Dog Knee Surgery Types and Options

Dog knee surgery types can be a daunting topic for many pet owners. There are several options available, each with its own set of benefits and considerations.

Arthroscopy is a minimally invasive surgical procedure that uses a small camera and surgical instruments to examine and repair damaged joint tissue. This approach is often preferred for its reduced recovery time and less invasive nature.

Total knee replacement surgery involves replacing the damaged joint with an artificial one, typically made of metal and plastic. This option is usually reserved for more severe cases of arthritis or joint damage.

The goal of any dog knee surgery is to alleviate pain, restore mobility, and improve the overall quality of life for the affected pet.

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The cranial cruciate ligament, or CCL, is a vital ligament in a dog's knee that connects the femur to the tibia. It's essentially the canine equivalent of the ACL in humans.

The CCL has three main functions: preventing cranial displacement of the tibia, preventing hyperextension of the knee, and preventing internal rotation of the tibia. These functions are crucial for maintaining stability and mobility in a dog's knee.

A CCL rupture can cause significant pain and discomfort for a dog, leading to hind-limb lameness. This is often a result of the ligament's inability to perform its functions properly.

Diagnosing a CCL rupture involves a veterinarian feeling the knee for cranial drawer motion, a procedure that's not painful but may require a sedative in some cases.

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Dogs typically tear their ACL through degradation over time, unlike humans who often suffer a single blunt injury. This degradation can be caused by a lifetime of chasing squirrels and jumping frequently.

Breed and genetics can play a role in ACL tears, with larger breeds like English cream golden retrievers and labradors being more commonly affected. Elderly dogs aren't the only ones to have degenerative joints, and most ACL surgeries are performed on dogs between the ages of two and five.

Being overweight adds stress to your dog's joints, making exercise more strenuous and potentially leading to a more sedentary lifestyle.

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Dogs typically tear their ACL through degradation over time, like from a lifetime of chasing squirrels and jumping frequently, rather than a single blunt injury.

Larger breeds like English cream golden retrievers and labradors seem to be more commonly affected by ACL tears due to their genetics.

Being overweight can add stress to your dog's joints, making exercise more strenuous and potentially leading to a more sedentary lifestyle.

Dogs that don't regularly exercise can develop weak muscles, forcing their joints to over-compensate for the loss of stability.

Overexertion can also contribute to ACL tears, highlighting the importance of finding a balance between play and rest for your pup.

Spaying or neutering may be linked to ACL injuries, although more research is needed to confirm this relationship, so it's always best to consult with your vet about the best time to spay or neuter your puppy.

CCLD is just one of many potential causes of persistent hind limb lameness in dogs.

Hip dysplasia is another common issue that can cause pain and lameness in the rear limbs of dogs.

Joint sprains or muscle strains can also be a problem, especially if your dog has been injured or overexerted.

Knee cap displacement can occur in combination with CCLD, adding to your dog's discomfort.

Neurologic disease, such as a ruptured disc, can cause pain and lameness in the rear limbs.

Bone or soft tissue cancer can also be a cause of persistent hind limb lameness.

Fractures and joint dislocations (luxations) can be painful and debilitating for dogs.

Tendon rupture, specifically the Achilles tendon, can cause sudden and severe lameness.

Panosteitis, an inflammatory bone disease, mainly affects young, large breed dogs and can cause lameness.

Osteochondrosis, a cartilage disease, can also cause pain and lameness in the rear limbs of dogs.

Diagnosing a ruptured CCL can be a bit tricky, but veterinarians have a few reliable methods up their sleeves.

The diagnosis of CCLR is typically based on the presence of the “cranial drawer sign”, which is felt by placing your dog on their side and feeling the knee for cranial drawer motion.

Some dogs may be too tense to allow thorough palpation, so a sedative may be given to complete the examination.

Other signs of CCL rupture include “medial buttress” (thickening or scarring on the inside of the knee) and “tibial thrust” (another method to check for cranial displacement of the tibia).

X-rays are taken to rule out other potential causes of hind-limb lameness and to evaluate the extent of arthritis within the joint.

For early partial tears, veterinarians may need advanced imaging such as MRI or surgical exploration to physically look at the ligament.

X-rays are usually taken to confirm the presence of joint effusion (fluid accumulation in the joint which indicates that there is a problem within the joint).

The “cranial drawer test” and the “tibial thrust test” are specific palpation techniques used to confirm a problem with the CCL.

These tests confirm abnormal motion in the knee and hence a rupture of the CCL.

X-rays do not show the status (i.e. intact or damaged) of the CCL or the meniscus because those structures cannot be seen on X-rays.

Surgical options for dog knee surgery vary depending on the dog's size, age, and activity level. The goal of surgery is to permanently control instability in the stifle joint and address damage to the inside meniscus.

For small dogs under 35 pounds, the lateral suture procedure is a common and successful option, with a 90% success rate. This procedure involves looping a suture through a hole in the tibia and fabella, and connecting it back to the tibia to anchor the bones together.

