Franklin Vets
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Most dogs that rupture this ligament do so because of degenerative disease in the joint, which weakens the ligament over months or years. The trauma involved in the final rupture can be very minor. This is a critical point to consider when deciding how to treat the injury.
It is best to think of a cruciate injury as a surgical problem. The ligament never heals once it starts degenerating; it just degenerates further until it finally snaps. Snapped cruciate ligaments never heal. The blood supply to ligaments is extremely poor, and the torn ligament cannot be sutured together again.
Surgery involves two parts. The joint is opened, and any torn ligament or cartilage is carefully removed. Secondly, the joint needs surgery to stabilise it now there is no cranial cruciate ligament.
There are essentially two ways of doing this. The more basic technique involves placing a restrictive band of some form that attempts to replace the function of the lost ligament. The more complex techniques involve changing the structure of the bones to alter the forces acting on the joint.
It is important to realise that orthopaedic surgery is complex and requires a high level of planning to choose the correct procedure. There is no one-size-fits-all option for cruciate surgery. Still, the best option should be selected after a detailed examination, x-ray imaging, and discussion with the patient’s owner.
This group of surgeries involves making various cuts to the tibia (shinbone) and then securing it with a bone plate and screws. This results in the forces previously resisted by the cruciate ligament either being neutralised or transferred to another anatomical structure.
Return to normal function after surgery can be dramatically faster than with the traditional nylon band technique.
There are multiple versions of these advanced procedures. They include the TPLO, TTO, and TTA.
The version we recommend and perform frequently at Pukekohe is the TPLO.
This is the most successful technique for normalising forces around the joint and has statistically the best long-term outcomes. We can now offer this surgery for dogs of almost any size, including small breeds.
The surgery involves making a single, curved cut in the tibia, then rotating the joint surface around a set number of degrees, and finally stabilising it with a bone plate and screws. The result is that the force that pushes the lower limb forward when the animal bears weight is removed, eliminating abnormal strain on the joint.
TPLO is an operation with a long history of success in many countries. This is the “gold standard” surgery in specialist practices worldwide for cruciate ligament injury. If the joint is suitable for this procedure and finances permit, this would be our recommended first-choice surgery where possible.
The TTA procedure is technically the simplest to perform and comes in various forms, depending on what plating system is used and what spacer is placed in the cut bone. The result is the stabilising action of the cruciate ligament is replaced by the strain being transferred to the patellar tendon instead.
TTA cannot be done if the tibial plateau angle (measured on pre-operative x-rays) is too high.
There are some concerns about risks with TTA, including a higher rate of post-surgical cartilage injury, risk of patellar tendinosis due to the added stress placed on it, and real problems dealing with any post-operative infection that might develop.
Studies comparing TPLO with TTA consistently show that TPLO produces better results for patients.
This is a procedure that involves three cuts in the tibia. It combines features of the TPLO and the TTA, but functions more like a TTA than a TPLO. TTO is a very versatile procedure, that can cope with severe tibial plateau angles, and can be adapted to manage patellar luxation at the same time relatively easily.
This includes what was traditionally the most popular surgery, where a single or double strand of nylon leader line or Fiberwire is placed to try and replace the function of the original cruciate ligament. This can result in good function, but the more significant the patient is, the less satisfactory the results tend to be. The implant is not physiological because it does not properly replace the original ligament and can lead to a rapid progression of arthritis in the joint. Recovery times from surgery can be prolonged. This is a fair option for small dogs, not very good for medium dogs, and not good at all for large dogs.
This technique is simple to perform and avoids the risk associated with cutting bone for the TPLO. However, the nylon will stretch over time, and ongoing support depends on periarticular fibrosis rather than removing abnormal movement, which the TPLO achieves. Additionally, while this technique is most commonly performed on small breeds of dogs, these breeds frequently have extremely steep tibial plateau angles, making them poor candidates for extracapsular surgery since this technique struggles to work when the slope is steep.
Many dogs now have had both knees operated on and returned to running and working. A dog who ruptures both cruciate ligaments can have the joints operated on relatively close together, which dramatically reduces recovery time.
The rest period after cruciate ligament surgery is quite long, up to 12 weeks. It is critically important that the instructions are followed closely to get the best results. We have a rehabilitation programme for you to follow during this period.
The price range for TPLO surgery is from $5000-6500, depending on patient size. The only charge for revisits is additional dressings or medications used and for sedation and x-rays at 6 weeks. Note that usually, no additional dressings or medications are required. The 6-week x-ray costs $330-380, depending on patient size. If needed, we can guide you on what to look for in post-op revisits for those having the checkups done locally.
Call Customer Services on 09 238 7486 or email referralsurgery@fvs.co.nz to discuss the transfer of your patient to our clinic for assessment and treatment. When you come, you may be asked to bring any clinical notes, X-ray images, and medications.
Dr Paul Eason BVM&S MANZCVS (Surgery; Emergency & Critical Care Medicine)
Franklin Vets - excellence in veterinary care for dairy, farming, lifestyle, equine and household pets. BESTPRACTICE ACCREDITED NZ.
