Orthopaedics and Cruciate Surgery
At Foothills Animal Hospital, we are able to offer basic to advanced orthopaedic surgery including fracture repair, excision arthroplasty, patella surgeries and cruciate surgery. If you dog has been diagnosed with cruciate disease we are able to advise you on the best option for option surgery option suited to your dog. These include extracapsular repairs and we are now also offering advanced cruciate repair techniques for medium and large dogs. This is called the Modified Maquet Procedure (MMP), and is suited to most dogs with cruciate ligament disease. For TPLO procedures we can arrange a referral to a specialist orthopaedic surgeon.
The cruciate ligaments are two bands of fibrous tissue that run through the stifle (knee) joint, forming an X when the stifle is viewed from the side. They are called the cranial/ anterior (CCL or ACL) and caudal/ posterior cruciate ligaments.
Partial or complete rupture of the ACL is a very common injury in the dog and also occurs in cats. Rupture causes instability of the stifle joint. In the short term this causes acute pain, and over time leads to degenerative joint disease (osteoarthritis). Commonly, there is also tearing of the meniscal cartilage within the joint, which makes the pain more severe and the prognosis less positive.
Diagnosis may be possible at the initial consultation. However most awake patients are sore and nervous, so they tense the muscles of the leg. This makes it very difficult to feel the instability in the joint. Usually a general anaesthetic is required to allow the veterinarian to make this diagnosis. Radiographs (xrays) are always recommended to allow surgical planning, look for any other problems, and assess the degree of arthritis already present.
Without surgical repair, pets with ACL lameness will never return to pre-surgical injury levels without pain. Arthritis will develop in the stifle joints of all pets with ACL injury, but will progress much faster and be more severe in untreated pets. Surgery is therefore recommended for any pet with ACL damage.
Extracapsular repair is recommended for cats and small dogs (up to 10-15kg). This involves:
Opening the joint to examine the meniscal cartilages.
Removing the torn ligament fragments and any damaged cartilage.
Tightening and suturing closed the joint capsule.
Replacing the function of the ruptured ACL with strong non-absorbable suture material placed from the bottom of the femur to the front of the tibia. (This is often secured with metal crimps, which you may feel under the skin.)
The tissues under the skin are then closed and tightened to further stabilise the joint.
Finally, the skin incision is closed using absorbable sutures.
Antibiotic cover (on the day and in some cases ongoing) and A LOT of pain relief is given throughout the procedure and recovery period.
The average cost of this procedure is around $2500 -3000 including initial xrays and most aftercare.
For large dogs, an extracapsular repair cannot hold up to the daily stresses an active or heavy dog will place on its joints. Hence, more involved surgical procedures are recommended in order to optimise the long-term outcome of the pet. The goal of these procedures is to limit abnormal movement of the tibia relative to the femur when the dog is weight bearing normally.
Modified Maquet Procedure (MMP)
An MMP procedure is recommended for many dogs over 15kg in weight as an alternative to specialist referral. The MMP is a modified form of the TTA (tibial tuberosity advancement) procedure. The surgery is performed in our hospital by an experienced general practitioner who has undergone special training in this procedure.
Opening, inspecting and managing the joint as for extracapsular repair.
Cutting a vertical slice into the bone at the front of the tibia and slowly but gently stretching the soft tissues until a wedge of orthopaedic titanium foam can be placed behind the patella ligament and into the tibia.
The wedge is then anchored with an orthopaedic wire and an orthopaedic staple.
Finally, the incision is closed using absorbable suture material in 3 layers.
Antibiotic cover (on the day and in some cases ongoing) and a LOT of pain relief is given throughout the procedure and recovery period.
The implants remain in place for life unless there is a complication necessitating their removal.
Tibial Plateau Leveling Osteotomy (TPLO)
This is the procedure most commonly recommended and performed by specialist orthopaedic surgeons for management of cranial cruciate ligament disease. Specialist training and equipment required make this the most expensive management option, but also the most optimal for these dogs.
- Joint inspection and management as for extracapsular repair
- Placement of a special jig to guide multiple cuts made around the top and front surfaces of the tibia.
- Rotation of the freed tibial segment until the top of the tibia (the ‘plateau’) is at the optimal angle to prevent adverse movement relative to the tibia when weight bearing.
- Placement of a bone plate to anchor the rotated segment until the surgical cuts have healed.
- Closure of the surgical site with several layers of absorbable +/- nonabsorbable suture.
- Appropriate antibiotic and pain relief cover as recommended by the specialist surgeon and anaesthetist.
- The implants remain in place for life unless there is a complication necessitating their removal.
The cost of a TPLO will vary but an estimate can be obtained upon request. There are several excellent specialist centres in Perth. We routinely refer to WAVES (in Beeliar), but if you would prefer a different specialist, we can also recommend Perth Veterinary Specialists, Rivergum Referrals, and The Animal Hospital.
If you would like to have your dog referred for specialist management of his/her cruciate ligament injury, please just ask.
If you have any questions or concerns about your pet, please do not hesitate to call us on 9497 7488, or send us an email at firstname.lastname@example.org