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This is a partial listing of the principal surgery services offered at Saint Francis Veterinary Specialists. To be connected directly with our surgeon, please call at 404-924-2000 x-112 .
Knee injuries in humans are fairly commonplace, and so the conversation surrounding canine knee injuries and ailments may contain terms familiar to you. However, the sheer volume and variety of terms and abbreviations used to describe both human and canine knee injuries can add to the confusion, such as “ACL, CCL, MCL, cruciate, tendon, ligament” to name just a few.
As with their human counterparts – knee injuries in dogs can cause pain, instability, exercise avoidance, abnormal gait and other symptoms. When your veterinarian identifies a rupture or tear in your pet’s knee musculature – that rupture must be surgically stabilized in order to achieve improvement in joint health.
The surgical procedure employed at Saint Francis Veterinary Specialists for the canine knee, is referred to as tibial plateau leveling osteotomy, or “TPLO”.
The following is a list of common questions surrounding canine knee surgery.
1) What is the cranial cruciate ligament (CCL)?
The CCL is a structure within the knee that connects the femur (upper leg bone) to the tibia (lower leg bone). It is essentially the same as the human ACL (anterior cruciate ligament), but the terminology differs due to distinctions in the dog and human anatomy.
2) What does the CCL do, and why is it so important?
The CCL provides a significant portion of stability to the knee. It has three main functions:
3) What is “cranial drawer” and “tibial thrust?”
For illustration, imagine a wagon on a hill. If the hill is the tibia (lower leg bone), and the wagon is the femur (upper leg bone), then the CCL would be the cable holding the wagon steady on the hill. If the cable is cut, then the wagon will roll away. The same concept can be applied to the knee. If the CCL is torn, then the femur slides off the back of the tibia. This motion is called cranial drawer, or tibial thrust.
When your veterinarian is assessing the knee for potential instability, they will place their hands in certain positions to elicit this abnormal range of motion of the knee. If a knee has a CCL rupture or tear, the tibia can be moved forward in relation to the femur, confirming the diagnosis.
4) Why is the CCL so critical to proper knee function?
Being that the CCL is a main stabilizer of the knee, a rupture can lead to instability and pain. This places additional stress on the other ligaments and soft tissues involved with supporting the knee, and may lead to meniscus (knee cartilage) damage. A CCL rupture also significantly predisposes the knee to arthritis formation.
5) What can be done to treat my dog and stabilize its knee, and what is a tibial plateau leveling osteotomy (TPLO)?
The TPLO is widely considered by the majority of veterinary surgeons to be the best method for stabilizing the knee in dogs with a CCL rupture. As a corrective procedure, the TPLO has been in use by veterinary surgeons for the longest period of time and employed in the highest number of cases.
Prior to surgery, your surgeon will take X-rays of the knee. Here at SFVS, special orthopedic radiography software is used to measure the tibial plateau angle. This angle is the slope at which the top of the tibia contacts the femur (remember the wagon and hill analogy). Once the slope is known, then the surgeon can plan the TPLO procedure.
The TPLO procedure uses a curved mechanical bone saw to carefully make a precise cut into the tibia. This will allow for rotation of the bone and leveling out of the slope to a more flat and neutral angle, thus preventing tibial thrust and stabilizing the knee. The bone ends are then held in place with surgical titanium plates and screws, specifically sized to your pet’s anatomy.
6) What is the surgery recovery period?
Most patients stay in the hospital for one night, but some may stay an additional night.
As the pet’s owner – your participation in a proper recovery process is absolutely crucial to the long term success of the surgical procedure and to your pet’s return to a healthy, active state.
Once your pet is released from the hospital, a customary recommendation is that the patient be confined for at least 10-12 weeks. “Confinement” typically consists of:
Here are some other milestones in the recovery period. At 2 weeks, the staples holding the skin incision closed can be removed. At 8 weeks, an orthopedic evaluation will be performed, and recheck X-rays will be obtained to document bone healing. Your surgeon will then discuss with you any potential increases in activity levels that may be indicated as healing progresses. Patients still need to be confined, however. Something as simple as jumping on the couch or charging the door when a friend comes over, may cause a serious setback (or injury).
At 12 weeks, most restrictions are lifted. Working dogs (agility, hunting, etc.) should not be reintroduced into training for 5 months. Too much activity, too soon in recovery, can lead to complications and prolonged recovery.
7) What are my odds for success with the TPLO procedure?
The overall success rate of this procedure is about 90% and is based on many years of research and client observation. This means that most dogs will recover to normal (or near normal) function, but they may be sore after a day of excess play. Of the remaining 10% of patients who don’t quite make a full recovery, results are most often hindered by pre-existing arthritis in the knee or in other joints of the limb. These dogs still show mobility improvement and benefit from the surgery, however. Even patients that have undergone an older, prior procedure still benefit from a TPLO, though their outcomes may not be as favorable.
8) What are the potential complications associated with a TPLO?
Anesthesia risks are always present (as they are in human medicine), but for most patients who are otherwise healthy – anesthesia risk is extremely low.
As with humans, arthritis is typically present to some degree at the time of surgery, and with time arthritis will progress in severity. However, it will be significantly reduced in comparison to the patient who suffers a CCL rupture that is not surgically repaired. Anti-inflammatory medications, glucosamine/chondroitin supplements (Dasuquin preferably), weight loss, and healthy activity levels all play a role in the treatment of arthritis.
(Note that for the remaining risks identified below – the pet owner will play a more critical role in reducing potential complications.)
The risk of infection is typically the risk of highest concern in an orthopedic procedure such as the TPLO. With this in mind, our surgeons take every procedural precaution (antibiotics, sterilized environments, etc.) to properly manage this risk. Most infections that do occur arise from patients licking and chewing their incisions. For this reason, most patients are discharged with an Elizabethan collar (“E-collar) which, though a nuisance – must be worn AT ALL TIMES.
Surgical plates and screws may bend or break if patients are allowed to be too active, too quickly. This can necessitate a second surgery.
Patella tendon strain may occur if animals are too active too soon. Typically, rest and anti-inflammatory medication will resolve this.
Fracture of the tibia can occur from over-activity. Depending on the location of the fracture, surgery may be indicated for repair.
If you would like to discuss your pet’s specific needs and treatment options – please contact our surgical staff to arrange for an appointment for your pet at 404-924-2000, or email firstname.lastname@example.org or email@example.com Thank you for visiting our website, we hope to welcome you soon!