Western Suburbs Adelaide Vet

Findon Vet Surgery and Seaton Vet Centre

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Current Cruciate Surgery Techniques

Here are the latest Anterior cruciate surgery techniques offered by Findon and Seaton Vets in Adelaide that we recommend for different dog sizes and knee joint angles.

Isometric Surgery

Medium Size Dog Breeds - LIGAfiba 250 Lb iso-toggle technique: CLICK to see full details>>

  • Performed at Findon Vet Surgery & Seaton Vet Centre
  • Isometric technique, Optimises the positioning and thus function of the prosthesis for dogs between 13 and 23kg.
  • EXCELLENT and RAPID return to use of the leg (ALSO reduces length of time OTHER knee at increased risk of rupturing its cruciate).
  • Minimal confinement necessary after surgery as compared to all other techniques.
  • Gives the best outcome of all the cruciate repair options offered by Adelaide vets that we have seen.
  • The LIGAfiba is doubled to provide an enormously strong, yet flexible, 500 Lb (227 kgs!!!) breaking strain. This is the strongest and most durable dog cruciate surgery available to Adelaide Vets.

Small to Small-Medium Dog Breeds - LIGAfiba 150 Lb Iso-toggle technique: CLICK HERE to see full details>>

  • Performed at Findon Vet Surgery & Seaton Vet Centre, Adelaide
  • Isometric technique. Optimises the positioning and thus function of the prosthesis in dogs from 5kg to 13kg.  NOTE: a 75 Lb LIGAfiba is used in toy dogs and cats giving the strongest and most flexible repair for such delicate pets!
  • EXCELLENT and RAPID return to use of the leg (ALSO reduces length of time OTHER knee at increased risk of rupturing its cruciate).
  • The LIGAfiba is doubled to provide 300 Lb (136 kgs!!!) breaking strain!
  • Minimal confinement necessary after surgery as compared to all other techniques.

Medium-Large to Large and Giant Dog Breeds - LIGAfiba 500 Lb iso-toggle technique: CLICK to see full details>>

  • Performed at Findon Vet Surgery & Seaton Vet Centre, Adelaide
  • Isometric technique, Optimises the positioning and thus function of the prosthesis for dogs over 23kg.
  • Proven excellent results in dogs up to 62 kg ... but appropriate for even larger dogs, especially if not interested in a TPLO procedure.
  • EXCELLENT and RAPID return to use of the leg (ALSO reduces length of time OTHER knee at increased risk of rupturing its cruciate).
  • Minimal confinement necessary after surgery as compared to all other techniques.
  • Gives the best outcome of all the cruciate repair options offered by Adelaide vets that we have seen for cruciate surgery in large dogs and giant dog breeds.
  • The LIGAfiba is DOUBLED, thus giving ONE TON of breaking strain...it does not break, and remains strong and subtle for the life of the dog.

TTO (Triple Tibial Osteotomy)

  • No Longer Performed at Seaton Vet Centre BUT we can refer for this procedure. 
  • COMBINES the functional benefits in the stifle of BOTH the TPLO and TTA techniques (see below)
  • TTO achieves a significantly better outcome than TTA alone
  • Rapid return to use of the leg and confinement for 8 weeks required on non-slip flooring
  • Patients that previously have had a TTO surgery and have now had the Isometric Ligafiba on their other leg have seen quicker recovery to very good activity and excellent outcomes. We therefore now recommend the Isometric surgery.

TPLO (Tibial Plateau Leveling Osteotomy)

Large to Giant Dog Breeds with Steep Tibial Plateau Angle

  • TPLO (tibial plateau leveling osteotomy) technique
    • Requires referral to a specialist
    • ​Changes the angle of the top of the tibia to alter the forces within the knee.
    • Significantly more costly than other procedures.
    • Requires several weeks of confinement on non-slip flooring.

As you can see, there are several anterior cruciate surgeries available, with the latest techniques providing superior results which result in an earlier and better return to function and minimise ongoing problems. The types of cruciate surgery can be classified into one of two broad methods: stabilisation of the stifle (knee) using a synthetic prosthesis, or extensive bone surgery that alters the knee's biomechanics such that there is little or no reliance on the need for an anterior cruciate ligament.

Many studies have been done comparing the outcomes from these different types of surgical techniques and the long term outcome, even after only 6 months, is similar - if not the same. Currently the procedure with the best results happens, luckily, to be one of the most cost effective with also the least complications and the fastest return to function of the affected leg. This is the technique using the isometric points of the knee to place a strong, yet flexible, synthetic material prosthesis to replace and stabilise the knee.

