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Hi. Welcome to Just Answer. My name is***** and I've been a veterinarian for 15 years. I'm sorry to hear about your dog's cranial cruciate rupture / tear situation. How long ago was this diagnosed? What has your regular veterinarian recommended? In situations with tears of the cranial cruciate ligament, surgery to stabilize the knee is recommended as that does the best to return the knee to the best function and minimizes future arthritis development. What procedure is done? Honestly, there are 3 main procedures being done now - the TTA, the TPLO and the tight rope procedure. Typically the tight rope procedure is done for the smaller dogs as they have less wear on it and less of a chance of it failing. The TTA and TPLO are done on the bigger dogs. Where is the line drawn for these? That varies from surgeon to surgeon on what they have had success with and what procedures they are most comfortable with. The best thing I can recommend here is getting a veterinary board certified surgeon involved in the care of your dog. They have specialized in surgery and can give their best recommendation based on what they are seeing first hand and based on their experience. Here is a link to the boarded veterinary surgeons in the Cincinnati area.
Here is also just a very good link on the ruptured cranial cruciate ligaments that I want you to have to read on.
The TTA and the TPLO are initially more invasive procedures as physical alterations in the bones are made. The reason those are done for the bigger dogs is that they in theory provide for better long standing stabilization of the stifle / function of the stifle. Picking a surgeon and getting a chance to have them evaluate her and to give you their specific recommendation would be best. They can tell you specifically which one they feel is best for her and why. They can also say why they might not recommend the tight rope procedure - at her weight, could she put enough stress on it to break it? As far as the least amount of pain, it should be also evaluated as far as making the decision that is best also based on long term prognosis with good use of the leg.
I would say that in general, most veterinarians are wanting the absolute best for their patients. Those that have gone through all the extra education and time to become boarded in surgery are the best at what they do with surgery. I would be absolutely surprised if you find any surgeon that does all the procedures. Most will be doing the tight rope procedure and either the TTA or the TPLO. Those that do the TTA are the ones that have had their education in it and are very good at it and like the results of it. Those that do the TPLO are the ones that have had their education in it and are very good at it and like the results of it. There will always be differing opinions about which of those two is better. At this time there are various papers / studies that have been done that haven't made vast separation as far as which one has better results with the larger breed dogs. Probably the biggest decision here is whether the tight rope procedure is done or the TTA / TPLO.