Adelaide Vet Centre for Cruciate repair in dogs.
The Adelaide vet dog cruciate repair centre is here!
BREAKING NEWS: American University study comparing three cruciate surgery techniques for large and giant breed dogs concludes that the Isometric Cruciate repair gives BETTER RESULTS than TPLO and TTA surgeries.
The Isometric repair surgeries give better results with less risk, faster return to activity and best long term outcomes. In America they refer to this as the Tightrope technique, but in Australia it is known as the LIGAFIBA ISOTOGGLE. It is certainly brilliant for small and medium sized dogs, but also remarkable in large and giant breeds, particularly if they are more activee dogs, GIVING THE BEST OUTCOMES WE HAVE SEEN.
The study found that the TTA surgery resulted in the most complications, poorest return to function and most arthritis. We no longer advise or offer the TTA procedure.
The Anterior Cruciate Ligament (ACL or Cranial Cruciate Ligament, CCL).
The anterior cruciate ligament is very important in the stifle or knee joint of dogs. The anterior cruciate ligament is one of two ligaments that cross over (Cruciate is derived from the latin and means to cross over, or over lap) and in one direction prevents the lower leg, the tibia, from sliding forward in the knee (the anterior or cranial cruciate ligament), and the other caudal cruciate ligament prevents the tibia from sliding backwards.
Because the anterior and caudal cruciate ligaments cross over, they allow some twisting or rotation of the lower leg at the knee joint. Often injuries occur when the leg is twisted (which applies a lot of tension on the cruciates) and then outward or lateral pressure is applied. This is the same cause of injuries to sports people, especially contact sports where jumping is common, and a sideways knock throws someone off balance and they land awkwardly eg Aussie Rules football and Netball, also snow skiing is a classic cause!
Most anterior cruciate ligament (ACL) injuries start as sprains, and many of these go unnoticed. A sprain involves minor tearing of a few strands of the ACL and is similar to a rope that starts to fray a little. However, in the knee the ACL is covered by a protective layer of cells similar to the joint capsule that hols all of the joint fluid in the joint and the ACL strands that break or 'fray', then are exposed within the joint. This causes inflammation with in the joint.
Adelaide Vets see many cruciate injuries in dogs, and occasionally in cats.
This inflammation is minor, but continues, and stimulates changes within the knee joint. The inflammatory fluid THINS the joint fluid, causing it to be less lubricating and the resultant rubbing causes more inflammation - and the cyle continues.
THIS IS ARTHRITIS. You may not notice much, iniitally, but because the ACL is weakened, and dogs do NOT know the meaning of ... take it easy (!!!), there is a gradual, continued, fraying of thed ACL. Eventually it fully ruptures or tears.
Occasionally an ACL just snaps without this gradual degeneration and fraying. Sometimes the end of the ACL that attaches to the bone on the top of the tibia actual breaks and pulls out (ACL insertion avulsion), requiring a completely different surgery to repair it.
Quick Link to recommended current anterior curicate surgery techniques:
X-rays are always advised, and are preferably done under a general anaesthetic. Often an ACL tear cannot be adequally felt in a consultation due to the pain and swelling in the joint. Acurate manipulation and palpation under the anaesthetic is required to determine if indeed the ACL is sprained, partially torn or a full rupture has occured. We also can determine how much pre-existing arthritis is present, whether the ACL avulsion has occured, if there is damage to the other knee ligaments (the medial co-lateral ligament and the lateral co-lateral ligament), and if it has also caused the knee cap to dislocate (medial patella luxation). Occasioanlly I have also found the patella to have fractured!
Dogs that already have a medial patella luxation have a significantly higher risk of rupturing their ACL because the pressure that the quadriceps muscles (the 'quads') provides via the patella on the front of the knee joint adds a lot of strength and stability. When the knee cap is out of its normal postion when it luxates or dislocates, the effect is that this weakens the knee and in particular causes a lot more pressure to end up on the poor ACL!
We also x-ray the hips to check if there is any arthritis or hip dysplasia present that will effect the recovery from ACL surgery.
Surgery is always advised for ruptured ACLs. Stabilisation of the knee or stifle joint is absolutely mandatory in minimising rapid degeneration (arthritis), limiting pain, and improving mobility. There are several surgery techniques available, and there is a constant evolution and improvement in this area.
The latest advances focus on the use of isometric points, titanium implants (PROS, BOSS and Crimps) and modern prosthetic fibres (Orthofiber and Ligafiba) that give a more natural motion after surgery, a faster recovery, much longer lasting (they don't break down like nylon) and have greatly reduced risks of complications. The long term comparisons with other techniques such as TPLO and TTA techniques shows little or no benefits over each other, however the isometric techniques are significantly less costly with a much faster recovery.
ALthough the De Angelis technique is still available here we recommend the Ligafiba Iso-Toggle ACL technique for dogs upto approximately 12 - 15 kg, and the Securos X-Gen PROS/BOSS Orthofiber technique for dogs over this size. Please read the information about these techniques, and their advantages.