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Cruciate Repair Surgery
Paws and More Veterinary Centre is fortunate to be able to call on the experience and expertise of Dr Michael Gibbs to perform this surgery at our hospital. Dr Michael is one of the most experienced general veterinary surgeons in Perth. He is happy to assist you as a pet owner direct, or via referral from your regular veterinary service.
Did you know your dog could “do their knee”?
Cruciate rupture or tearing is a common condition in dogs of all ages. The cranial cruciate ligament (CCL) in the stifle (knee) is a short tough ligament that stabilises the joint. In humans this is called the anterior cruciate ligament (ACL). Humans invariably break the ligament due to trauma from playing football, netball or other accidents. In many breeds of dog however, it is their conformation that causes the problem.
There are essentially two broad options to repair the joint. The old fashioned method is to essentially repair the broken CCL or more accurately in dogs we replace or mimic the original ligament. Unfortunately, this technique is less than ideal and although the materials we used to use to restabilise the joint are amazing, they are not as good as the original ligament. To some extend we are trying to stabilise the joint while the dogs own scar tissue braces it for the longer term. Whilst the outcome is generally good for small dogs who are lighter and possibly less active than larger breeds, it is not considered the best option otherwise.
The more modern approach is to correct the underlying conformation that caused the CCL rupture in the first place. This essentially involves cutting the bone in the lower leg (tibia) and repositioning it so that the mechanics are altered and the femur then presses onto the tibia rather than trying to slip off. The CCL effectively becomes redundant with these techniques. The instability of the joint when the dog moves is stopped and the pressure comes off the meniscus and so the meniscus usually heals and carries on its normal functions. Several techniques have been developed and have long descriptive names that become abbreviated to TPLO, TWO, TTO and TTA.
TTA stands for tibial tuberosity advancement. In this technique the front of the tibia (lower leg bone) just below the stifle joint is cut, moved forward and stabilised. This changes the direction of the pull on the patellae tendon (from the knee cap to the tibia) that is one of the major forces in the joint. A titanium foam wedge is placed into the gap and steel pins and wire lock it in. The titanium foam is a particularly useful material as it allows infiltration of bone and the immune system making it strong and in the unfortunate event that of a post-operative infection it does not harbour the bacteria like stainless steel does.