CRUCIATE DISEASE IN DOGS

Fixed Price TPLO / TTA fee includes initial consultation and FREE 6-8 week follow-up re-examination & x-rays

<20kg: £2750 incl. VAT at 20%

20-50kg: £2950 incl. VAT at 20%

>50kg: £3400 incl. VAT at 20%

Background There are two cruciate ligaments in the knee (or ‘stifle’ as we call it in dogs). Disease of the cranial (or anterior) cruciate ligament is one of the most common orthopaedic conditions seen in dogs. In people cruciate ligament (or ‘ACL’) ruptures are typically seen as acute sporting injuries, in footballers and skiers for example. In dogs it is a little different. In most dogs the condition is a more chronic degenerative condition. The ligament degenerates and gets weaker with time and at some point will start to tear. The signs associated with the initial stages of the condition can be subtle and may be missed –signs such as stiffness on rising from rest and mild, occasional lameness. As the ligament continues to tear the signs may become more obvious but it is not uncommon for owners to first realise their dog has a problem when the already weakened ligament finally tears completely, often during relatively normal activity. At this stage the stifle will be unstable –the two bones of the stifle (the tibia and femur) will rock back and forth during walking. This instability will often lead to the menisci (cartilage ‘shock absorbers’ of the knee) being torn, which can cause significant lameness and discomfort unless treated appropriately.

Diagnosis The diagnosis is often made on palpation/manipulation of the stifle, although in some dogs this may require sedation. X-rays will show signs of osteoarthritis (OA or ‘arthritis’). Early cases may be less easy to diagnose, sometimes requiring exploratory surgery/arthroscopy to visually examine the cruciate ligament.

Treatment Small dogs (less than 15kg) may do well with a period of rest and antiinflammatories alone, although surgery may offer a quicker recovery. Larger dogs are less likely to do well without surgery and so surgery is always advised. Surgery involves examination of the menisci, so that any torn pieces can be removed, and stabilisation of the joint. Numerous stabilisation techniques have been described. The most successful techniques involve placing a restraining suture around the outside of the joint to try to replicate the function of the torn ligament (known as extracapsular or lateral retinacular suture stabilisation) or changing the geometry of the tibia to counteract the forces that are responsible for the instability (e.g. tibial plateau levelling osteotomy, or TPLO, and tibial tuberosity advancement, or TTA). Both strategies, in the right hands, can provide good results for dogs of all sizes although most specialist surgeons would agree that techniques such as TPLO or TTA offer a quicker and more reliable outcome, especially in larger dogs or very active dogs.

Preoperative x-ray showing the tibial plateau angle (TPA), x-rays following TPLO, TPLO cartoon

Extracapsular suture – Key Points:

• Reliable technique in small/medium dogs, but risk of suture stretching/failure which can result in recurrent instability
• Postoperative function enhanced through the use of a minimally invasive arthrotomy, isometric suture placement & use of high stiffness nylon and crimps

TPLO / TTA– Key Points:

• Very reliable techniques even in very active or large/giant breeds of dog
• Early return to limb use (often weight-bearing next day)
• For TPLO, Synthes locking plate technology provides mechanical advantages and reduces risk of complications compared to other cheaper implant systems
• Greater cost than suture stabilisation due to the complexity of the surgery and implant costs
• We offer both TPLO and TTA and will advise the most appropriate surgery for your dog after assessment of his or her condition and x-rays

Further information on TPLO is available here: www.TPLOanswers.com

Why choose Anderson Moores?

• One of our surgeons will fully assess your pet and discuss all the options for their treatment with you at the time of consultation.
• Our orthopaedic surgeons have a wealth of experience in treating dogs with cruciate disease. They have performed hundreds of these surgeries. Treating dogs for orthopaedic disorders is the only thing we do, every day, all year, and cruciate disease is the most common condition we see.
• Since we perform both TPLO and TTA surgeries we can recommend the procedure which we feel is most appropriate for your pet
• We have invested a lot of time and money in state of the art surgical and anaesthetic facilities, which means reduced risk of complications for your pet (see our infection audit page).
• Pain management is a priority of ours, including eipidural pain relief as standard for TPLO/TTA surgery. Fully qualified nurses are on-site 24 hours/day to ensure your pet is comfortable through-out the night following surgery.

Tibial Tuberosity Advancement (TTA)

Downloads

Print-friendly version (pdf)

Sample discharge instructions for TPLO or TTA surgery (pdf)

James' overview of cruciate disease, published in 'Dogs Monthly' April 2012 (thanks to Dogs Monthly for allowing this to be posted here www.dogsmonthly.co.uk)

The reason why we do this:

"Dear Andy, Thank you for your skill, care and attention to Bryn (TPLO surgery May 2010). We are pleased to report that Bryn is exercising really well, no limping and extremely happy. We will always be grateful to you and wish you and your family a healthy and happy 2011. Wendy & Bill R."