VetClick
Menu Menu
Login

VetClick

/ News
Thursday, 28th March 2024 | 4,184 veterinary jobs online | 103 people actively seeking work | 5,479 practices registered

Veterinary Industry News

Send us your news

Commonly Asked Questions About Cruciate Ligament Surgery

14 years ago
10665 views

Posted
7th January, 2010 00h00

Author
NEF


Dr Paul Manning of Astonlee Veterinary Hospital and Surgery in Newport Pagnell, Buckinghamshire, gives us his answers to his most commonly asked questions about cruciate ligament surgery. Cruciate ligament, or dog knee problems are the commonest orthopaedic condition in dogs, and Paul takes a very keen interest in this ever since being taught by the late Col Hickman (a very well respected surgeon) at the Cambridge Vet School in 1978. What is the likely success rate with your operation in your hands? 96% return to ‘normal’; ie : the walking/running capabilities the dog had before the rupture of the cruciate ligament. 2% chance of being slightly lame. 2% failure rate. What are the treatment choices for my dog? Extracapsular suture Intracapsular techniques with use of grafts Bone sawing/osteotomy techniques. Why do you choose your skin graft technique? It has a very long track record, the principles of the technique having been invented in Finland in 1952 with modifications since, and I have audited the results of my clinical cases in 100 dogs of many breeds and sizes and ages over a 15 year period (see vets section on this website) I choose skin as my preferred graft because published papers in the 1960’s and 70’s showed it was better than nylon or fascia (Vaughan 1966 at the Royal Veterinary College). No other technique replaces the ruptured cruciate ligament in the position in which it achieves re stabilisation of the stifle joint, which I believe is essential to the restoration of normal function in the long term. Sawing the bone without replacing the ruptured ligament seems to me like an idea that no human patients would contemplate for themselves, so why would they think of doing it for their dogs? Premiership footballers (humans) have their cruciate ligaments repaired using tunnel and graft techniques, and they can still be playing in the same League 10 years later. . What are the costs of each choice of procedure? Using a skin graft with 2 bone tunnels in my chosen technique costs about £2000, but can be as little as £1000 depending on size of dog and complexity of the particular case. Extracapsular suture is likely to cost about £1000. Bone sawing/osteotomy techniques commonly cost in the region of £4000. What is the potential for things to go wrong? My results show that there is only a 2% chance of the operation ‘failing’ which has been judged by myself and my clients in that the operation has failed to restore the leg to normal function with the ability to play, walk and run. When the operation has failed, it is usually within the first 3 months after the operation when perhaps the skin graft has not healed properly or the graft itself failed, or the dog has exercised too violently before the end of the strict 3 months post op period of ‘strict lead exercise only’. This compares to published results for bone sawing techniques where the quite serious complication rates can be in the range 8% to as high as 25%. If the operation does fail, what can be done about it? In the small number of cases where the operation has failed, one was a very old Yorkshire Terrier so it was decided that the old dog should have a choice and not go through another operation, and he was happy to potter around with a limp for his last year or so. The procedure does not alter the alignment of the leg (bone osteotomy techniques do), and the situation in a failed operation using the tunnel and graft techniques is almost the same as it was before the operation was carried out. It is a relatively uncomplicated procedure to repeat the operation and insert another skin graft, which is highly likely to succeed. This compares to very serious potential complications with bone sawing techniques where there have been failures of the stainless steel plates and/or screws, and the potential for arthritis to develop seems to be much higher with the bone sawing which is a much more aggressive technique than using a skin graft. What are the chances that the opposite leg will need surgery? My results with my technique show that there is about a 10% chance that the opposite leg will need surgery for the same problem. This compares to most other published results where the chances range from a minimum of about 50% to 80% chance. How long have you been using your technique? Since I qualified in 1979 from Cambridge University where I was taught how to do it. If you have a question that is not answered above, please contact me and I will try to answer it for you.

More from NEF


You might be interested in...