Surgery
When treating cruciate disease, our most frequently utilised technique for stabilization of the Cranial Cruciate Ligament (CCL) deficient stifle is tibial plateau leveling osteotomy (TPLO) via radial cut and wedge ostectomy (CCWO).This surgical treatment involves altering the sloped weight bearing surface at the top of the tibia – the tibial plateau – so that it is flattened, or levelled. Generally pre-operative tibial plateau angles will be in the region of 26 to 30 degrees. The surgery reduces this angle to 5 degrees. This adjustment eliminates the abnormal cranial displacement of the tibia seen during weight bearing in CCL diseased stifles. The removal of tibial thrust normalises stifle movement and enables comfortable joint function.A surgical arthrotomy, through a small medial approach, is critical in evaluating the stifle of CCL deficient patients. The meniscus must be evaluated in every patient.
Inside the joint - arthrotomy
A thorough evaluation of all the structures in the stifle is critical to the treatment of cruciate disease in dogs. The menisci are paired semi-lunar cartilaginous structures which are anchored to the tibial surface via menisco-tibial ligaments. They play a crucial role in dissipating the force through the stifle during weightbearing via a mechanism called ‘hoop-stress’. The caudal component of the medial meniscus is secured to the tibia and is commonly damaged during cruciate rupture as the femoral condyles move caudally over the meniscus. In fact, 40% of dogs with CCL rupture have evidence of meniscal pathology and treating these tears, typically via resection of damaged meniscus, is a key factor in the successful management of this disease. Rata surgeons will always perform arthrotomy to assess and treat meniscal injuries.
Surgical options for cruciate disease
The TPLO technique has been used successfully since the 1990’s with 90-95% of dogs going on to return to pre-injury activity levels. The technique has been refined over the years and the advent of locking implant systems has reduced implant associated complications. As a group, we have largely evolved away from Tibial Tuberosity Advancement (TTA) procedures because the current veterinary literature reveals improved long term outcomes in dogs managed with TPLO when compared with TTA. The most notable difference between the procedures is that there appears to be fewer late meniscal injuries in dogs treated with TPLO when compared with TTA.For smaller or less active dogs, or where financial restraints direct against an osteotomy technique, we offer an isometric lateral suture or the traditional fabella-tibial lateral suture.
See specific procedure sheets for detailed information on all the above surgical techniques.
We are passionate about contributing to the evolution of understanding for this common condition and encourage owners of dogs with cruciate disease to sign up to the RCVS Canine Cruciate Registry.
