Posted by: christopher

Comment(4)

              I recently read an article by veterinarian Roby McCarthy, who discusses the many surgical procedures used to treat cranial cruciate ligament injury in dogs. What follows is my take on what he has to say.
Cranial cruciate ligament injury is the most common cause of lameness in the stifle joint (knee).  In fact, the Wall Street Journal reveals that the number of cruciate ligament surgeries in dogs exceeds that in humans in the USA, and the estimated repair cost of these surgeries was about 1.23 billion dollars in 2003.
The standard procedure for stabilizing of the stifle is the lateral fabellotibial suture (lateral suture). The procedure has been performed for over 30 years and is considered quick, affordable, and safe.  It has been observed that the procedure is most effective for smaller dogs (less than 20 kg) as near normal function of the leg is returned, but larger more athletic dogs can only expect a fair outcome.
In 1993, the tibial plateau leveling osteotomy (TPLO) was introduced by Dr. Barclay Slocum. It involves changing the angle of the knee joint by cutting the bone (an osteotomy) so that there is less strain on the cruciate ligament. An advantage of this procedure is that dogs are back on their feet quicker and with less dog arthritis than the normal lateral suture. However there exists a higher complication rate. Most veterinary surgeons including Dr McArthy recommend tibial plateau leveling osteotomy for large, athletic dogs or large arthritic dogs that need a quick recovery.
The most recent surgical techniques in the treatment cranial cruciate ligament injury are the following
•              Tibial tuberosity advancement
•              Triple tibial osteotomy
Both of these procedures attempt to stabilize knee joint by using existing tendons as well as cuts in the tibia. You can think of them as variations of the TPLO procedure. Veterinary surgeons recommend these procedures for large dogs as well.
What we can take from this article is that there are many ways to treat a ruptured cranial ligament. The problem it seems is that no one technique has been proven superior to the others. So how do you choose? There is no right or wrong here and you should be discussing these surgeries with your vet. You need to consider the following factors:
·        Costs
·        Complications
·        Speed of recovery
·        Success rate

Costs

The older suture technique is quick and relatively affordable. The new bone cutting techniques are 2-3x the price of a lateral suture.

Complications

No surgery is risk-free. Complications of the lateral suture include pain, infection, breaking the suture, a sore back, trigger points and tears to the cartilage pads (menisci). Some of these complications require surgery.
The bone cutting techniques carry the additional risk of the bone plate breaking and the shin bone quite literally falling apart. They mostly go well but if they go bad, they go really bad.

Speed of Recovery

This is most important in dogs that have other bone or joint problems and need to recover as quickly as possible. The bone cutting techniques are best here, especially for big dogs.

Success Rate

The success rate is about 95% for all of these procedures. They are highly successful surgeries and most dogs will do very well regardless of the technique, though the lateral suture techniques get more thickening and swelling around the joint that may suggest dog arthritis

Where to from here?

There is no doubt we have come a long way with dog cruciate surgery but there is still a lot of research to be done to clearly define the advantages and disadvantages of each technique. Here Dr McCarthy concludes, “Dogma, common belief, and professional opinion should be questioned, evaluated, and authenticated.”

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Comments (4)

  1. Posted by: kerry May 6, 2011, 6:27 PM

    I am dealing with an acl tear in my 80 lb lab. He has been on conservative management for 8 weeks but had an oops moment 3 weeks in so i’m calling CM 5 weeks at this point. He has improved remarkably during this time, but is still limping. He does not seem to be in pain. If I decide to do surgery I’m going to get the old school Traditional excap. I’m on research overload though! What I want to know is why the vet’s are SO divided over this issue and the treatment choices? My old vet who unfortunatly retired the month before this happened is very pro CM. surgery as absolute last choice if no improvement is seen. another old vet who is teaching at college now has told me CM works great even on large dogs most of the time then if i do surgery he would only go for a Traditional. My ortho surgeon gave me choices of lateral suture,TTa,Tplo. Pushed the TTA because of his size but had no problem when i called back 4 weeks later and wanted a lateral suture. I have sincebeen to a couple others to compare thoughts and was told by anothe ortho surgeon very firmly that he only wanted to do tplo and that my dogs lateral will fail(basicly outright refused to do one) and one more reg. vet who is also trained in orthopedics who pushed tplo very hard but agreed to do lateral suture when he found out i wouldn’t cave. I like my origional ortho surgeon, he is one of the best, but his estimate (high and low) is 1-2 thousand more than the reg vet! i will be paying almost the same amout that most people in california pay for a tplo which shocked me. So any insite into why there are so many opinions in the vet world as to a successful outcome wether CM is chosen or TTA, TPLO, or a Trad? Its very confusing to the comsumer (especially those who really research it such as myself)Thanks!

    Reply
    1. Posted by: christopher May 13, 2011, 1:00 AM

      Hi Kerry. Yes everyone has an opinion on this which says there is no simple, single treatment that works and best fits all dogs in all situations.

      In a large dog I like to avoid arthritis by doing some form of surgery so I would not suggest conservative management. If he is still limping after 2 months I think that says enough about CM but yes it can work for some (mostly small) dogs.

      Type of surgery? I do extracapsular repairs though I do suggest some of the fancier surgeries for some dogs. I think an excap is fine for most BUT if your dog needs to be back on his feet fast then the fancy surgeries have a much quicker recovery time.

      Does that answer your question?

      Christopher

      Reply
  2. Posted by: Jana Rade November 12, 2010, 3:56 AM

    Actually we did extracapsular repair for both Jasmine’s knees (Rottweiler) and worked out great. The post-op is a bit more sensitive but there are studies showing that 18 months post-op there is no difference between this repair and say TPLO.

    We are glad we chose this surgery as it is much less invasive and with lesser risk of complications. We combined this with stem cell treatment.

    From the newest surgeries I have to say I would pick the TTO. I think it takes the best from both TPLO and TTA, and it seems to have lesser room for error and trouble.

    Reply
    1. Posted by: dogarthritis101 November 12, 2010, 6:04 AM

      You are into this Jana! I do extracapsular repairs (or lateral sutures I sometimes call them on the blog) just about all the time. I will combine this with a meniscal release. I have done close to a thousand of them so I do them FAST. The only problems I have relate to the extracapsular suture irritating the dog so I sometimes take them out after 3 months when enough scar tissue has formed to stabilize the joint.

      The other procedures have a place due to the faster post-op recovery but they are all doing about the same by 6 months post-op.

      Reply

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