We are providing some further information about surgical procedures commonly performed at Animal Care Cranbourne, together with aftercare notes.
Cruciate ligament disease
- The cruciate ligament is located in the knee (stifle) joint.
- Cruciate ligament disease usually affects dogs, but occasionally cats and is a result of damage or rupture of the ligament.
- May occur as a result of an accident, but more commonly as a result of gradual weakening of the ligament over time, with eventual breakage of the ligament. This breakage may be complete or result in a partial tear often with less severe lameness.
- Damage to the cruciate ligament leads to development of arthritis in the stifle joint and may be associated with damage to the menisci (cartilages) within the knee joint.
- We diagnose cruciate ligament rupture by manipulating the stifle joint (usually under heavy sedation or light anaesthetic) and observing for a “drawer” sign. In most cases we will also take X-rays.
- We generally recommend surgery for cases of cruciate ligament rupture. Occasionally cats and small dogs will respond to rest and pain relief over a period of 6-8 weeks. Larger dogs will generally have a persistent lameness made worse by exercise.
- There are many different opinions as to the best method of fixing a ruptured cruciate ligament, partly related to the size of the dog, but also taking into account breed, age and degree of arthritis already present in the joint.
- In general we recommend that small to medium sized dogs and cats have a “de Angelis” procedure performed. This is a procedure we can perform at Animal Care Cranbourne and consists of implanting a loop of heavy gauge nylon around the joint to simulate the broken ligament. We sometimes perform this procedure in very old larger dogs too. The cost of this procedure is usually $1000 to $1500, which includes an epidural injection for pain relief.
- Larger dogs, very active dogs and medium to large sized dogs with partial tears may benefit from having a specialist procedure performed. This can be performed at one of the Specialist orthopaedic surgeons mentioned under the links page (but please get a referral from us first). The Specialist surgeons have a number of techniques they can use including TPLO (tibial plateau leveling osteotomy), TTA (tibial tuberosity advancement) and TWO (tibial wedge osteotomy). These procedures are more complex and require cutting and realignment of the tibia bone beneath the stifle joint. The cost of these procedures is usually between $3000 and $4000.
- There is great debate about which procedure is the “best”. The Specialist surgeons usually recommend the more advanced procedures, although there is currently not much evidence that the long-term outcome is any better and there are more potential complications.
- After surgery there is generally a convalescent period of 2 – 4 months with a gradual improvement in function of the leg and a reduction in the lameness. Many dogs are completely normal on the leg at the end of this time, although some will have some lameness particularly with exercise. In many cases this persistent lameness is associated with the development of arthritis that usually occurs even with surgery. Occasionally dogs can develop damage to the knee cartilages after surgery and this can cause more severe lameness and the requirement for further surgery.