Orthopedic Surgery & Procedures for Your Pet

Surgical Procedures Currently Offered:

1. Cranial Cruciate Ligament Disease Repair

Rupture of the CrCL is one of the most common reasons for hind limb lameness, pain, and resultant arthritis in the knee.  Since the development of this problem in dogs is much more complex than in humans, and they experience different degrees of rupture (partial or complete), the canine condition is referred to as ‘cranial cruciate ligament disease’ (CrCLD). While the clinical signs (symptoms) associated with CrCLD vary, the condition invariably causes rear limb dysfunction and pain.

40-60% of dogs that have CrCLD in one knee will, at some future time, develop a similar

problem in the other knee. At this time Otto’s right knee does not yet show evidence of cruciate injury.

Cranial cruciate ligament disease can affect dogs of all sizes, breeds, and ages, but rarely cats. Certain dog breeds are known to have a higher incidence of CrCLD (Rottweiler, Newfoundland, Staffordshire Terrier, Mastiff, Akita, Saint Bernard, Chesapeake Bay Retriever, and Labrador Retriever) while others are less often affected (Greyhound, Dachshund, Basset Hound, and Old English Sheepdog). A genetic mode of inheritance has been shown for Newfoundlands and Labrador Retrievers.

Signs & Symptoms:

Dogs with CrCLD may exhibit any combination of the following signs (symptoms):

  • Difficulty rising from a sit
  • Trouble jumping into the car
  • Decreased activity level
  • Lameness (limping) of variable severity
  • Muscle atrophy (decreased muscle mass in the affected leg)
  • Decreased range of motion of the knee joint
  • A popping noise (which may indicate a meniscal tear)
  • Swelling on the inside of the shin bone (fibrosis or scar tissue)
  • Pain
  • Unwillingness to play
  • Stiffness

Diagnostics:

Diagnosing complete tears of the CrCL is easily accomplished using a combination of gait observations, physical examination findings, and radiography (X-rays). By contrast, partial CrCL tears may be more challenging to diagnose.

X-rays allow us to:

  • Confirm the presence of joint effusion (fluid accumulation in the joint, indicating that there is an abnormality present)
  • Evaluate for the presence / degree of arthritis
  • Take measurements for surgical planning
  • Rule out concurrent disease conditions

Specific palpation techniques that veterinarians use to assess the CrCL include the “cranial drawer test” and the “tibial compression test”. These tests can confirm abnormal motion within the knee consistent with a rupture of the CrCL.

Treatment:

Many treatment options are available for CrCLD. The first major decision is between surgical treatment and non-surgical (also termed conservative or medical) treatment / management. The best option for your pet depends on many factors including their: activity levels, size, age, skeletal conformation, and degree of knee instability.

Surgical treatment is typically the best treatment for CrCLD since it is the only way to permanently control the instability present in the knee joint. Surgery addresses one of the main issues associated with CrCLD – knee instability and the pain it causes as a consequence of the loss of normal CrCL structural support.

The goal of surgery is not to “repair” the CrCL itself. Due to biological and mechanical influences the CrCL has no ability to heal once tearing begins regardless of the degree of severity. Unlike in humans ACL surgery, the canine CrCL is not typically “replaced” with a graft. This fact is largely due to the major mechanical differences that exist between biped (human) and quadruped (canine) knees that make graft-based techniques less reliable in dogs. If present concurrently, meniscal injury will be addressed by your surgeon by removing the damaged meniscal parts when preforming surgery to stabilize the knee.  To address knee instability, many surgical treatment options are available. These different techniques can be categorized into two groups based on different surgical concepts:

  1. Osteotomy-based techniques require a bone cut (osteotomy) which damages the way the quadriceps muscles act on the top of the shin bone (tibial plateau). Stability of the knee joint is achieved without replacing the CrCL itself but rather by changing the mechanics of the knee joint. This can be accomplished by either advancing the attachment of the muscle (Tibial Tuberosity Advancement (TTA)), offered in-house by Court Street Vet; or by rotating the plateau (slope) of the shin bone (Tibial Plateau Leveling Osteotomy (TPLO)), which is a surgery often best performed by an orthopedic specialist surgeon.

    Figure: TTA x-ray image

  2. Tibial Tuberosity Advancement (TTA) requires a linear cut along the front of the shin (tibia) bone. The front of the tibia, called the “tibial tuberosity” is advanced forward until the attachment of the quadriceps is oriented approximately 90 degrees to the tibial plateau. This is a way to accomplish altered bio-mechanical angles to render the knee more stable in the absence of the Cranial Cruciate Ligament.

tibial tuberosity advancement (TTA) medial illustration

a. Extra-capsular structure stabilization (also called “Ex-Cap Suture” or “lateral fabellar suture stabilization”) is a popular technique. While there are many variation of this technique, suture material used, and types of securing implants, the consistent goal is to “mimic” the function of the ruptured CrCL with a suture placed in similar orientation to the original ligament. The long-term goal is to facillitate the formation of organized scar tissue periarticilar (around the joint) that will provide stability even as the suture gradually stretches or breaks. The most common complications after this procedure involve failure of the suture and progressive development of arthritis. The main risk factors for complications with suture-based techniques are patient size and age. Larger and younger patients have more complications for these reasons, many surgeons reserve suture techniques for small breed, older, and / or inactive dogs.

2. Femoral Head & Neck Ostetomy:

The femoral head osteotomy is the hip surgery where the head and neck of the femur (thigh bone) are cut off and permanently removed. There are many reasons why a veterinarian may recommend the removal of the femoral head and neck to improve a pet’s condition. Some typical reasons include:

  • A dislocated hip
  • A broken femoral head and / or femoral neck
  • Hip arthritis
  • Legg-Perthes disease (a developmental hip degeneration)

Legg-perthes x-ray image

Ultimately, the goal of the femoral head and neck ostectomy (FHNO) surgery is to create a false hip joint that will be more comfortable and yield better mobility than the diseased joint the patient had before. Since results are generally so good with surgery, provided the patient is relatively small and / or relatively active, often simply removing the femoral head is the least invasive, least costly, and fastest route to a pain-free mobile hip.

*Educational information and images made possible through Veterinary Information Network & Veterinary Partner).

Office Hours

Monday:  8:30am – 6:00pm
Tuesday:   8:30am – 7:30pm
Wednesday:  8:30am – 6:00pm
Thursday:   8:30am – 7:30pm
Friday:   8:30am – 6:00pm
Saturday:   9:00am – 1:00pm
Sunday:   Closed

Phone: 603-357-2455
Email:
[email protected]

 

686 Court Street Keene, NH 03431

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