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Torn ACL

Symptoms

A rupture of the anterior cruciate ligament is one of the most common causes of hind limb lameness in dogs. The symptoms are caused by a partial or complete tear of the anterior cruciate ligament, which causes discrete to obvious instability of the knee.

Techniques

Over the years, various techniques have been described for treating cruciate ligament tears: in addition to conservative treatment with anti-inflammatory drugs and rest – which is particularly effective in small dog breeds – there is also surgical treatment, which aims to prevent instability.

Older techniques focus primarily on restoring stability by reconstructing the anterior cruciate ligament or by strengthening the joint capsule. Newer techniques reorient the forces within the knee, thereby eliminating instability. Older techniques focus primarily on restoring stability by reconstructing the anterior cruciate ligament or by strengthening the joint capsule. Newer techniques reorient the forces within the knee, thereby eliminating instability.

Imbrication

In imbrication, the joint capsule and soft tissues around the knee joint are tightened in order to restore stability to the knee joint. Over time, the sutures may loosen and the knee may become slightly unstable again. This technique can be used successfully in both small and large dog breeds, although the long-term results are better in smaller breeds than in larger breeds.

FLO ligament

Worldwide, the most commonly used technique is still the placement of an artificial cruciate ligament outside the joint (known as the “FLO ligament”). This ligament runs in the same direction as the torn cruciate ligament, thereby helping to restore stability to the knee.

The technique is successful because it is relatively easy to learn and also offers fairly good results, especially with lighter breeds of dog. With larger (heavier) dogs, osteotomy techniques (see below) have been scientifically proven to be superior.

TTA Rapid

The latest method for performing a TTA is TTA Rapid.

In a TTA (Tibial Tuberosity Advancement) technique, the front part of the tibia is cut through and fixed in a more forward position with a cage. A bone graft or bone paste is applied in and around the cage to stimulate filling of this space. The implants were developed by the company R. Leibinger and the technique was perfected by our own department.

TTA Rapid X-Ray

A TTA_Rapid is successfully used on large to giant breeds, but can also be performed on smaller dogs.

This technique allows us to apply the same proven principle of a classic TTA, but with fewer implants (less chance of failure) and faster surgery (shorter anaesthesia for the dog).

TPLO

In a TPLO (Tibial Plateau Levelling Osteotomy), the top of the tibia is cut through, tilted backwards and secured with a plate and screws. A TPLO is successfully performed on both large and small dog breeds.

CBLO

CBLO is the abbreviation for CORA Based Leveling Osteotomy. CORA, or Centre of Rotation of Angulation, is based on a surgical technique used in human medicine, in which the curvature in the bone is corrected mathematically (using trigonometry) according to specific axes.

Since dogs have a natural (but sometimes excessive) curvature in the tibia, there is a slope in the joint surface of the knee. When the principles of CORA are followed, the CBLO surgical technique will eliminate the curvature in the tibia. At the same time, the upper part of the tibia will tilt forward. CBLO therefore has a dual effect: correction of an excessively sloping knee surface and forward displacement of the knee ligament. The latter phenomenon is comparable to the TTA technique.

Therefore, with CBLO, it is not necessary to push the tilting of the tibia to extremes. With CBLO, the support axes of the tibia are corrected so that the knee joint is balanced during weight bearing. Correct pressure is also created in the knee joint. CBLO is particularly suitable for animals with a severe slope of the tibial bearing surface (>28°). Animals with a normal slope are eligible for a TTA or imbrication technique.