Dog Knee Injury » leader line

Tightrope Surgery vs. Extracapsular or Traditional Repair

admin — Thu, 05 Feb 2009 17:39:04 +0000

How is Tightrope CCL Different from Extracapsular Imbrication or Traditional Repair?

The major difference between extracapsular imbrication/traditional repair methods and tightrope ccl is the way in which the knee joint is stabilized. In a traditional CCL repair, a leader line (suture, or you can also think of this as a fishing line) is woven across the knee in a figure-eight pattern, connecting a bony protrusion on the femur to a small hole drilled in the top of the tibia. The veterinary surgeon is able to access the knee through an incision on the knee a few inches long. During the healing process, the leader line serves as a temporary way to stabilize the knee while scar tissue forms. Eventually the leader line will break, and the scar tissue is solely responsible for providing knee joint stability.

In tightrope repair, a stronger material called Fiber Tape is used to connect bone to bone. The FiberTape is held in place on the bone via metal anchors and small holes drilled through the bone. The surgeon makes a few small incisions to access the points of attachment to the bone. While the Fiber Tape will eventually degrade and possibly break over time, it is thought of as a superior material for larger dogs due to its greater durability and strength – buying your dog more recovery time. While in place the Fiber Tape will act to control tibial thrust and prevents the cranial drawer sign, while allowing your dog to maintain full range of motion.

Both traditional repair and tightrope are considered to be minimally invasive procedures when compared to other surgical options like TTA and TPLO, which both involve cutting and changing of bone angles.

Tightrope Surgery vs. Extracapsular or Traditional Repair is a post from: Dog Knee Injury

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Extracapsular Repair Postop Recovery

admin — Wed, 30 Apr 2008 23:39:35 +0000

Your dog will be in a lot of discomfort upon their arrival home from surgery. This is especially true if their extracapsular repair was an out patient procedure, and they were released back into your care the same day of the surgery. It is important to follow all the instructions your veterinarian has provided for pain management, as well as antibiotic use, to be sure that your pet has the best recovery possible. Within the first 24 hours after traditional repair, it is normal for dogs to not put any weight on their injured leg. Your dog may have a modified Robert Jones bandage on his limb, further restricting movement, and decreasing the possibility your dog will try to do to too much, too soon.

For the next two weeks (which is the duration of time the bandage will remain on if you dog was fitted with one) your dog will not be putting much weight on the injured limb. They may hold the leg up if they do not have the modified Robert Jones bandage in place, while others will exhibit some toe-touching behavior. After the sutures are removed, at about the 2 week mark, you veterinarian will determine the course of therapy for your dog to proceed with. In many cases your vet will recommend exercise restriction until 4 to 8 weeks, at which point short, 2 to 5 minute walks, can be reintroduced to your pet.

At 6 to 8 weeks you should begin strength training exercises to help your dog rebuild some of the muscle that was lost during the recovery from the extra capsular repair. Your dog will let you know how much exercise they can handle, and you should try to gradually do more and more each day. Water therapy is a great way to regain muscle mass, as it is gentle on the joints and discourages any sort of jerky motion that can be damaging to the joint. Your dog should not be engaging in any rough housing or unsupervised play during this period, as there is an increased potential of injuring your dog’s opposite cranial cruciate ligament.

After 4 to 6 months your dog will be able to return to normal activities without any restriction. The leader line placed in the knee will break at 2 to 12 months post-op, and your dog’s scar tissue will support the knee on its own. Restriction of movement is absolutely key for the successful healing in patients undergoing extra-capsular imbrication repair surgery. Rest will help to encourage fibrous tissue formation and also prevent the premature breakage of the monofilament suture stabilizing the joint during the healing process.

All dogs with CCL injuries will go on to develop some level of arthritis. It is a good idea to have your dog’s knees x-rayed during your yearly veterinary visits to examine the presence of arthritis and determine what type of treatment plan would be best for your pet to make them the most comfortable.

Extracapsular Repair Postop Recovery is a post from: Dog Knee Injury

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Extracapsular CCL Repair Complications

admin — Wed, 30 Apr 2008 23:05:46 +0000

For both humans and animals alike, any surgical procedure carries a risk of complications. You dog should have a full evaluation done, complete with blood work and other baseline testing, prior to surgery to help minimize any risks. Pre-surgical testing can often diminish the risk of death from anesthesia and other preventable complications related to your canine’s health. Overall, complications with cruciate surgery occur in approximately 5 to 10% of patients. Complications can range from mild and easily resolved, to more severe complications requiring additional surgery, expense and disability. While uncommon, complications do arise during and after extracapsular repair procedures, and you should have a discussion with your veterinarian regarding ways to minimize and avoid these risks.

