On-Site Orthopedics by Dr. Righter

Cruciate Repair

basics video

                                                                              TTA Procedure Overview
Normal Joint
The normal joint, viewed from the side, shows the upper

bone, the femur and the lower bone, the tibia. The Tibial

Plateau is the actual point ofcontact between the femur

and the tibia. In this diagram the Patellar Tendon is clearly

visible. It is this structure that must offset the abnormal 

                                             forces that are created with a

                                             rupture of the cranial cruciate ligament.


                                                       Typical Joint AngleIn the typical joint, the

                                                       angle formed between the Tibial Plateau

                                                       and the Patellar Tendon is about115 degrees

                                                       when the leg is in a normal standing position.

                                             

                                                       Corrected Angle 

                                                       The abnormal motion that occurs in a knee with

                                                       a torn cruciate ligament is Tibial Thrust. After the

                                                       TTA Surgery, the corrected angle is now

                                                       90 degrees, which will offset the forces in the knee that tend to make it unstable.

                                                       

                                                        Surgical Appearance
                                                        This diagram shows the knee once it has been stabilized with the appropriate                                                                 Titanium implants. These implants are very lightweight and are designed to stay                                                             in permanently.

Femoral head and neck ostectomy (FHO)

Femoral head and neck ostectomy (FHO) is a commonly performed procedure for surgical treatment of traumatic
and chronic conditions affecting the hip.
The option to do an FHO is typically presented along with other surgical alternatives. Some surgeons see it as a last resort or a ?salvage? procedure, whereas others believe it to be a primary recommendation for many orthopedic diseases of the hip.


INDICATIONS
Common indications for an FHO include:
? Femoral head and neck fractures
? Catastrophic acetabular fractures
? Coxofemoral hip luxations
? Failed total hip replacements
? Chronic pain associated with hip degenerative joint disease
(including traumatically induced disease, Legg-Perthes disease, and canine hip dysplasia).
Excision of the femoral head and neck palliates pain by eliminating bony contact between the pelvis and femur, allowing formation of a pseudoarthosis. The pseudoarthrosis that forms comprises dense fibrous tissue lined by a synovial membrane.


OUTCOME
The procedure has the best outcome and is typically recommended for mature pets and dogs weighing < 17 kg; however, physically fit dogs of all sizes tend to rehabilitate and respond favorably regardless of their weight. In addition, muscle mass has been found to be one of the most important variables in determining outcomes of the procedure. Postsurgical FHO patients have some degree of limb shortening and gait abnormality; however, with aggressive rehabilitation, these animals have been reported to respond well to the procedure
and return to an active lifestyle.

Knee Problems In Your Dog Patellar Luxation - Luxating Kneecaps


Grade 1

Grade one pets do not experience pain. Their kneecap pops out of place intermittently and can be easily massaged back into place when the leg is fully extended.

Grade 2

Grade II pets have less stable knees. The kneecap can be massaged back into its groove - but it pops back out again once the knee is manually flexed or after the pet has taken a few steps. With time, many of these pets will develop knee pain and arthritis associated with their problem.

Grade 3

Those in which the problem seems more pronounced or when persistent pain or arthritic changes are already present are placed in grade III.

Grade 4

These are pets whose kneecap will not stay in its groove even for short periods. These dogs have a hard time walking. Dogs that have suffered this degree of joint damage for more than a year or two usually have pain, developing arthritis and degenerative joint disease. They usually walk with a crouching stance and stand knock-kneed with their toes turned inward.

In contrasted with cruciate ligament or hip surgery , patellar surgery is less invasive, less expensive and generally has much better outcomes. When patellar surgery is performed before arthritic changes have occurred in the knee, the surgery is usually very successful. Once arthritic changes have developed, surgery is much less likely to produce a pain-free leg.

What needs to be done depends on what structures in your pet?s knees are abnormal and how abnormal they are. No two cases are exactly alike. There are three surgical procedures that are used to treat patellar luxation. Most cases can be cured with the first. If your veterinarian decides that ligamental reinforcement (lateral imbrication) will not be sufficient, the vet will add the second procedure, deepening of the trochlear groove. If that will not be sufficient, the surgeon may move the point where the patella's ligament attaches to the tibia (tibial crest transposition).

In many mild cases, it is sufficient to simply reinforce the weak lateral ligaments that keep the kneecap in alignment. When the inner or medial ligament has contracted or pulls too hard to the inner side of the knee, that ligament can be ?stretched? (medial desmotomy) at the same time to allow the patella to glide in its groove in a straighter course.

Your pet?s patella rides in a channel on the face of the femur. Sometimes, this channel or groove is not deep enough in toy breeds to hold the patella in track (course). This track is coated with a slippery cartilage that allows for smooth motion. In this surgery, this cartilage (hyaline cartilage) is carefully lifted off to one side while the notch is deepened, or a wedge of bone and cartilage are removed and then replaced in a deepened channel.


THE FOLLOWING ARE SOME OF THE MOST COMMON PROCEDURES

If you are interested in a consultation or have questions for the doctor please contact us.