TPLO - Corrective Surgery for ACL Rupture

How does the CCL (ACL) get damaged?

Damage to the cruciate ligament in humans is a common injury caused by trauma such as in athletes (football players) or an accidental slip etc. However, this is not the case in dogs. In dogs, this is a slow and progressive weakening of the ligament almost like fraying of a rope. We do not exactly know the cause of CCL rupture, but speculate many factors, one being from years of constant forward thrust of the tibial bone.

Symptoms and Identification of CCL Rupture

Frequently, the first sign of CCL rupture is an acute lameness in which the dog may cry out and is suddenly holding up one of the hind limbs due to pain. Other times with a more chronic issue in which the CCL is becoming more and more frayed, dogs will have chronic soreness in the hind limb and walk with a limp in the affected knee. If your dog has any of these symptoms, your pet should be taken to your veterinarian for evaluation. Upon evaluation of your dog by the veterinarian, certain simple tests will be performed and likely, sedated X-rays will be performed to get a more clear diagnosis.

Surgical Repair of CCL Rupture (ACL rupture)

CCL ruptures can be treated effectively, most commonly through surgery. Here are the most common surgical techniques

• Extracapsular repair/Lateral Suture Technique: One of the oldest of the CCL repairs. In simplest terms, a suture material (artificial cruciate ligament) is placed from the back of the knee joint around to the front of the knee, acting like an artificial CCL. One small bone tunnel is necessary to perform this procedure. The suture material tends to stretch or break prior to strong enough fibrosis to occur to help stabilize the knee.
• TTA (Tibial Tuberosity Advancement): This is a surgical procedure which involves cutting the top of the tibia and moving it forward and stabilizing it in a new position with implants.
• Tightrope Technique: The Tightrope technique, which is the latest procedure, was designed to be a minimally invasive procedure that augments the principles of the lateral suture technique by increasing stabilization from bone to bone fixation at highly researched isometric points on both the femoral and tibial sides of the limb. Newer and improved stronger implants that were developed for this technique will allow for stronger stabilization of the knee. This stronger and improved material stabilizes the knee to allow for improved periarticular fibrosis in the post-operative recovery phase, allowing the patient to get back to a more normal life prior to the ligament rupture.
• TPLO (Tibial Plateau Leveling Osteotomy): The TPLO is considered the gold star standard in cruciate rupture. It is also considered the most invasive and most expensive procedure due to the complexity and specialized plating and screw systems applied to the repaired limb. The way this procedure works is by eliminating what is called the Cranial Tibial Thrust, which are the forces that cause the damage to the cranial cruciate ligament in the first place. This procedure is considered the best form of stabilization of the Cruciate Deficient Stifle. Although not every procedure is right for all pets, this procedure is best for most. See animated video of the TPLO procedure below.

Does your Pet Have CCL Problems?

At Summit Boulevard Animal Hospital, Dr. Eric Schnirman has advanced surgical training in orthopedic repairs of dogs and cats. Cranial Cruciate Ligament Ruptures are a very common cause of lameness and osteoarthritis in dogs. This has been one of Dr. Schnirman’s main focus for many years. He has had advanced training in fracture repair, and TPLO/Tightrope Stabilization of the Cruciate Deficient Stifle. At Summit Boulevard Animal Hospital, the TPLO for CCL Rupture is offered. Please contact us for a complimentary consultation with your pet for an evaluation and discussion on which surgical procedure would be best for you and your pet.