Cruciate surgery is performed to repair a torn cranial cruciate ligament (CCL) in the stifle (knee), which is same as the ACL in humans. CCL surgery is the most common orthopedic surgery performed in dogs and is said to make up 85% of all dog orthopedic surgeries performed every year. Given that this is such a common injury, several procedures have been developed over the years to repair the ligament. Each technique comes with its advantages and disadvantages, so it is important to discuss the options with your veterinarian to decide which procedure is best for your dog. Factors to consider when choosing the technique to repair your dog’s torn CCL include the patient’s age, weight, size, and lifestyle. The surgeon’s preference, as well as the cost of the procedure, are also factors to consider.
Extracapsular (outside the joint) repair of the cruciate ligament is probably the oldest and the most commonly performed procedure performed to correct this injury. The goal of the surgery is to restore stability to the stifle (knee) by placing sutures outside of the joint. The cranial cruciate ligament is responsible for preventing the tibia from sliding forward and out from underneath the femur, and by placing artificial sutures outside the joint this external stabilization mimics the normal activity of the cranial cruciate ligament. For this surgery, a continuous monofilament (one fiber) nylon suture, similar to fishing line is placed around the fabellar bone of the femur and looped through a hole drilled into the tibial tuberosity. The two ends of the suture are then securely held in place using a stainless steel clip.
Additionally, rupturing the cranial cruciate ligament leads to instability in the knee, which can lead to damage to other structures within the joint, including meniscal tears. This is where appropriate diagnostics become important. Finding the extent of the injury will aid in choosing the correct procedure for your dog, and will increase the chances of a successful recovery.
Depending on which surgery type you go with the cost can go upwards of $4500.00 US dollars. If you choose the extracapsular repair (the more traditional “fishing-line approach” the cost ranges from $900.00 to $2,500.00. The exact cost will depend on the area you live, the skill and experience of the veterinarian, as well as the hospital in which the surgery is performed. Typically, the cost includes not only the surgery, but also pre-surgical bloodwork, anesthesia, post-surgical care and medications. Some hospitals may even include post-surgical physical therapy.
Although extracapsular repair is often performed, it is not the only option for repairing your dog’s torn cruciate ligament. Therefore, it is important to have a conversation with your veterinarian or veterinary surgeon to discuss all of your options. As previously mentioned, there are several things that should be considered when choosing the right surgery. Here is a list of things to consider:
Three of the most common alternatives to extracapsular cruciate ligament repair are:
Regardless of which surgery you choose, it’s the post-operative care that will determine how successful the procedure is. Dogs that are non-weight bearing will quickly begin to lose muscle mass and range of motion in the affected leg. The sooner the knee is stabilized, the less muscle atrophy that occurs, and the faster the recovery post-op.
The first 12 weeks following surgery are a critical time of recovery and rehabilitation. Controlled exercise and encouraging the dog to begin using the leg are keys to a successful recovery. This is where canine rehabilitation comes in. In the last 20 years, human physical therapy principles and techniques have been developed and adapted to help dogs recover properly after major orthopedic surgery. Physical therapy for dogs is correctly referred to as Canine Rehabilitation, and many of the techniques used are the similar to those that would be used if you had to see a physical therapist after orthopedic surgery. Rehabilitation can usually be initiated shortly after surgery when an extracapsular repair is performed. These exercises focus on safe weight bearing of the limb, combating muscle atrophy, and improving range of motion.
Remember that like humans, not all dogs recover at the same speed. It is best to be conservative and consistent. Do not force your dog to do certain exercises if they are unwilling. It is always best to seek professional guidance if available. It is important to note that while recovery takes 12 weeks, it actually takes a full 6 months to have complete healing and return to function.
According to the American College of Veterinary Surgeons (ACVS), the long term prognosis for animals undergoing surgical repair of the cranial cruciate ligament is good, with reports of improvement in 85-90% of the cases. However, all surgical procedures carry the risk of complications. The most common complications encountered with this particular procedure are infection, lack of stabilization, and implant failure. The most common complication caused by a torn cranial cruciate ligament is osteoarthritis of the affected joint. Unfortunately, arthritis progresses regardless of treatment, but is much slower when surgery is performed and the knee is stabilized. It is important to realize that arthritis is a progressive disease and develops fairly quickly in an injured stifle joint. Therefore, arthritis management and prevention and joint supplements are recommended for any dog with this injury, no matter which surgical procedure is chosen.