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Veterinary Surgery

ACL stabilisation options: mmp vs tplo vs tta vs de angelis

A common issue for pet owners is having to fork out thousands of dollars for intensive surgery. At South Eastern Animal Hospital, we believe that imperative procedures for your pet shouldn’t cost you an arm and a leg. Instead, we pride ourselves on offering affordable and highly effective services to help your furry friend overcome illnesses or injuries, such as an ACL stabilisation procedure.

This article seeks to provide a quick overview of the different options for ACL stabilisation.


Modified maquet procedure (MMP):

This is a modification of the TTA procedure. The tibial crest is cut and advanced and held in position by a titanium wedge and secured with a titanium staple and stainless steel bone pin. It has advantages over the TTA in that the cut portion of the tibial crest is fully supported along its length. The titanium wedge is also a block of titanium foam rather than a solid block of titanium, so bone is able to grow into the implant. This is unique for an implant as bone cannot normally grow into an implant, thus forming a much stronger union in this case. The surgery itself takes only 30mins. It has two significant advantages, firstly, recovery in most cases is rapid, with many dogs being 90% sound and back to 10-20min walks by as little as 4-5 weeks post-surgery. Secondly, we offer this procedure for $1,200 to $1,300, which is incredibly cost-effective for an orthopaedic procedure and is quite likely the cheapest you’ll find for this service offered in Australia. The MMP method has been used over 60,000 times around the world already, so it is well tested and has been shown to achieve similar results to the TPLO – at a fraction of the cost!

You can see how quick recovery is from the videos below of our brave patient Lola – first 4 weeks, then 16 weeks after successful MMP surgery:


Tibial plateau levelling osteotomy (TPLO):

Considered the gold standard for many years in anterior cruciate ligament stabilisation and return to function. Involves cutting and rotating the top of the tibia, which changes the angle that the femur bears down through the tibia. For mine, when I look at this surgery and compare with the MMP, both appear to stabilise the affected stifle by increasing the tension in the patella tendon, thus keeping the tibia in place/stable during motion. Controversial viewpoint yes, but it has never been completely understood how the TPLO works. The main thing is, it certainly does. The disadvantage is simply the cost of $4,000 to $5,000!


Tibial tuberosity advancement (TTA):

This option is similar to and developed earlier than the more recent MMP, and most likely developed to provide a cheaper, surgically quicker, and just as effective method of anterior cruciate ligament stabilisation. It is usually very effective, but has a higher failure rate than the MMP, simply because the implant used to keep the tibial crest advanced does not support the crest itself along its full length, thus creating stress points where fractures can occur. Advantage – cheaper than TPLO, typically $2,800-$3,200 is a common range. Disadvantage – still far more expensive than we offer the MMP procedure, which also has a lower failure rate.


De angelis – lateral stabilising sutures:

The original technique for stabilisation of a stifle after tearing the anterior cruciate ligament. This involves using wire or suture through the tibial crest and angled back towards the caudal distal femur and secured. This approximates the angle of the recently torn anterior cruciate ligament and thus stabilises the stifle complex. This technique can work well, but has a slower recovery rate generally and a much higher failure rate, hence the development of the other techniques listed above over time. Advantages – cost, $1,500 to $2,000 is a good guide for this at most practices. Disadvantages – longer recovery times and still much more than we perform the MMP procedure for.

Typically the MMP method would be around $2,000 to $2,500 at most other practices that offer the procedure. We choose to offer this method of repair at a much lower price point to allow more owners to be able to afford a first class method of stifle stabilisation, that is both highly effective and leads to rapid return to full function. We like to think we are quite unique in that we run a practice model of high turnover, yet low margin, which means we can still pay our staff but makes access to veterinary services much more affordable.

If you’re dog requires ACL stabilisation, be sure to get in touch with our practice so we can help them get back on their feet ASAP.

Related Tag: Animal Surgeons Melbourne