There are three main orthopedic operations to repair an ACL tear: lateral suture, tibial plateau leveling osteotomy (TPLO), and tibial tuberosity advancement (TTA). The choice of surgery depends on the dog's size and breed, as well as the veterinarian's preference.

Tibial plateau leveling osteotomy (TPLO) is the most common surgery and is not dependent on the dog's size or breed. During this surgery, the veterinarian makes a curved cut to the tibia and turns the tibial plateau to level the tibia and femur.

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Tibial tuberosity advancement (TTA) involves cutting inside the shin bone, removing some of the menisci, and attaching a metal plate to the tibia and a bone graft to promote healing. This surgery is often preferred for large, active dogs.

Here are the three main orthopedic operations to repair an ACL tear:

It's essential to remember that no surgical procedure will completely heal the dog, and treatment of ACL injury is a lifelong process involving rehabilitation, nutrition, and chronic use of pain control medications.

There are several surgeries that can be performed to repair a torn CCL in dogs. The extracapsular suture (MRIT) is one option, which involves using heavy-gauge sutures to decrease joint instability.

The Tightrope CCL procedure is another option, which is often used in smaller breeds. Tibial tuberosity advancement (TTA) and tibial plateau leveling osteotomy (TPLO) are also options that provide dynamic stabilization by neutralizing the shear forces in the stifle joint.

These surgeries all have some commonalities, such as the goal of achieving stability of the stifle joint, and the importance of proper case selection, knowledge of anatomic landmarks, and postoperative care.

The CCL rupture can have a ripple effect on other parts of the joint. The medial meniscus, a fibrous pad attached to the top of the tibia, can be injured at the time of CCLR or after prolonged instability of the stifle joint.

The medial meniscus acts as a cushion inside the joint, but without the support of the CCL, the femur puts abnormal pressure on it, leading to tearing or shredding of the meniscus. This can cause further arthritic change in the joint.

The abnormal movement caused by a torn CCL can also damage the cartilage pads in the joint, known as the menisci. Damaged menisci lead to further arthritic change, which can result in constant pain for the dog.

In many cases, the joint becomes so damaged that surgery is the only option to alleviate the dog's pain.

Torn ligament surgeries for dogs aim to restore stability to the knee joint, but no surgery can completely heal the dog. The goal is to alleviate pain and improve mobility, rather than achieving a full recovery.

Some common surgeries for a torn ACL in dogs include the extracapsular suture (MRIT), Tightrope CCL, Tibial tuberosity advancement (TTA), and Tibial plateau leveling osteotomy (TPLO). These procedures have varying degrees of success and are often chosen based on the dog's size, breed, and activity level.

The extracapsular suture method involves using heavy-gauge sutures to stabilize the joint, while intracapsular methods involve replacing the cruciate ligament with autogenous or autologous grafts or synthetic materials.

Tibial osteotomy techniques, such as TPLO and TTA, provide dynamic stabilization by neutralizing shear forces in the stifle during weight bearing. However, these techniques may not be suitable for larger, athletic dogs.

The keys to a successful outcome with any of these techniques include proper case selection, knowledge of anatomic landmarks, proper application of the technique, postoperative care, and rehabilitation.

Here are some potential complications that can arise from these surgeries:

The Lateral Suture Procedure is a common surgery for cruciate ligament injuries in dogs. This procedure involves placing an artificial fiber on the outside of the joint to stabilize abnormal motion.

It's more likely to fail in larger breed dogs. Small-breed dogs are more likely to see success with this procedure.

There's a tendency to overtighten the artificial ligament, which can lead to excessive joint compression and damage to the cartilage. This can also result in a decrease in the normal range of motion.

The procedure's real benefit may be to keep the leg in a forced rested position, allowing the dog's body to build up scar tissue and limit abnormal motion. This can be a temporary solution until the dog's body heals.

Most surgeons agree that artificial ligaments will eventually break, so this procedure isn't a long-term solution. Many surgeons are now moving away from this procedure in favor of newer techniques.

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The TPLO procedure is a surgical method used to treat a torn ACL in dogs. It's designed to alter the slope of the Tibial Plateau, which some advocates claim is the cause of the rupture.

The procedure involves making a circular cut in the tibial plateau and rotating the contact surface until it's relatively level. This orientation of the tibial plateau renders the knee relatively stable, independent of the CCL.

The cut in the bone needs to be stabilized by a bridging bone plate and screws. Once the bone has healed, the plate and screws are not needed, but are seldom removed unless there's an associated problem.

The greatest advantage of the TPLO procedure is its perceived superior outcome, with improved limb function and less progression of arthritis, especially in young, large breed dogs.

However, the major disadvantage is the need to perform an osteotomy, which requires healing of the bone. If a problem is observed, such as implant failure or failure of the bone to heal, it may require multiple revision surgeries and the outcome may be poor.

Here's a comparison of TPLO and TTA procedures:

The decision between TPLO and TTA is based on concurrent problems, surgeon preference, and the anatomic configuration of the dog's knee. Some dogs' knees may not lend themselves to safe or effective application of one or both techniques.

Surgical treatment is recommended for CCLD because it's the only way to permanently control the instability in the stifle joint and evaluate the structures within the joint.

