Cranial Cruciate Ligament Part 2 - Repair

There are three different surgical techniques commonly used to repair ruptured Cranial Cruciate Ligaments. The Extracapsular Repair, TPLO and TTA. Your veterinarian can advise you on which would be the best procedure for your pet.

Extracapsular Repair
In this procedure a strong nylon line is placed to hold the stifle in place. The suture will eventually break, but by that time the dog has formed scar tissue enough to hold the knee in place without the extra support of the line. During the surgery the knee joint is opened and inspected and the torn cruiciate ligament removed. After the procedure your dog will require at least 12 to 16 weeks of restricted exercise and rehabilitation. This procedure is typically considered in small to medium sized dogs or geriatric/older patients.

TPLO (Tibial Plateau Leveling Osteotomy)
In this procedure the biomechanics of the joint are changed. The knee joint is again opened and the damaged meniscus and cruciate ligament inspected and removed as needed. Then a section of the tibia bone is cut and rotated to change the angle of the joint and create greater stabilization. Special metal hardware is placed to hold everything in place. Typically these dogs are toe-touching by 10 days post surgery, but again restricted activity and rehabilitation exercises are required for12 to 16 weeks. Most patients are back to normal activity 6 months after surgery. This procedure is typically considered in young, very active and large breed dogs.

TTA (Tibial Tuberosity Advancement)
Similar to the TPLO, in this surgery the tibial crest where the patellar ligament attaches is cut and repositioned using titanium implants and bone grafts to stabilize the new angle. The recovery is similar to that of the TPLO and it is also recommended for young, large and very active dogs. Which of these two surgeries is better? Whichever one your surgeon is more comfortable performing. Studies have shown that the results at one year post-operative seem to be the same regardless of which procedure is performed.

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Reading Between The Lines

Reading between the lines:


Understanding the value of pre-anesthetic and annual blood work

We offer pre-anesthetic blood work for all surgeries, including spays and neuters for puppies and kittens.

But my puppy is so young, healthy and vibrant! I thought blood work was for seniors only.

Testing blood from a healthy pup will give us the ideal baseline levels for your puppy as an individual. Later in life, when blood work becomes an annual recommendation, we will have the perfect reference! We will be able to use your dog’s personalized blood work guidelines as opposed to relying on average guidelines for all dogs.

I can see your point but he seems fine to me and I’m just not sure it’s worth it.

Pre-anesthetic testing also screens for conditions that may not be detected upon physical exam alone. For example, your pup may have an infection brewing that should be treated with a course of antibiotics prior to going under an anesthetic. This gives all of us peace of mind!

Ok, and what happens if you do find something?

Depending on what we find with the blood work levels, this may give reason for us to modify our routine anesthetic protocol to suit their needs as an individual. Making their anesthetic experience as safe and worry-free as possible! The other thing to keep in mind is that some pets with certain conditions should avoid anesthetic procedures altogether.

This sounds pretty good! Now let me ask, what exactly do you look at with pre-anesthetic blood work?

A Pre-Anesthetic Panel looks at the CBC (Complete Blood Count) and the Chemistry Profile (organ function and electrolytes).

CBC is the Complete Blood Count which shows us the RBC (Red Blood Cell), WBC (White Blood Cell) and Platelet (clotting-factors) levels.

RBC’s (Red blood Cells) should fall within specific ranges and when high/low they indicate conditions that may require treatment. For instance, low RBC’s is a sign of anemia.

WBC’s (White Blood Cells) should also fall within specific ranges and when high/low indicate conditions that may require treatment. For instance, high WBC’s is a sign of infection.

Platelets are the clotting factors that play a vital role in healing. If the platelets are low, they will have problems clotting and we certainly don’t want this when we are doing a surgical procedure!

Chemistry Profile shows us organ function focusing primarily on the liver and kidneys. The liver is the organ in charge of breaking down the anesthetic drugs used during surgical procedures and kidneys filter wastes from the blood and transport them to the bladder for excretion. It is crucial that these organs be doing their jobs properly! We also look at electrolytes and protein levels, both of which are indicators of conditions/illness (such as diabetes, infection, cancers and dehydration to list a few). Electrolytes are critical to body function and must be maintained in very narrow limits.

Wow! That shows a lot more than I thought! So, what happens when my pooch enters his senior years? Why is annual blood work important?

A complete physical exam along with a detailed history can give good reason for annual blood work since it gives us a bigger picture of what is going on. Our four-legged family member ages a lot faster than we do and for that reason a LOT can change in one year.

Oh yes, they sure do, I wish they lived longer! I know I can feel my arthritis these days, do they feel pain the way we do? Is there anything we can do to be sure they are comfortable?

Yes, they certainly do feel pain the way we do but may not show it as readily as humans do. If something such as arthritis is found upon physical examination and medications are indicated to aid in the comfort level, blood work is essential! We want to be sure that all of your pet’s organs are functioning properly before we introduce a daily medication. This will also help your Veterinarian choose the ideal medication for your pet.

If other conditions arise that require daily medication, we need to do blood work at least annually to be sure we have their medications at the best dosage to keep levels where they should be.

This makes me feel better about pre-anesthetic screening and annual blood work. I didn’t realize how important this is and I want my pet to have the best for their entire life!

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