The isometric points can be imagined as that spot on both the end of the femur (thigh bone) and the apposing spot on the top end of the tibia (shin bone) that, when they are joined/connected by a line, this line remains the same length no matter what angle or range of motion the knee goes through.

Other cruciate surgical techniques available

TTA (tibial tuberosity advancement) technique

  • Not recommended by our prcatice.
  • Note that the MMP technique (Modified Marquet Procedure) is identical mechanically to the TTA but utilising different implants. Although I am trained in the TTA procedure and perfromed TTA surgery, I agree with the American studies that the Isometric surgery, and even the TPLO, are preferable due to better short, medium and long term outcomes and significantly less post operative complication rates. Research study in America 2013 advises Isometric Repair (seeLigafiba above) in preference to TPLO and TTA. << Read Short Research Abstract Article>> 
  • The TTA was the LEAST recommended surgery, as a result of the study, for ACL in large and giant breed dogs in America with the highest level of complications and worst long term outcome of the three tested procedures.

The advent of the isometric surgeries above that reduce the cost, yet provide excellent stabilisation and funtion, are now preferred by us over the TTA in medium, large and giant sized dogs.  In medium-large to Large dogs specialists in Australia recommend the TPLO or TTO technique.

The TTA does not stabilise the knee, it remains loose, but a change in the direction of the pull of the kneecap tendon alters the forces on the knee such that the tibia is not pulled or displaced forward when the leg is used. A constant issue with this surgery is that the meniscus cartilage will often tear or split soon after surgery, causing pain and a need for further surgery.

To prevent this, many surgeons will do a medial meniscal "release" (where the medial meniscus cartilage is cut so that it cannot split or tear after surgery) BUT the result of this is greater instability in the knee, and less cushioning of the femur as it hits the tibia, and more rapid onset of arthritis. So there are unavoidable complications associated with a TTA surgery. If the surgeon does not accurately apply the bone plate, the knee cap also dislocates.

Catestrophic fracture of the upper tibia can and does occur, requiring siginificat bone plating and costs that are also higher than the original surgery.

Costs are approximately 50% higher than the isometric techniques.

De Angelis or lateral suture technique

  • By far the most commonly performed cruciate surgery world-wide as can be performed by a general veterinary surgeon with minimal specialised equipment.
  • We no longer recommend this technique as it has been surpassed by the Isometric techniques.

We have previously had very good results over the many years performing this technique but there are some issues with it that were unavoidable. If performed by a poor surgeon, it is ineffective - totally. Although results and technique here have been optimal, much better results are seen with the isometric techniques and we now perform these surgeries.

In the De Angelis lateral suture, the nylon monofilament line is placed through the ligament at the back of the femur that holds the small accesory bone called the fabellum. I spent most of my time ensuring this placement is correct and strong, however a constant problem with inexperienced surgeons is poor placement, and the nylon immediately loosens and does not help the knee in any way at all.

Ensuring the nylon is tightened correctly is a problem unless a crimping and tensioning device is used or a tightening knot over a doubled loop of nylon is used. Most do not utilise these methods and the knee is not as stablised as it should be.

The nylon will break if only one thread is used, or if the line is damaged during tightening, or will break at the knot. Also the knot is bulky and the stiff ends of the cut nylon potentially irritate and cause fluid collection in the tissues causing problem if the ends are not left long and flexible and buried securely in the deeper tissues.

A major issue is that because the nylon extends from the lateral side at very back of the knee behind the femur, to the very front of the knee at the bony top of the tibia, when adequate tightening to stabilise the knee is applied, the effect also is to rotate the tibia outwards and often the patient will then have a stance with the leg held out from the body. The added effect is a non-natural gait or walking and running action which contributes to arthritis.

Because the nylon may be placed over the top of a lot of deep tissues on the side of the knee, after tightening this tissue is crushed - causing pain and some swelling, but also as the tissue disintegrates, the nylon loosens a bit as well. Tunneling beneath these tissues is paramount to success for a long term outcome, however it is not often done as it then saves time, so the nylon loosens. We always buried the nylon to prevent this loosening and crushing of tissue.

Regardless, of all of the many minor improvements we have made to the De Angelis/Lateral suture technique, the new Isometric techniques have shown immediate, greatly superior results, which ensure best long-term outcomes for the injured knee, and reduced time for recovery that then reduces the danger period for the dog injuring its other cruciate during its healing/return to function period.