Download Cranial Cruciate Ligament Rupture With TPLO Surgery for Correction

Cranial Cruciate Ligament Rupture
With TPLO Surgery for Correction
Cranial cruciate ligament (CCL) rupture is the most common cause of hindlimb lameness in
large to giant breed dogs. In a very small percentage of dogs the cause is purely traumatic, but
most often it is a natural degenerative change within the ligament that causes it to be weak.
The history is typically a chronic wax and waning lameness with times of improvement. This is
typically due to an initial partial tear that then becomes a complete tear or a meniscal tear
develops. Large to giant breeds are at increased risk. Predisposed breeds include the
Rottweiler, Bullmastiff, Chow Chow, Labrador, Newfoundland, Akita, and Staffordshire Terrier.
A rupture during middle age is more common in large breeds where smaller breeds more
commonly suffer one at an older age.
The cranial cruciate ligament runs
from the back of the femur to the
front of the tibia and its function is to
prevent hyperextension, excessive
internal rotation and tibial thrust.
Commonly, dogs with a CCL rupture
sit with the stifle (knee) extended or
sit on one hip. Clinical signs include
mild lameness, apparent after lying
down, or non-weight bearing
lameness. There is usually a bump
on the inside (medial) aspect of
stifle, called the “medial buttress,”
which is soft tissue that the body
lays down to help stabilize the knee.
The patellar tendon becomes no
longer palpable due to swelling
within the stifle. Other clinical signs
include pain on stifle extension,
muscle atrophy, crepitus on range of
motion indicating osteoarthritis,
“click or pop” on flexion range of
motion, which may indicate a
meniscal tear and indicators of
instability. Two manipulative tests
called the cranial drawer and tibial
thrust are performed during the
dog’s exam to determine if instability
is present.
Dogs have a normal slope on the tibia (see picture
on the left). This slope is known as the tibial plateau
angle (TPA). If the CCL is ruptured it makes the
femur want to slide down and results in instability
when the dog bears weight.
femur
stifle
Tibia
Surgical intervention is usually required to resolve
the lameness from a CCL tear. There are multiple
surgical options. The two that we perform here are
the lateral suture and TPLO (tibial plateau leveling
osteotomy). The lateral suture is a heavy gauge
fishing line that is placed in the same plane as the
CCL, but lies outside the joint, under the skin.
The TPLO realigns the knee to decrease the tibial
plateau angle/slope and level out the top of the
Radiograph of left stifle and tibia highlighting
the tibial plateau angle (TPA) The yellow line
femur to prevent the tibia from sliding down and
shows the slope prior to surgery and after a
resulting in instability. This is achieved by performing
TPLO has been performed. The femur now is
an osteotomy, which is stabilized by a plate and
stable in weight bearing.
screws. One of the most important parts in either
surgery is the joint exploratory to evaluate if the menisci (c-shaped fibrocartilages within the
joint that act as shock absorbers) are damaged. If there is a meniscal tear, then this portion is
removed because it can be a residual cause of lameness.
The type of surgery recommended for your dog, depends on several factors, which can only be
determined after evaluation. TPLO is usually recommended for large/giant breed dogs, active
dogs, bilateral ruptures, steep tibial plateau angles, or partial CCL ruptures, because it
preserves the remaining part of the ligament.
On the day of surgery, your dog is given a premedication with a sedative and pain medication
prior to being intubated and maintained under isoflurane inhalant gas anesthesia. Preoperative
radiographs are taken to plan the surgery and evaluate the anatomy. During surgery, a skilled
surgical assistant monitors the patient constantly by multiple parameters, including an ECG
monitor, blood pressure, pulse oximetry, end-tidal CO2, +/- ventilator. We also administer a
constant rate infusion of intravenous pain medications during the procedure along with
antibiotics to decrease risk of infection. After the surgery is performed, which includes the stifle
exploration and TPLO procedure (90 minutes), postoperative radiographs are taken to assess
the osteotomy and positioning of implants.
The patient is hospitalized overnight for close monitoring along with treatments to ice the stifle
every 4-6 hours for swelling and pain control, and for the continued administration of
intravenous pain medications. The patient is then sent home with oral pain medications and
antibiotics. You are given detailed instructions about what to watch for, exercise restrictions,
recommendations for rehabilitation, and joint diets or supplements. We see the patient back in
10-14 days for follow up and staple removal, and again in 8-10 weeks for a recheck
examination and radiographs to assess the healing.
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