The recovery process will require at least 3 months of exercise restrictions, including leash walks only, no running, jumping, or rough house play. Physical therapy and rehabilitation are also essential and will be outlined for you and your pet.

You'll need to follow a detailed post-operative care plan, which may include restricting activity to leash walks only for the first few weeks, and avoiding strenuous activity for at least 3-4 months. This will help prevent severe complications and ensure proper healing.

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Here are the three main orthopedic operations to repair an ACL tear:

It's essential to follow your veterinarian's instructions and avoid strenuous activity for at least 6 weeks after surgery. Most dogs will need to wait 12-16 weeks before gradually increasing their walks and activities.

Surgery is often the best option for treating a torn ACL in dogs, but it's not a one-size-fits-all solution. The best surgical procedure depends on factors such as your dog's size, age, and activity level.

There are three main orthopedic operations to repair an ACL tear: lateral suture, tibial plateau leveling osteotomy (TPLO), and tibial tuberosity advancement (TTA). Each of these procedures has its own success rate and indications.

For small dogs under 35 pounds, the lateral suture procedure is often performed with a success rate of about 90%. However, this surgery doesn't completely heal the dog, and some dogs may experience intermittent periods of stiffness and lameness for the rest of their lives.

In contrast, TPLO and TTA surgeries can provide more stability and reduce the risk of arthritis, but they may not completely eliminate the risk of lameness or stiffness. It's essential to work with a veterinarian to determine the best course of treatment for your dog.

Here are some common surgical options for treating a torn ACL:

Each of these procedures has its own advantages and disadvantages, and the best option for your dog will depend on their individual needs and circumstances.

The recovery process is a crucial part of your dog's ACL surgery, and it's essential to follow the instructions carefully to ensure a smooth and successful recovery.

For the first six weeks, your dog will need to avoid running, jumping, or climbing, so it's best to set up a comfortable staycation for them in a small space away from tempting surfaces and activities.

Short, leashed walks are allowed during this time, but it's essential to keep the walks short and gentle to avoid putting too much strain on the affected leg.

You'll need to keep an eye on your dog's activity level and make sure they're not doing any strenuous activities, such as playing fetch or running around the yard.

Recheck appointments with your veterinarian will be required at 4-6 weeks and 3 months after surgery, and x-rays may be taken to assess bone healing if a TPLO or TTA was performed.

Most dogs will need at least 3 months of exercise restrictions, which means leash walks only, no free roam of the backyard, and no running, jumping, or rough house play.

Physical therapy and rehabilitation will be essential, and a detailed program will be outlined for you and your pet to follow.

After 12-16 weeks, you can gradually make your dog's walks longer, but they probably won't be completely back to normal for the first six months.

It's also essential to maintain muscle mass and joint function (range of motion) during the recovery period, and multiple studies have shown that physical therapy speeds up the recovery and improves final outcome.

Proper postoperative care limits activity to leash walking for a minimum of eight weeks and no running, jumping, rough-housing, or off-leash activity.

Complications from dog knee surgery can arise, with some owners experiencing post-operative infections, such as osteomyelitis, which can be life-threatening if left untreated.

The cost of dog knee surgery varies depending on the type of surgery, with cruciate ligament repair surgeries typically costing between $1,500 and $3,000.

Some dog owners have reported experiencing chronic pain and arthritis after surgery, which can impact their pet's quality of life and require ongoing veterinary care.

Potential complications of surgery can be concerning, but it's essential to understand what they are and how to prevent them. Excessive bleeding is a potential complication of surgery, and it's crucial to follow post-operative instructions carefully.

Any time an animal undergoes anesthesia, there's a risk of adverse reactions, including death, although this is rare. Blood work is performed prior to anesthesia to identify any underlying medical conditions.

Complications associated with surgery are uncommon, but they can include infection, fracture of the tibial crest or fibula, and surgical implant failure. Infection can often be prevented by following post-operative instructions, such as restricting your dog's activity and keeping the incision clean.

Delayed healing of the bone is a potential complication of osteotomy techniques, and it may require multiple revision surgeries. Non-healing of the bone is another possible complication, which can also lead to further surgery.

Healing in an incorrect position, such as with rotation of the limb, can be a serious complication of osteotomy techniques. Fracture of the bone is also a potential complication, and it may require additional surgery.

Following exercise-restriction guidelines and having an experienced surgeon perform the procedure can help minimize the risk of serious complications. Serious complications that require a second surgery are rare when these precautions are taken.

The cost of dog ACL surgery is a significant concern for many pet owners. ACL surgery can range from around $1,000 to up to $5,000.

The cost varies depending on the type of operation. Extracapsular Lateral Suture Stabilization (ELSS) is the least expensive option, costing between $1,100 and $2,500.

Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are more expensive options, costing between $2,400 and $4,500.

Pre-operation procedures such as bloodwork and postoperative physical therapy may or may not be included in the cost. Many surgeries and post-surgical rehabilitation are covered by pet insurance.

Here are the estimated costs for each type of surgery:

It's worth noting that some hospitals may include post-surgical physical therapy in the cost.