Cruciate repair

Re: Cruciate repair

Malcolm Ness — Wed, 01 Aug 2012 12:58:43 GMT

[quote user="CatherineThomas"]What activity level do you recommend? At the moment I have instructed just short lead walks. Should we be letting him run around as normal?[/quote]

As long as activity is not causing obvious discomfort then I would encourage normal levels of activity - at least that way you will be easily able to guage the level of any disability/clinical problem.

Re: Cruciate repair

Kate Richardson — Wed, 01 Aug 2012 12:24:38 GMT

Hi Catherine, no orthopaedic advice here! but as Malcolm says there is no rush to go to surgery, this does at least give the owners time to save/work out a financial plan/get a loan if nec/beg/borrow (not steal!) which may mean that if after an appropriate amount of time surgery does seem indicated then they may be in a position to be able to afford the most appropriate surgery. (if it then doesn't need surgery they can use the money to go on holiday instead!)

Re: Cruciate repair

CatherineThomas — Wed, 01 Aug 2012 12:14:15 GMT

Thanks Malcolm, thats just the information I was hoping for. Usually with dogs of this size I would really encourage referral for surgery. But this time I don't think it's going to be possible. I've given the owners all of the information and they are thinking about it, so there's a slight chance that they may change their mind and go for referral. I'll give him 6 weeks before we make any decisions.

What activity level do you recommend? At the moment I have instructed just short lead walks. Should we be letting him run around as normal?

Re: Cruciate repair

Malcolm Ness — Wed, 01 Aug 2012 12:10:56 GMT

Partial tears in my experience have always progressed to full tears in time - the advice is the same either way. PM me if you want to discuss in more detail

Re: Cruciate repair

CatherineThomas — Wed, 01 Aug 2012 12:05:47 GMT

The joint doesn't have a cranial draw so I think it is only a partial tear and it will be ok with conservative treatment for now. But obviously there is the chance that it could go completely at some point so I want to be prepared for what we will need to do if/when that happens.

Re: Cruciate repair

Malcolm Ness — Wed, 01 Aug 2012 11:59:22 GMT

There is no need to rush into surgery.

NSAIDs and normal activity (not rest) are appropriate at this point. Wt reduction is always a good idea but sucessis neither guaranteed nor necessary for a good clinical outcome.

Contrary to popular belief, some dogs (even of this size) will do just fine with a conservatively managed CCL failure. If the dog remains disabled (lame and unable to exercise as previously) after six weeks of conservatism then surgical treatment becomes appropriate.

In a dog of this size, a mechanical modification procedure (TPLO or TTA) performed properly would offer much the best chance of returning the dog to full activity and that would be plan A. Other surgical options exist and of those, a lateral fabello-tibial suture using stiff nylon (so-called leader line) tensioned and fixed with crimps would be my choice. Though widely practiced, the technique is open to error - most common technical error relates to the position of the tibial drill hole which needs to be very much more proximal than many think. I would caution against using Ligafibre or similar - I was told in the late 1970's that buried braided materials were bad news from an infection point of view and I have seen nothing over the years that has been inconsistent with that teaching. While the newer materials are much stronger (size for size) they are still braided and while the materials might be modern, the bacteria causing the infection remain old-fashioned. In any case, the reason for failure of these fabello-tibial sutures is related to cyclic loading and attrition so a massively high ultimate tensile strength (breaking strain) is less important.

The reason that this technique is not universally recommended is not that it doesn't work - it often does work very well - but rather the rate of clinical failures and poor outcomes which, while remarkable low in small, sedentary patients, is very much higher in bigger dogs, more active dogs and over-weight dogs.

The degree of palpable instability either at diagnosis or at any stage after surgery correlates poorly with quality of clinical outcome - many of the dogs that are doing very well following fabello-tibial suture surgery will have markedly unstable stifles.

Re: Cruciate repair

Laurence Webb — Wed, 01 Aug 2012 11:34:47 GMT

Liga Fiba is strong but cheap. Off the top of my head the largest size is 500lbs breaking strength and costs £17.50 from Vet Instrumentation. As it is a braided implant you need to be careful about asepsis and knot slippage is an issue if you don't tie it correctly. The nylon leader line works well and is a bit cheaper. I use a double loop and use a McKee/Miller self locking knot in big dogs (pictures in the Vet Inst catalogue) although you will be left with a fairly chunky knot compared to crimps or a single loop and a knot.

Re: Cruciate repair

Mark Holmes — Wed, 01 Aug 2012 10:55:38 GMT

How unstable is the joint, if its an acute reuptue and a very unstable joint I would be tempted to operate as Martin points out,but if it is a chronic largely stable joint but arthritic I think I would be tempted to invest the money in hydrotherapy, weight loss and NSAIDS as the long term result of the repair is unlikely to be significnantly better than the current situation.

Re: Cruciate repair

Martin Atkinson — Wed, 01 Aug 2012 09:35:52 GMT

Problem is the dog is not going to lose weight with a dodgy leg. If the owner can't afford anything else then personally I would perform a lateral fabella suture with the largest leader line kit I have which has a 100lb breaking strain then get it in for hydrotherapy ASAP. If there's stronger material then use that if you can get it. On the matter of charges: how much do you charge for the procedure?, then ask how much it should really cost - you should be able to do one of these in half an hour.