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Ruptured Cranial Cruciate Ligament in a Dog's Knee: How to Fix It |
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July 2005
- Eliot Kaplan, DVM -
Injury to the cranial cruciate ligament (CCL) of a dog's knee is the most common orthopedic injury that occurs in dogs. If the dog is over 35 pounds, surgical intervention is almost always the best option. If the dog is less than 35 pounds, surgery is still often a good option, but many patients can still come along okay with conservative medical management. This means no running or jumping for 10-12 weeks, weight loss if needed, and supplements that are shown to be chondroprotective (they help cartilage).
If the dog is over 35 pounds, they will especially benefit from surgery. There are two techniques that are routinely done. The first one is an extra capsular repair. It is a technique in which an implant is applied to the outside of the joint to supply the stability that was lost when the CCL was damaged. This technique works well, but it is important, for the best result, that the surgeon fully explores the knee joint, removes any damaged structures, and frees up the medial meniscus, a cartilage shock absorber that is anchored to the top of the tibia. Once the CCL is damaged, the medial meniscus is vulnerable to injury. By freeing up the meniscus so it can move a bit, the medial meniscus can literally move out of 'harm's way' thereby preventing injury at a future time. This procedure is called a meniscal release and definitely helps the overall success of the surgery.
I like the extra capsular technique a lot because I have been doing it for 20 years and know that it has a good success rate when done properly. The down side of it is that over 3-5 years following the repair, some arthritis will occur. However, the arthritis is usually easy to manage and in many cases is mild enough not to require medication.
A relatively new technique has been developed which apparently reduces the amount of arthritis that occurs postoperatively. It is called a TPLO (tibial plateau leveling osteotomy) and has an excellent success rate. In this technique, the angle of the knee is modified by cutting and realigning the top of the tibia. This eliminates the need for a CCL. In a recent study, dogs did just as well 6 months after surgery whether the TPLO was done or the extra capsular technique was done. But advocates of the TPLO technique feel that 3-5 years down the road from surgery, the TPLO dogs have less arthritis so probably do better. This still needs to be proven in scientific studies. The downside of the TPLO is that it is very expensive compared to the extra capsular technique.
My recommendation at this time is to do the extra capsular technique on all dogs 35 to 55 pounds. For dogs weighing over 55 pounds arthritis can be more problematic and the TPLO technique should be considered. However, if the expense is a problem, get the extra capsular repair done by a surgeon who will also do a meniscal release. Most dogs will do fine with this technique and it is certainly much better than no surgery at all. |
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