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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 Avi Bechar to perform this surgery at our hospital. Dr Avi is a very experienced surgeon. Dr Bechar performs TPLO, TTA and soft tissue repairs of ruptured cruciates 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 use to restabilise the joint are amazing, they are not as good as the original ligament and nothing is being done to correct the underlying problem. 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 up to 5Kg that 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.
TPLO stands for tibial plateau leveling osteotomy. In this technique the the top of the tibia has a circular cut. The top of the tibia is rotated so that the forces in the joint are vertical and not trying to sheer across it. A steel or titanium plate is used to stabalise the bone while it heals. Ask Dr Avi which is the best option for your pet.