By Dr. Laura Hady
Last month, I discussed the possible causes of lameness resulting from knee injuries in pets. This article will address potential surgical options, conservative management, and what to expect on the road to recovery. The best tip I can give owners before, during, and after treatment is to write down a list of questions that you want to ask your family veterinarian and/or veterinary orthopedic specialist so that you will understand the whole process.
- The extracapsular lateral suture technique for a torn or ruptured cranial cruciate ligament works to help recreate knee stability. In this procedure, a specialized ultra strong suture is looped in a figure-eight fashion from a hole placed in the top of the tibia (shin bone) to a small bone behind the knee called the fabella. The suture will promote scar tissue formation over time that will help stabilize the joint. The recovery time is usually eight weeks, with the first two to four weeks most critical for resting the leg. Pre- and post-surgery non-steroidal anti-inflammatory medications, such as carprofen, Deramax and Galliprant can lessen pain by reducing inflammation. Additional pain medications such as opioids or gabapentin are usually prescribed for at least the first week after surgery. Arthritis may still occur in the knee joint, and your surgeon may recommend nutritional supplements like glucosamine/chondroitin and fish oil for the rest of the dog’s life to promote good joint health. I personally prefer this technique in smaller and less active dogs and cats. Physical rehabilitation may start about two weeks after surgery when the incision has healed.
- Tibial plateau leveling osteotomy (TPLO) surgery involves pre-planning X-rays to properly cut, rotate and place a bone plate and screws for a cranial cruciate ligament tear. This should promote healing of the tibia (shin) bone in an improved, more level angle with the femur. The TPLO surgery prevents the abnormal shearing relationship between the tibia and femur, and limits the need for an intact cranial cruciate ligament to stabilize the knee. The surgeon will also open the joint or use an arthroscope to see if the meniscus (the C-shaped shock absorber between the femur and tibia) has a tear. If there is a tear of the meniscus, the surgeon may take out a very small piece of the damaged tissue. The healing period for a TPLO surgery is typically eight to 16 weeks, with the first eight weeks the most critical for resting the leg. I prefer this surgery for larger and more active dogs. The start of formal physical rehabilitation is dependent on surgeon preference, with special attention to the fact that a bone was cut and needs to properly heal. While the TPLO surgery will cost more than the extracapsular technique, pets typically tend to have less arthritis later in life.
- Medial patellar luxations may need a combination of techniques to resolve issues of a kneecap (patella) that pops out and is difficult to put back in the groove, or that stays out all the time. The first step is to move the attachment of that big patellar ligament in relation to the tibia (shin bone) so that the alignment of the ligament and the patella are correct. Secondly, the patellar groove needs to be deepened by cutting out a wedge in the groove and seeding it deeper so that the patella does not pop out over the edge. Alternatively, some pets may need an actual patellar groove replacement made of titanium for proper gliding of the patella in the groove. Finally, the joint capsule that holds the patella may need to be tightened (imbrication) to prevent a luxation from happening. Physical rehabilitation can start in two to six weeks after surgery, depending upon which combination of techniques is used.