Complications and risks associated with traditional repair techniques for cranial cruciate ligament surgery are as follows:

Adverse reactions to anesthesia including nausea, vomiting, fatigue and in rare cases – death.
Infection of the surgical site.
Seroma – a build up of fluid at the surgical site which must be drained (aspirated).
Allergic reaction to sutures or medications used.
Allergic reaction to leader line, making re-operation for removal necessary.
Patellar luxation – knee cap dislocation.
Entrapment of the peroneal nerve – which can lead to paralysis and/or loss of the limb.
Blow out of stifle joint, tearing of leader line. This requires surgical intervention and a TPLO is often used for repair.
Tearing of mensicus.

Extracapsular CCL Repair Complications is a post from: Dog Knee Injury

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Extracapsular Imbrication Surgery, Traditional Repair Procedure

admin — Wed, 30 Apr 2008 22:36:49 +0000

In the extracapsular imbrication, also known as the traditional method and lateral fabellar surgery, your dog will have a strong leader line placed within the knee to provide stabilization. Some veterinarians will only perform this procedure on small dogs and cats, while others will use the technique on dogs of all sizes. There is no definitive study evidence showing that tibial plateau leveling osteotomy, or TPLO, is superior to the extracapsular method in large dogs, in fact, the University of Pennsylvania, one of the nation’s leading veterinary hospitals, will not perform the TPLO procedure as the cost/risk risks do not outweigh the benefits. For more information see the article here – What’s new in orthopedics? – The Canadian Veterinary Journal

Extracapsular stabilization involves stabilizing the stifle using some means external to the joint capsule. During the first part of the procedure a 3 to 5 inch incision will be made through which the surgeon will have access to the stifle. First, the damaged cranial cruciate ligament is completely removed. Second, the veterinarian will examine the mensicus to determine whether or not there has been any injury or deterioration of the tissue. At this point the doctor my decide to remove the meniscus depending on the amount of injury, only removing the meniscal tissue that has been damaged. A partial meniscectomy is preferable over a complete meniscus removal, and dogs left with some healthy meniscus intact tend to develop less arthritis later in life.

During the extracapsular imbrication a large, non-absorbable suture is placed in a figure eight pattern within the structure of the knee. The leader line is placed around the lateral fabella through a hole in the tibial crest, mimicking the course of the CCL and preventing forward movement of the tibia, also known as the clinical drawer sign. The monofilament nylon leader line has a range of tensile strengths, and depending on the size of your dog, your veterinary surgeon will select a size between 40-100 pounds. Over time scar tissue will develop on the side of the knee joint where the large suture was placed, providing stifle stability in the absence of the canine cruciate ligament.

Extracapsular Imbrication Surgery, Traditional Repair Procedure is a post from: Dog Knee Injury

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Surgical Repair Options for Cranial Cruciate Ligament Repair

admin — Wed, 23 Apr 2008 21:35:41 +0000

For dogs diagnosed with cranial cruciate ligament tears or ruptures there are a number of non-surgical and surgical options available. Each dog is different, and your veterinarian will take into consideration your canine’s weight, size, overall health, severity of injury and the duration since onset when determining what treatment is best for your pet. Non-surgical options are generally referred to as “conservative management” and this treatment involves the use of weight management, prescription non-steroidals and rest to strengthen the joint and begin the healing process.

There are a few different surgical options for dogs with canine cruciate injuries, and not all veterinarians are trained in each procedure. It is important to find out from your vet what procedures they perform, and ask for referrals to specialists if you would like more information on a different type of procedure. There are vets the specialize in orthopedics and, if possible, it is preferable to choose a physician with this type of experience. Be sure to read up on each of the 4 surgical procedures before talking to your veterinarian about which one he/she recommends.

Surgical Repair Techniques for CCL Repairs:

Traditional Repair or Extracapsular Imbrication Technique – A leader line is woven in a figure-eight pattern through the joint beginning at the outer aspect of the femur to the tibial crest. The heavy suture will eventually be replaced by scar tissue providing support for the joint.
Tibial Plateau Leveling Osteotomy or TPLO – The head of the tibia is surgically altered and plated to create a new joint angle and prevent the femur from sliding off of the tibia. This procedure is an invasive on and involves cutting and plating of bone; it is associated with a higher rate of complications than the other surgical options.
Tibial Tuberosity Advancement or TTA – This is very similar to TPLO, yet considered to be less invasive, and involves stabilization of the stifle joint by cutting the bone and changing the angles of the knee.
Fibular Head Transposition – The head of the fibula is rotated and the lateral collateral ligament is moved in such a way that it mimics the cruciate ligament. The new positioning of the fibula is held in place using pins and wires. This procedure is not done very often and you may have a hard time finding a veterinarian that will actually perform it.
Tightrope Repair – An extracapsular technique using the lateral suture stabilization (LSS) procedure in conjunction with a material called FiberTape to provide bone to bone stabilization. Similar to traditional repair, the joint will form scar tissue, but the Fibertape will also provide support for a greater length of time.

Surgical Repair Options for Cranial Cruciate Ligament Repair is a post from: Dog Knee Injury

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