The Canine Stifle
The most common cause of rear limb lameness in the dog is rupture of
the cranial cruciate ligament in the stifle(knee) joint (figure 1).
This injury resultsin progressive arthritis, damage, and meniscal injury.
Early surgical ntervention can stabilize the knee and allow
for return to good function.
BIOMECHANICS
The cruciate ligament is responsible for stabilizing the knee during
normal activity. Dogs have constant stress on the cruciate ligament as
they stand on their toes with their knees in flexion. During activity, the
femur slides down the tibial slope, and the tibia is forced forward
(Figure 2) putting stress on the cruciate ligament. Strenuous exercise,
poor conditioning, obesity and a steep tibial slope contribute to
excessive stress on the cruciate ligament.
DIAGNOSIS
Cranial cruciate ligament damage occurs most frequently in middle
aged, large breed, and overweight dogs. The signs of lameness may
occur acutely or they may appear gradually with intermittent signs of
discomfort. The discomfort exhibited varies from mild intermittent
signs to continuous non-weight bearing lameness. A definitive
diagnosis and evaluation of each patient requires palpation and
manipulation of the knee for instability. Radiographs and palpation
under sedation are required for preoperative evaluation and surgical
planning.
SURGICAL STABILIZATION
Immediate surgical stabilization of the joint is recommended to enhance
the return to function and prevent chronic arthritic changes.
TPLO Surgery
The Tibial Plateau Leveling Osteotomy (TPLO)
procedure has proven effective in returning
injured stifles to full function. This procedure is very
effective in all breeds but is especially important in large
active dogs due to the structural stability it provides.
The Tibial Plateau Leveling Osteotomy is used to
reduce the tibial slope by surgically rotating the top
of the tibia (plateau) and plating it into place (Figure 3).
Please visit our page on post-op care for dogs undergoing TPLO
surgery for more information
Lateral Suture
Lateral suture stabilization techniques utilize the surrounding ligaments,
muscles and bones, or synthetic ligaments to replace the action of the
damaged cruciate ligament. Surgical intervention greatly slows the
progression of arthritis and results in a stable knee with more normal
function.
Please visit our page on post-op care for dogs under going lateral
suture stabilization for more information
TTA
Tibial tuberosity advancement (TTA) is a new surgical procedure
developed at the School of Veterinary Medicine, University of Zurich,
Schwitzerland by Dr's Slobodan Tepic and Pierre Montavon. The
procedure was developed over a 2 year period starting in December
2001 and was first taught to surgeons in the US in October of 2004.
As of July 2005, TTA has been performed on approximately 4,500
dogs.
TTA stabilizes the knee by altering forces across the knee so that the
stifle is stable during weight bearing, eliminating the need for an intact
cranial cruciate ligament. TTA achieves stability by moving the patellar
tendon,, whereas TPLO achieves stability by rotating the tibial plateau.
In contrast to TPLO.
Meniscal Injury
The meniscus is the cartilage padding in the joint and is often injured
during the original cruciate ligament tear. Meniscal injuries are also
addressed during the surgical procedure.
Cranial Cruciate Ligament Rupture
Figure 2 |
Figure 1 |
Figure 3
1. Trochlea of femur
2. Tibia
3. Fibula
4. Cranial cruciate ligament
5. Caudal cruciate ligament
6. Lateral meniscus
7. Medial meniscus
2. Tibia
3. Fibula
4. Cranial cruciate ligament
5. Caudal cruciate ligament
6. Lateral meniscus
7. Medial meniscus
