Extracapsular Repair for Cranial Cruciate Rupture

See the black dots -- that is where the "fishing line" goes to make a ligament.

See the black dots — that is where the “fishing line” goes to make a ligament.

So this is the second installment in discussing cranial cruciate rupture and the first in how we surgically treat this problem. Extracapsular surgery for cranial cruciate rupture is an older surgery that still does the job especially in smaller candidates weighing less than 50 pounds.  The surgery is practiced by most general practitioner veterinarians and does not need specialized equipment.

The surgery is performed when the cranial cruciate ligament has ruptured due to slow degeneration over time or acutely through trauma.  The surgeon will incise the joint and expose the joint itself.  The torn ends of the ligament are removed and the meniscus, the shock absorber of the joint, is examined for damage.

If your pet has a cranial cruciate rupture the chances are that his medial meniscus is also torn.  In about 40-50% of pets with cranial cruciate rupture an audible click can be heard when the leg is flexed this is usually the medial meniscus making the sound.  The debris in the joint is cleaned and the meniscus is either removed or sutured depending on the degree of trauma to it.

Non-absorbable suture (“fishing line”) is used to make a false ligament.  The suture is passed around the lateral fabella and through a hole drilled in the tibial crest.  The suture is tightened down and the joint is flexed several times through a range of motions prior to closing the skin. The two black dots on the picture show where the suture is situated.

This surgery can decrease cranial drawer movement but it can loosen over time.  It is not a surgery recommended for dogs over 50 pounds.  The suture eventually disintegrates and scar tissue is formed to stabilize the joint.  This surgery has been shown to improve the signs of lameness in about 85% of pets.  An unfortunate note is that if your pet has a torn cranial cruciate ligament there is a 33% chance that he will tear the other one also.

Rehabilitation exercises are recommended for recovery.  The rehabilitation exercises include cryotherapy, nsaids, passive range of motion exercises, and leash walks in the beginning.  As the incision heals treadmills and underwater treadmills can be incorporated.  The ideal situation would be for the pet to achieve normal range of motion values by 10 days post-op.  Strengthening exercises such as stairs, uphill walking and pulling carts will be added in eventually.  Jumping on the rear legs is prohibited for at least 10-12 weeks post-surgery.

If your pet has had or will have cranial cruciate surgery, please ask your veterinarian about rehabilitation post-op. If you need us, we are here for your pet’s recovery — ARCC — Animal Rehab & Conditioning Center.

Next week we will discuss one of the two specialty surgeries for cranial cruciate rupture.

 

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