle is in 90 degrees of flexion, the cross-over point. So, when the CrCL is ruptured, the stifle can be stabilized by shifting the cross-over point to full extension of the joint. This can be performed by either TPLO, or TTA.

THE PROCEDURE
The amount of advancement required to move the tibial tuberosity is determined from a preoperative standing angle lateral radiograph of the stifle. The stifle is approached medially, and a frontal plane osteotomy is performed. The tibial tuberosity and cranial border are held in advancement by (1) a titanium cage, (2) a titanium fork, and a (3) titanium tension band plate. The cage transfers the compression component of the patellar ligament force from the tuberosity to the proximal tibia. The tension band plate transfers the axial component of the patellar ligament force from the tibial tuberosity to the proximal diaphysis of the tibia. The open-wedge osteotomy may be grafted by cancellous bone or a commercially available product.

CLINICAL EXPERIENCE
Having performed both procedures, the author finds the TTA to be technically easier to perform than the TPLO. Now having performed over 200 procedures around the United States since early 2004, the complication rate seems to be related to technique. Thorough examination of the joint, either by arthroscopy or arthrotomy, is a must to evaluate medial meniscus health. Placement of the osteotomy is forgiving, but the fork and tension band plate must be placed accurately to avoid fragmentation of the bone postoperatively.

INTERESTED IN MORE?
Contact the author for more details concerning instructional classes, in-hospital surgeries, and implant availability. Hardware is available to perform the procedure on any sized patient. Although the implants are proprietary, the hardware to install them and the procedure itself is not.

 

 
     
  And that’s not all…

We are equipped with the most modern blood analyzing machines.

We have access to internal medicine specialist at IDEXX Corporation for follow-up consultations on difficult cases.

Surgical patients at Jewell Animal Hospital are monitored for all vitals during procedures including "Bair Huggers" to keep anesthetized patients warm and cardiovascular machines to measure anything from blood pressure to carbon dioxide output.

We have access to the latest information using the Veterinary Information Network and have established relations with veterinary specialists from neurologists to dermatologists.
 
     
 
 
 
 
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