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Cranial cruciate ligament failure is one of the most common causes of lameness in dogs. It
can have devastating effects on your pet without treatment. Treatments, generally, involve
surgery, either replacing the ligament with a synthetic prosthesis, or applying bone plates
to the tibia.
The Cranial Cruciate ligament is one of a pair of strong ligaments that connect the bottom of
the femur and the top of the tibia. The CCL "runs" from the bottom of the femur and attaches
to the front of the articular surface of the tibia. Part of its connection also involves the
medial meniscus. When the ligament fails or breaks, it causes significant pain in the joint,
oftentimes several days to weeks. Failure of the CCL causes instability in the joint.
Load-bearing on the limb becomes difficult due to that instability. If left without treatment,
the patient's joint becomes arthritic while attempting to stabilize the joint.
Initially, after diagnosis, the patient is treated with non-steroidal-anti-inflammatory agents
(NSAIA's), such as Rimadyl, Deramaxx, Previcox, Meloxicam, etc. These agents reduce the
inflammation within the joint and thereby reduce pain as well. Many practitioners elect to
treat these early diagnosed patients with overt pain killers, such as Tramadol, Tylenol with
Codeine, etc. It is important for the patient to be comfortable and without pain. Surgery is,
generally, the next step, in pets over 25 pounds. Stabilizing the joint will decrease the
pace of osteoarthritis and offer the patient successful load-bearing on the limb. There are
several procedures for repair of the failed ligament. We will discuss the operation as
performed at our practice.
EXTRA-CAPSULAR PROSTHESIS USING SECUROS BONE SCREW
This technique actually replaces the ligament by using a heavy strand of prosthetic material.
The joint is initially explored and the remnants of the ligament are removed.
The joint is liberally lavaged with warmed sterile saline and closed, using an imbricating or
tightening pattern. The joint is then injected with a local anesthetic that provides
post-operative analgesia in the joint for several hours. A hole is then drilled into the
tibial tuberosity, and a special bone screw is placed into the outside of the femur. This
screw has an eyelet that the prosthesis passes through. The prosthetic material is passed
through the bone screw and through the hole in the proximal tibia. The prosthesis is
tightened and secured with a sterile crimping tube. This, then, recreates the "action" of the
CCL and immediately stabilizes the joint.
Complications are low and the success rate, statistically, is equal to the other techniques
(Paper presented to ACVS, October 2006 comparing results of all techniques). Please visit:
vetsurgerycentral.com/cruciatelrt.htm
for further information concerning this procedure.
In any operation of the stifle or knee joint in the dog, physical therapy is very important
to bring the patient back to full use of the limb. In our practice, we regularly evaluate
these patients, oftentimes, weekly. We counsel owners on passive physical therapy and active
therapy. In some patients, weight-bearing and "successful" use of the limb is almost immediate,
but in others, recovery can take several weeks.
POST-OPERATIVE ANALGESIA
In our practice, we prescribe a Fentanyl Patch to the lower operated limb. This patch is a
narcotic pain killer; its effects will last for 72 hours. Following the use of the Fentanyl
patch, we will generally prescribe milder analgesics, such as Tramadol. It is very important,
during the post-operative period, to continue these patients on anti-inflammatory agents to
reduce swelling and inflammation.
We have performed this procedure, in varying techniques as the technology advances, for
thirty years with good to excellent results. However, before a decision is made to operate on
your pet, we always advise pet owners to seek a second opinion and become more familiar with
the disease process.
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