Cruciate Disease Repair:
Several surgical methods can be used to repair a ruptured cranial cruciate ligament tear in a dog’s stifle; for example:
- Extra-capsular techniques have been used for years with good results, especially in smaller breeds of dogs and in older dogs. Extra-capsular methods of repair are less invasive, and thus are usually less expensive.
- Current literature suggests that a TPLO (Tibial Plateau Leveling Osteotomy) procedure is a preferred method of repair for younger dogs and especially larger breeds of dogs with cruciate disease. A TPLO procedure is more invasive requiring cutting and plating of the tibia, and is therefore more expensive.
- TTA (Tibial Tuberosity Advancement) surgery is another, more recent suggested repair that accomplishes the same mechanical results as the TPLO.
I have been offering TPLO surgery since 2004 with very good results, and have been repairing cruciate disease with extra-capsular methods for decades. Which method of repair ultimately used is a decision between the veterinarian and the client, keeping in mind the best outcome for the patient.
In order to better help you and your client make a decision on anterior cruciate repair, the description below teaches you how to measure the tibial plateau angle. While many factors play a role in determining which method of ACL repair to recommend, our current thinking is that any animal over 50 pounds with a tibial plateau angle over 22 degrees will probably do better with a TPLO repair versus an extra-capsular repair. Even small dogs with very acute angles (>30 degrees) will probably do better with a TPLO repair.
The rationale is this: When patients with steep tibial plateau angles are repaired (especially dogs over 50#) with an extra-capsular technique, the tremendous forces placed on the extra-capsular implant my cause premature failure of the implant: breakage before adequate healing has occurred to stabilize the joint.
Radiograph the lateral stifle including the tibial tarsal joint on one plate. The stifle and hock should be flexed to 90º with the x-ray beam directed over the stifle.