Dr. Nietz has performed extracapsular cruciate surgeries since 2002. This is a good option for smaller dogs, and older or less-active patients. Dr. Nietz completed additional training in the TTA (tibial tuberosity advancement) procedure with Dr. Matthew Barnhart and Dr. Jeff Mayo, and became certified in the procedure in 2007. The TTA procedure is the preferred treatment method for ACL/CCL tears in larger and more-active dogs. We have had excellent success using both procedures, particularly the TTA.