Cruciate (ACL) Repair Surgery

Cruciate ligament rupture is one of the most common causes of rear lameness in dogs. Typically, we will see a dog that is demonstrating sudden rear leg lameness, so painful that the dog may not place any weight on that leg at all! Luckily, Dr. Heller has provided a remedy and relief to dozens of local dogs through surgical repair.

What is a Cruciate Ligament?
The knee is a complicated joint. Assorted ligaments hold everything together and allow the knee to bend the way it should and keep it from bending the way it shouldn’t. The Cranial Cruciate Ligament (CCL) is one of 2 ligaments that cross inside the knee (stifle) joint. The cruciate ligaments function to prevent the femur and tibia from sliding back and forth on each other.

As the ligament deteriorates, a combination of inflammatory factors released from the ligament coupled with increasing instability of the joint from the weakened ligament, causes arthritis to develop quickly within the joint. When the ligament is weakened or ruptured, every time the pet bears weight on the affected leg the femur slides down the tibial plateau with nothing to halt its movement. This sliding action damages a cartilage cushion in the joint called the meniscus. Once the meniscus is torn arthritic change accelerates and perceived pain worsens.

What should be done before a cruciate repair surgery?
A thorough physical exam by the surgeon is important to establish a doctor-patient relationship, evaluate your pet’s health and discuss the surgery, complications and recovery with you.

Since arthritis can set in relatively quickly after a cruciate ligament rupture, radiographs (x-rays) to assess arthritis are helpful. Another reason for radiographs is that occasionally when the cruciate ligament tears, a piece of bone where the ligament attaches to the tibia also breaks off. This will require repair and the surgeon will need to know about it before beginning surgery. Arthritis that has set in prior to surgery limits the extent of the recovery after surgery, though surgery is still needed to slow or even curtail further arthritis development.

A full panel of blood work should be performed prior to anesthesia to identify any other health problems that may pose anesthetic or recovery complications.

Will this procedure have a negative affect on the opposite leg?
No. Surgical repair of cruciate tears has no negative affect on the opposite leg. In fact, early repair and subsequent early return to function in the affected leg may decrease the stress on the unaffected leg.

Will my dog’s other knee need to have surgery?
Forty percent of all dogs with cruciate rupture on one side will develop the same problem on the opposite side sometime in the future.

Weight bearing studies have shown that dogs with a damaged cruciate ligament bear only about 20-30% of the normal amount of weight on the affected leg. As a result, the weight is shifted to the other rear leg placing even more stress on that limb's cruciate ligament. Therefore, one of the most effective ways to decrease the percentage of your dog’s other knee requiring cruciate repair is early surgical repair of the first leg to allow for even weight distribution. In addition, weight loss in overweight dogs is recommended to decrease the added stress placed on the joints, not to mention other health benefits!

What happens during surgery?
Dr. Heller will open and inspect the knee joint. The torn or partly torn cruciate ligament is removed. Any bone spurs of significant size will be removed. If the meniscus is torn, the damaged portion is removed. A facia lata graft is performed from the biceps muscle and passes through and around the joint to stabilize the knee. A large, strong suture is passed on top of the graft and around the fabella (behind the knee) and through a hole created in the front of the tibia. This tightens the joint to prevent the drawer motion, effectively taking over the job of the cruciate ligament! As the graft scar is left, it will help permanently stabilize the knee after the sutures placed eventually will dissolve on their own.

What type of recovery is to be expected?
Typically, the dog may carry the leg up (not placing much weight on it) for about 2 weeks after surgery. The knee will be increasingly used over the next few month until it eventually will be expected to return to normal function.

Your dog will require approximately 8 weeks of exercise restrictions after surgery (no running, jumping, leash walks only). In addition, your pet may need some assistance getting up until he or she is comfortable doing so on their own. Dr. Heller may prescribe some physical therapy to be performed at home during your dog’s recovery period.

Will my pet experience pain after the TTA surgery?
Like any surgery, some post-operative discomfort is unavoidable and all patients vary in their response to pain. All dogs undergoing cruciate repair at All about PetCare will have a pain management plan implemented before, during and after surgery. At home pain medications will be dispensed for you to continue to help your dog’s recovery and comfort.

How long will my pet stay at All about PetCare?
We like to keep our cruciate patients overnight in our hospital for a one night stay post-surgery. This will allow our Doctor and team to closely monitor the recovery and comfort of your pet. In addition, a hospital stay will ensure a quiet, safe place for your dog to convalesce to further promote recovery.

What happens to a torn cruciate ligament without repair?
Without an intact cruciate ligament, the knee is unstable. Wear between the bones and meniscal cartilage becomes abnormal, and the joint begins to develop degenerative changes. Bone spurs called osteophytes develop, resulting in chronic pain and loss of joint motion. This process can be stopped by surgery but cannot be reversed.

How do I schedule surgery?
If your pet is not a patient of Dr. Heller and is being referred by another practice, please call to schedule a pre-surgical consult at our office. At this appointment, please be sure to bring any veterinary records, including radiographs and blood work, that your veterinarian may have performed.

This appointment will allow for Dr. Heller to evaluate your pet’s condition, make pre-surgical recommendations (including possible blood work and radiographs) and answer any questions that you may have.

If your pet has been diagnosed with a torn cruciate by a Doctor at All about PetCare within the last month, you may call to schedule the surgery. Typically, surgery can be scheduled within 2-3 weeks.

If you are interested in scheduling a pre-surgery appointment or surgery reservation, or if you have more questions, please feel free to call our office at (513) 424-1626.