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Posted on 05-13-2013

Cruciate Surgery

If your dog goes lame in one of his hind legs, he may have torn or ruptured his cruciate ligament, or ACL.

Cranial Cruciate Ligament tear or rupture is the most common orthopaedic problem affecting dogs today.  This ligament, also known as anterior cruciate ligament (ACL) connects the back of the femur (the bone above the knee) with the front of the tibia (the bone below the knee). The ACL is responsible for stabilizing the knee joint by keeping the tibia in place beneath the femur.

 Unlike humans, untreated canine ACL tears are almost always debilitating and often lead to progressive osteoarthritis. The underlying cause is chronic biomechanical wear and tear. Clinical signs of an ACL tear in your dog may come on quickly or slowly.   Depending on the severity of the injury, a dog’s symptoms may range from being unable to bear weight on the injured leg to having just a hint of lameness.  A dog with an ACL injury might also have swelling on the inside of the knee.

There are two basic surgical strategies.


1) Hold the bones in position at the joint with a surgically installed restraint which will allow near-normal movement of the joint while preventing improper movement.  Tough fibrous scar tissue will then build up around the joint.  This scar tissue will provide long-term stability.  These are called 'Conventional' or 'Traditional' surgeries.


2) Cut the bones and reposition sections of the bones using metal plates or implants to alter the relationship of the bones to each other, changing the tibeal plateau angle at the stifle joint.  The procedures used to do this are TPLO and TTA.


Some veterinarians will recommend TPLO or TTA for most or all dogs with ligament injuries.  These very invasive bone altering procedures have much greater risk of serious complications than conventional surgeries.  The cost of TPLO and TTA surgeries can also be prohibitive. Conventional surgery, as a rule, is more affordable for the client.


At World of Animals at Bethayres Veterinary Hospital, general practitioners, Donald Shields, VMD  and Geza Incze, DVM  focus on Conventional Stabilization Surgery.  Dr. Shields and Dr. Incze have been performing conventional cruciate surgeries for 30 years at our Huntingdon Valley hospital. Extracapsular procedures are generally recognized as the best choice among the various conventional procedures.  Extracapsular stabilizations usually use heavy suture similar to nylon fishing line attached to the bones outside the joint to hold the bones in place.  The theory behind all conventional surgeries is that by holding the bones in place at the joint in a way that allows near-normal joint movement, the surgical stabilization will provide conditions under which the body can begin building up  permanent scar tissue which will provide joint stabilization.

A 'Conventional' stabilization surgical procedure using the standard ortho-suture materials is best for most dogs who need surgery.  But for large high-energy dogs, making bone-geometry-altering procedures TPLO & TTA may be necessary. We recommend getting more than one opinion when it comes to such a major surgery for your dog.

It is very important to be careful about proper activity restriction during  post-op recovery.  Activity must be sufficiently restricted to allow the new supporting scar tissue to slowly develop without being damaged by excessive stresses on the joint.  This can take months.   The amount of time needed will vary with the dog's age and size, so it is not possible to state an exact length of time. Your dog’s veterinarian will want to be confident that the re-stabilized stifle is safe from re-injury before allowing unlimited exercise. Being cautious is always best when deciding on activity for a recovering dog.

If your dog has difficulty with lameness and needs an evaluation, please call to schedule an appointment: 215-947-5110.

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