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