Cranial Cruciate Ligament Surgery

Surgery to treat lameness caused by Cranial Cruciate Ligament [CCL] trauma or disease is one of the most common orthopaedic operations in dogs.

There are two cruciate ligaments within the stifle [knee] joint which act in opposite directions to each other to counteract shearing forces between the Femur [thigh bone] and Tibia [shin bone]. When damage occurs to these ligaments, it is almost always the cranial ligament that is affected. The ligament can be torn by straining / twisting of the ligament during exertional exersize, but more commonly in the bigger breeds the ligament is gradually torn over a period of time - causing either continuous or intermittent lamenss. It is now widely accepted that this is a 'disease' of the ligament rather than simple trauma. Unfortunately, once the ligament is damaged the gradual process of osteoarthritis [degenerative joint disease] will commence. Surgical treatment is designed to remove as much pain and lameness as possible and reduce the onset and severity of arthritis.

Currently there are a number of surgical techniques used  to treat these cases. They can be divided into techniques that Do or DONT involve osteotomies [cutting into the bones].

  1. Without an osteotomy, can offer the Lateral Suture Technique which, after inspection of the menisci [cartilages] in the joint and removal of any damaged sections, involves placing a special FIBREWIRE suture from behind the lateral fabella to a small hole drilled in the tibial crest. The concept of this repair is to stabilise the joint with the prosthetic suture by placing it in a simiar direction and taughtness to the original cruciate ligament. Eventually the prosthesis will break, but by then there should be enough fibrosis around the joint for it to cope.
  2. Osteotomy techniques are now many and include tibial plateau levelling operation [TPLO], tibial tuberosity advancement [TTA], triple tibial osteotomy [TTO], tibial wedge osteotomy [TWO] and others. These operations are all designed to remove the shear forces on the joint thus alleviating pain and lamenss. They are all more complex procedures and inevitably involve the risk of bigger complications, but usually give a much better outcome and quicker than lateral suture. Recently a variation of the TTA surgery has been developed called the Modified Maquet Procedure [MMP] using a Titanium Foam Wedge insert which is very exciting because the success rate is so high and the complication rate is much lower. We are now pleased to be able to offer this surgery and would recommend it as the best option for most cases. For more information contact us at any of our surgeries.