TreatmentoptionsforcranialcruciateligamentinjurydisasethedogkneeThean - PDF document

1 Treatmentoptionsforcranialcruciateligame
Treatmentoptionsforcranialcruciateligamentinjury/disasethedogkneeTheantecruciateament(ACL) istornpeople.Dogs, likeans,oftenrupturethis ligentperlyalledthecraniruciateent(CrCdogs. nlikehumans,thistearis oftenthe Choosing whichCrCLsurgicaltreatmentbestfor your petOur philosophyoffervarietysurgicaltreatmentsfor CrCLtearanddo our verybestwork withyou, thepetowner, totailorour treatmentrecommendationstheuniqueneedsof your petandfamily.Variables thatwe takeintoaccountwhen makingour recommendationsincludeyour pet’sactivitylevel,size,ageand conformatithedegreeof kneeability,andeachoption’saffrdabilityyour familyet.Surgical Surgicaltions Extracapssuture abiliztion(alsocalled“ExCapsuture”,“lateralfabellarsuturestabilization” andthe“fishinglinetechnique”)aditionalsurmentthathas been veterinarysurgeon, and24/7supervisedanestheticrecoveryandpainmanagmentapproximatelyTibialPlateauLevelingOsteotomy(TPLO)Thismethodwas aradicdeparturefromtraditionalExtracapsularSutureabilizationtreatmentwhen it was firintroducedthe1990’s. Our surgicalteamhas now performed1000’s of theseproceduresandhas gainedan understandingof thetechnique’sstrengthsandweaknesses. TPLO involvesmakingcircularcutthetopof theshin bone(tibialplateau)androtatingcontactsurfaceof this boneuntilattainsrelativelylevelorientationthatputsit at~ 90 degreesthepatellartendon.Thisorientationthetibialplateaurendersthekneerelstale, independentof theroleof theranialcruciateligent.The cutthestabilizedby theuse of abridgingplateandscrews. Oncethehas healed,theboneplateandscrews areneeded,areseldom removedless thereassociatedproblem.A recestudydemonstratedsuperirityof thistechnique oversuturestabilizatgiantbreedsof dogs. WepreferthismethodExtracapsularSuture Stabilizationactivedogs, young dogs, dogs over~ 40 pounds anddogs thathaverelativelystable kneestartwith(sutureabilizationdoesn’tseemableimprovethesepatientsmuch).Thecost of TPLO variesamongstveterinarycente

2 rsdependingupon theamountof preoperative
rsdependingupon theamountof preoperativescreening, degreeof anestheticmonitoring,sureontraining,costof imlantsused, amountof postopercare, etc.At CSU, we use theestlityimplalable.Theostof perative exam,rays, anestheticmanagementsupervisedby aboardcertified anestheiolgist,rgeryperforme/directedby aboardcertifiedveterinary surgeon, and24/7supervisedanestheticrecoveryandpainmanagementis approximately. Postoperativecarehomeverycriticaland involvesstrictactivityrestrictionr ~ 4 months.Premaureandexcessive activityrisksfracureof theprihealing.Tibialtuberosityadvancement(TTA)Thismethodmakeslinearcut alongthefrontof thetibia(“shinbone”).Thefrontof thetibia,calledthe“tiialtubeosity”ancedrward untilthepatellartendonoriented approximately90 degreesthetibiticethatthissimplyanotherway toccomplishthesamerientationas tTPLO). Thisorientationrendersthekneereltivelystable,independentof the roleof thecranialcruciategament.Theamountof advancement neededtainthisntationminedwe haverecentlycompletedstudythathas helpedus todeterminehow thisplanningbestperformed.cutthestabilizedwith bridgingboneplateandscrews. Oncethebonehas healed,theplatescrews areneeded,areseldom removedunless thereassociaproblem.LikewiththeTPLO, we preferthismethodExtracasularSutureabilizationactie dogs, young dogs, dogs over~ 40 pounds anddogs thathave relstablekneestawith(suturestabilizationdoesn’tseemableimprovethesepatients much).In somedogs, we discoverduringtheirpreoperatiplanningthattheirkneestructuredoes not lendsafeor efctiveapplicationthistechnique.OthertimesthedecisionbetweenTPLO and TTAbasedupon concurrentproblems,surgeon preference,etc.Thecostof TTAvariesamongst veterinarycentersdependingupon theamountof preoperativereening,degreeof anesthetic monitoring,levelof surgeon training,costof implantsused, amountpostoperativecare,etc.At CSU,we use thehighestqualityimplantsavailable.Thecostof preoperativeam,rays, anesthetic managementsupervisedby a boardcertifiedanethesilogisurgey performed/d

3 irectedby aboard certifiedveterinarysurg
irectedby aboard certifiedveterinarysurgeon, and24/7supervisedanestheticrecoveryandpainmanagementis approximately. Postoperativecarehomeverycriticalandinvolvesstrictactivity restrictionfor ~ 4 months.Prematuandexceactivityrisks rctureof thebonepriorbone healing. NonSurgicalOptions Activitystriction,weiloss and antimatoriesThiscomationatmentperse becauseoesstabilizetheknee.Thismenmayallthekneejointflammationbside somewhat.Whilethemptomsf lamenessandpainmaybsidewithtime,temturnto normactiitylevelswilltenlimitedby theprogession of osteoarthritis. In general,we do not advisethistherapytheidealof treatment, mayappropriatefor individualdogs due to somembinationf thverysize,inactifestyle,otherconcurrentinjuriesdiseases,or financialrealities. importantpointthat,general,therlierurgicpies are performed,themoreeffectivetheyare;thus“waitandsee”approachsurgical manageme basedonlyon wishful thnkingseldomadvised. Rehabilittiontherapy,custombracing,Thereampleevidencethatperioperative rehabilitationtherapyby atrainrehabilitationpractitoneradvanceandhastentherecoveryfrom surgery. Therelittle/noevidencesuggest thatthisconistentandpredictablealternativeto surgicalmanagemer mostoccanallymbinationf concurrentinjuriesr diseases, advancedage,patientsizeandnanciallimitationsleadpetowners topursuethisoption.Customknee bracingrelativelynewcanineorthopedicsandtherelittle/noscientificevidenceon thetopic applieduciateamentjuriehaveworked withOrthoPets (w.orthopets.co andhave found satisfactoryaccmplisof themangementalsselectedpatie General approach atCSU offerallof theoptionsdescribedabove.Afterexaminationof thepatient, discussionwiththener,andreviewof pertinentrays, we maker bestatmentcommendationfor theindividualpatientandowner. Inmostinstances,your primarycareveterinarianguideyou withsurgicaltreatments.If you or your veterinarianwishes toconsiderrgicalmanagement,pleasecallour appointmentdesk 970.297.5000 tomakeappointmentwithof our “smallaniorthopedicsurgery services”.