Failed Lateral Suture Cruciate Repair

RE: Failed Lateral Suture Cruciate Repair

Martin Atkinson — Tue, 04 Jul 2017 17:08:35 GMT

[quote user="Thomas Johnson"] I was worried I'd done something silly, [/quote]Well you might have done but we've all done that as well, even me and I'm (practically) perfect!

RE: Failed Lateral Suture Cruciate Repair

Thomas Johnson — Tue, 04 Jul 2017 15:52:01 GMT

[quote user="Martin Atkinson"]

AN ON, assuming this is the same AN ON in all posts, I just wondered why you felt the need to remain anonymous. As you can see from the replies we've all had cock-ups/made mistakes/had unexplainable failures, its nothing to be ashamed about.

[/quote]

It was me, I think I posted anonymously as I was worried I'd done something silly, but I'm happy to own up now.

RE: Failed Lateral Suture Cruciate Repair

Rob Davis — Tue, 04 Jul 2017 11:07:51 GMT

[quote user="Martin Atkinson"]

[/quote]

Indeed it is nothing to be ashamed about, but if allowing the anon login for posts like this encourages posting, then I think it is only a good thing. Not everybody has your self-confidence!

RE: Failed Lateral Suture Cruciate Repair

Martin Atkinson — Tue, 04 Jul 2017 09:33:16 GMT

RE: Failed Lateral Suture Cruciate Repair

An On MRCVS — Tue, 04 Jul 2017 08:52:49 GMT

[quote user="Beats"]

I had one like this that pulled through about 2-3 weeks post-op. and did it again and was clearly pulling through the tissue where would normally be firm during surgery. I didn't have a bone anchor to hand and placed it at 90 degrees to my normal plane around the fabella - that pulled through within a few days also (and got infected...). Owner wasn't keen on third procedure and was doing all right anyway. I would probably have done TTA for third procedure as would have felt a numpty to have placed a bone anchor in distal femur only for lateral suture to fail a third time due to some other reason.

I think these things happen sometimes. If you have generally good results might not be worth changing anything drastic based on single case.

[/quote]

Thank you for sharing this, I did another lateral suture repair 3 weeks ago in an 8kg terrier, I probably spent more time than I needed to checking everything, but I didn't make any changes to my technique as I haven't had any problems before, and she's doing very well so far, but I have been worrying far more than I normally would about it.

RE: Failed Lateral Suture Cruciate Repair

An On MRCVS — Tue, 04 Jul 2017 08:47:18 GMT

I've just seen the dog to remove sutures 10 days after implant removal. A lot of the swelling around the joint has gone down, and she is walking on the leg a little better than before the implant removal, though still quite lame. She has been referred so I'll have to wait and see what the referral centre think when they see her.

RE: Failed Lateral Suture Cruciate Repair

James Dunne — Mon, 03 Jul 2017 21:22:11 GMT

I would recommend synoviocentesis to screen for an infective process; it is surprisingly commonly associated with failed lateral femorotibial suture repairs. Removing the suture would likely lead to resolution of lameness and if there was significant periarticular inflammation present at the time of revision surgery then waiting for it to settle prior to definitive stifle stabilisation was wise. The ensuing periarticular fibrosis may provide sufficient stability to allow limb use. If the dog remains lame, referral for geometry-altering surgery may yet be the best option.

RE: Failed Lateral Suture Cruciate Repair

Beats — Mon, 03 Jul 2017 18:08:43 GMT

I think these things happen sometimes. If you have generally good results might not be worth changing anything drastic based on single case.

RE: Failed Lateral Suture Cruciate Repair

An On MRCVS — Mon, 03 Jul 2017 15:39:28 GMT

[quote user="robloxley"]My suspicion is that you'd not gone through enough of the tough femero-fabellar 'ligament' when you passed your needle[/quote]

It's possible, though I had pulled very hard on the suture after placing it around the fobella. I guess the next question is how to make sure this doesn't happen again? I have done dozens of these successfully in the past and only had one complete failure, but that was a lunatic springer spaniel and I had warned the owner before the surgery that his temperament might be a problem.

RE: Failed Lateral Suture Cruciate Repair

Rob Loxley — Mon, 03 Jul 2017 14:21:37 GMT

[quote user="An On MRCVS"]appeared to have slipped distally from its position behind the lateral fobella. At the time of the original surgery I was happy with the placement of the suture, the fobella was easy to feel and I definitely got the suture behind it[/quote]

My suspicion is that you'd not gone through enough of the tough femero-fabellar 'ligament' when you passed your needle

RE: Failed Lateral Suture Cruciate Repair

Martin Atkinson — Mon, 03 Jul 2017 11:18:14 GMT

I suspect that, despite what you believed at the time, you hadn't actually got securely around the fabella. Other possibilities are that your tibial crest tunnel (assuming you do drill a tunnel) was too proximal to the joint and fractured; the crimp wasn't tight enough and the line slipped or there was a lot of pre-op swelling which resolved and the line became relatively looser.