One of my biggest Veterinary interests is Orthopaedics – the study of bones and joints. An injury we see in practice is rupture of the cruciate ligament in the stifle (knee) joint.
The cruciate ligament is an important structure in dogs stifles as it holds the femur and the tibia in alignment so that the joint can function properly. In Dogs, their cruciate ligament is in tension whenever they stand so damage to the ligament leads to serious problems. The cruciate ligament can weaken over a period of time and then rupture without warning.
Rupture of the cruciate ligament leads to sudden onset pain and lameness in the affected leg, damage to the cartilage (called the meniscus) on the joint surface and the development of arthritis. In dogs with ruptured cruciate ligaments, surgery is usually required to regain good use of the leg.
A variety of surgical techniques have been used over the years to help dogs with cruciate damage. Currently we mainly use one of two techniques:
- A technique called a “fabello-tibial suture” is where a loop of nylon is fastened behind the joint then passes through a small tunnel in the front of the tibial bone. This nylon is tensioned and held in place with a small metal crimp. This technique is often successful in smaller dogs however the nylon can stretch and break with the forces a larger dog exerts.
- A relatively new technique which overcomes this problem is a procedure called a TPLO (tibial plateaux levelling osteotomy). The operation involves making a semicircular cut in the tibia with a specially sized titanium saw, then rotating the portion of bone by a certain number of degrees. The bone is then held in place with a specially designed plate and 6 screws. This effectively realigns the stifle joint so that a cruciate ligament is no longer required. Although it is much more complex surgery, the results compare very favourably with the more straightforward procedure.
Often the TPLO is a procedure which vets refer to specialist centres however we have recently invested in equipment and training and are now performing this procedure at our surgery at Maple Street. We have now performed a number of TPLO procedures and it is very rewarding to see larger dogs recovering well from their cruciate surgery. The surgical team performing the TPLO operations consists of 2 vets and 2 vet nurses.
The radiograph above shows the post-op view of Ruby Flynn, a Rottweiler from Primrose Hill who we operated on some weeks ago and is making an excellent recovery. The x ray shows the curved cut in the bone and the plate used to fix the portions of bone in place.