Cruciate Ligament Surgery (TTO)

Lab.jpgInjuries to the cranial cruciate ligament in dogs are extremely common, especially in large active breeds.

The majority of dogs who rupture this ligament do so because of degenerative disease in the joint weakening the ligament over a period of months or years. The trauma involved in the final rupture can be very minor.
This is an extremely important point to be aware of when deciding how to treat the injury.
Most of these patients will benefit from surgery, but there are a vast array of techniques available for you to choose from.
The techniques are basically divided into two main groups: those that involve placing a restrictive band of some form that attempts to stabilise the joint, and those that alter the forces acting on the joint so that there is no need for a cruciate ligament any more.
The first group includes what was traditionally the most popular surgery, called a De Angelis repair, where a double strand of nylon leader line is placed to try and replace the function of the original cruciate ligament. This can result in good function, but the larger the patient the less satisfactory the results tend to be. The implant is not physiological, in that 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.
Cruciate_Ligament_1.jpgThe second group of surgeries involve making various cuts to the tibia (shinbone) and rotating part of the stifle joint around, finally securing it with a bone plate and screws. This bizarre-sounding operation results in no requirement for a cranial cruciate ligament since when the patient weight-bears there is no force for the ligament to withstand. The hope with the surgery is that by removing the abnormal forces acting on the joint (which in the majority of cruciate-injured patients is why they ruptured it in the first place) the tendency for arthritis development is reduced.
Not only does arthritis development appear to be slowed in this group, but return to normal function after surgery can be dramatically faster than with the traditional nylon band technique.
Cruciate_Ligament_2.jpgAt Franklin Vets Pukekohe, Paul Eason has been performing cruciate surgery using the Triple Tibial Osteotomy technique for over three years. This involves three cuts in the tibia, and rotation of the joint. The results have been very impressive in terms of patient recovery times, return to normal function, and reduced need for arthritis treatment after surgery.

At Franklin Vets we now recommend treatment for cruciate-injured dogs as follows:

  1. Dogs under 15kg bodyweight with cruciate rupture or partial rupture: De Angelis nylon band surgery.
  2. Dogs over 15kg bodyweight with cruciate rupture or partial rupture: Triple Tibial Osteotomy surgery.
  3. Dogs over 15kg bodyweight which have had a previous nylon band surgery but the results have been unsatisfactory: consider Triple Tibial Osteotomy surgery.