Procedures Available Through Back Mountain Veterinary Hospital:
- Angular Limb Correction
- Bone Biopsy
- Cast Application
- Cork screw tail amputation
- Extracapsulary Cruciate Repair
- MPL repair
- TTA Procedure
- Fracture Repair
- Femoral Head Ostectomy
- Head and Neck Procedures
- Hemi/dorsal laminectomies
Soft Tissue Procedures
- Abdominal Exploratory
- Cherry eye correction
- GDV w/ Pexy
- Intestinal R&A
- Laryngeal Tie Back
- Mass removal (cutaneous)
- Perineal Hernia (uni-bi)
- Salivary Mucocele
- Subtotal Colectomy
- TECA/LBO (uni-bi)
- Ventral Bulla Osteotomy
Cranial Cruciate Ligament Rupture
The cruciate ligament is a major part of the canine knee. Cruciate injury is one of the most common orthopedic complications seen in dogs. Sometimes called ACL or CCL tear, a ruptured cruciate is often a painful and immobilizing injury. While not a serious or life-threatening injury, it is still one that must be addressed for the sake of your dog’s mobility. It is important to understand the signs and treatments of this injury, as well as know how to prevent it.
While most dogs with cruciate injuries require surgery, a small number will improve with conservative therapy. This mostly involves several weeks of cage rest, with very brief, calm leash walks for bathroom breaks only. Some vets will place knee braces or only prescribe anti-inflammatory medication, but these methods are most often ineffective. A small percentage of dogs will eventually recover with cage rest, but typically these are dogs that weigh less than 25 or 30 pounds. Even the dogs that do recover can re-injure the knee in the future, or even tear the cruciate ligament on the other knee.
Surgical Repair of Cruciate Ligament Rupture:
The initial part of the surgery is joint “housekeeping”. The remnants of the torn ligament are removed and the joint is inspected for other damage. If damage to the meniscus is found, the torn portion is removed.
The preferred method of cruciate ligament repair is surgical. In general, prognosis is good. However, there are different surgical approaches, each with its pros and cons. The traditional surgical procedure is often called the “extracapsular repair.” In this method, the damaged ligament is removed and a very strong suture essentially replaces the function of the cruciate ligament. The tissue of the knee heals over several months and the suture eventually breaks, leaving the healed tissue to stabilize the knee. This is a relatively quick and uncomplicated procedure that can be successful in many dogs, especially medium and small dogs. It is less expensive than other methods, and has been used successfully in veterinary surgery for over 40 years in all sized of dogs and cats, but long-term success is not excellent in large or giant breed dogs.
The TTA allows the knee to function without a cruciate ligament. The details of this method involve cutting of the tibia and placement of hardware. In the TTA the osteotomy is made into the tibial tuberosity (not a weight bearing part of the knee joint). Most TTA dogs are able to begin weight bearing within the first 24 to 48 hours postop. Some surgeons describe the TTA as a less invasive procedure than other tibia reconstruction procedures.
Regardless of the surgery type, a postoperative resting period of eight weeks or more is crucial to the healing process. In addition, physical therapy is recommended and can be extremely successful for long term recovery.
Some surgeons bandage the affected leg for 24-48 hours, regardless of the method of repair. Activity is restricted to leash walking for a minimum of 6-8 weeks. Supervised rehabilitation of the knee should start within 48 hours and should include a regime of passive range of motion, balance exercises, and walks on leash.
Prescribed medications should be given as directed to control pain and reduce swelling in the stifle joint. The incision needs to be checked for signs of infection daily which include swelling, pain, discharge and redness. A cold compress should be applied to the stifle three times daily, ideally 20 minutes per session for the first 2 days to help reduce the swelling. Metamucil or a stool softener of choice should be added to your pet’s food to ease your pet’s ability to pass stool.
Starting on the third day after surgery, a warm compress is applied to the stifle in order to soften the connective tissues. This should be done 10 minutes per session prior to passive range of motion exercises of the joint. Passive range of motion of the joint involves flexing and extending the stifle joint, and should be done 10 minutes. This therapy should be done until your pet is using the limb well.
Exercise should be limited to short leash walks for two months. During the third and fourth months after surgery, exercise should be gradually be increased to normal. Running, jumping, and rough play are not allowed during the first four months after surgery. Swimming is also an excellent non-weight bearing activity, once the incision is healed.
All therapies should first be cleared through your veterinary surgeon, prior to their implementation. Long term prognosis for animals with repaired CCL is good, with clinical reports of improvement in 85-90% of the cases. Unfortunately, degenerative joint disease or osteoarthritis progresses regardless of treatment. It is expected that 50% of all dogs operated will have some degree of lameness that may be associated with weather changes or heavy activity. Long term outcome includes a decrease in activity over time, an increasing level of disability, an adverse response to cold weather, and stiffness after inactivity related to progressive degenerative joint. Weight loss, joint supplements (glucosamine, chondroitin, hyaluranic acid, and/or MSM) and an exercise regime of daily moderate activity can help to alleviate these clinical signs.
Patellar luxation involves displacement of the knee-cap from its normal position towards the inside of the knee with medial luxation and toward the outside with lateral luxation.
Small dogs are affected approximately 10 times more often than large breed dogs and females are affected 1.5 times more frequently than males. Patellar luxations are divided into medial (inside) and lateral (outside) categories with four degrees of severity. Grade one luxations are the least severe and grade four luxations are the most severe.
Dogs with patellar luxation most often have an intermittent non-weight bearing lameness that does not generally appear painful. A definitive diagnosis is made upon physical examination, most often with the aid of radiographs of the entire limb.
Surgery is recommended for animals with grade 2, 3 or 4 luxation and a history of lameness. Surgery generally involves deepening the distal femoral groove, movement of the tibial tuberosity and manipulation of the tissues that surround the knee cap.
The prognosis for a complete resolution of lameness following surgery with grade 1, 2 or 3 luxation is excellent. The prognosis for return to normal or near normal function with grade 4 is less predictable.
Activity restriction following surgery is required for 8 weeks to promote the best chance of a return to normal function and avoid potential surgical complications.