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Cranial Cruciate Repair – Case Study

Dogs are particularly prone to damage to their cruciate ligaments in the knee. It is the central stabilising ligament of the knee joint which if damaged is painful and if torn destabilises the knee joint. Medium to large dogs have more problems with cruciate instability and are ideally treated by the specialist surgery the TPLO.

Cruciate injury is similarly debilitating in humans. The complex surgery is followed by a long period of recovery. To get the best results, an excellent surgical team and focused aftercare is invaluable.

Without surgical repair to stabilise the joint the affected leg will be a significant problem for the rest of the dogs life. Extra pressure is placed on the unaffected knee joint, increasing the possibility of damaging the other knee.

Pittwater Animal Hospital has a specific protocol on how to get the best results from specialist cruciate repair surgery (TPLO). Animals have initial diagnostic xrays and examination under general anaesthetic then an assessment is made. If a TPLO is recommended, our estimates include all surgery, medication, follow up visits, cartrophen injections, post surgical xrays and rehab.

Follow Jet’s story through his cruciate injury.

  • Jet is an 8 year old Bordoodle (border collie x poodle).
  • 16 months before his big injury, Jet was seen for a sore right hind leg. The stifle (knee joint) was sore especially on extension but also when testing his cruciate draw. Jet’s stifle was not unstable so no surgery was suggested and he improved with rest and anti-inflammatory medication. He was however always a little lame in his on one of his hind legs.
  • Jet loves to chase a ball. Just over a year later he was running at the park and was suddenly very sore in his right back leg.
  • Jet came to see Dr Jill King. The leg was sore but the right stifle was also unstable. Jet needed to have a specialist repair to get back to best function.
  • Jet was booked in for a general anaesthetic and assessment with Dr Jen Stewart who oversees all the cruciate surgeries at Pittwater Animal Hospital.  His stifles and hips were xrayed. Under anaesthetic his stifle joint was very unstable and there was some hip instability.
The left hip is difficult to get completely straight. There is no notable arthritis in the knees but there are some squaring and dysplastic changes of the hips. The left hip is worse than the right
With the cranial cruciate ligament in the right stifle torn, the tibia (lower bone) is pushed forward.
  • It is important to know that Jet’s hips are not perfect for future reference. If his left hip was causing pain this may have placed more pressure on the right knee. Our new rehab classes with Fran Wilcox were going to be very important for Jet.
  • Our specialist surgeon Dr Eugene Buffa needs the lower xray of the stifle to measure up for Jet’s implant.
  • Xrays are sent off to Eugene and surgery was scheduled for the next day.
  • When Jet arrives for surgery he is still obviously lame in his right back leg despite rest and anti-inflammatory treatment.
  • Jet is placed on intravenous fluids and anaesthetised. The right back leg is clipped, cleaned and prepped for surgery.
  • The specialist surgeon and his team of three nurses arrive and set up in Pittwaters dedicated surgical room. Dr Eugene has done hundreds of the TPLO operations. Using his experience and expertise the procedure usually goes very well.
  • An incision is made over the joint. The stifle joint is explored looking for any meniscal damage which may complicate recovery. The tibia is remodelled by sawing the bone with a specially selected saw, moving the bone piece to the correct angle then screwing the selected implant into the bone.
TPLO implant attached to the tibia.

  • Post surgical xrays show the angle change created by the implant. This angle along with the bony ledge formed are key to changing the way this knee functions making it more stable and less painful. 
  • The bone has been sawn through and remodelled. It will take some time to repair and strengthen. 

  • Jet stays in hospital at Pittwater for 1-2 days. He is given pain relief, intravenous antibiotics and is carefully managed in recovery. 
  • Jet is sent home with pain relief, antibiotics and strict at-home-care advice.
  • Very soon after surgery, Jet attends one of his three private scheduled rehab appointments. Just like human joint surgery, we like to get movement in the damaged joint as soon a possible to aid recovery. 

  • Ten days after surgery the sutures are removed from Jet’s wound at Pittwater Animal Hospital. He is given the first injection of cartrophen as part of a 4 week course. 
  • 6 weeks later having had surgery, medication, a cartrophen course and three rehab sessions Jet returns for post op Xrays. This is usually just a morning procedure done while Jet is still awake. 
  • The bone has healed well and is in good place. Jet is walking well and the surgeon is happy.