Articles from Dr. James St. Clair, DVM.

Founder of TopDog Animal Health and Rehabilitation

Cranial Cruciate Ligament Rupture Repair

Extracapsular repair -Lateral Fabellar technique (Nylon Band Technique)

Cranial cruciate ligament rupture is the most common orthopedic condition of dogs and affects all breeds. The lateral imprication is ideal for small dogs and shows excellent results in small breeds but is not recommended for the larger breeds. Larger breeds of dogs are recommended for Tibial Plateau Leveling Osteotomy or TPLO (information found below). If a dog is suffering from this condition it is important to know what went wrong. The cranial cruciate ligament is one of the main stabilizers of the stifle joint in dogs (equivalent to the knee in humans). The ligament is there to prevent forward motion of the tibia bone (shin bone in humans), relative to the femur bone (thigh bone), to prevent further rotation of the tibia bone and limit hyperextention of the stifle. However, this cranial cruciate ligament may undergo tearing or can sometimes rupture during normal physical activity. Mostly, middle-aged dogs are affected but the rupture can still occur in younger dogs. Rottweilers, Mastiffs, and Labrador Retrievers are some of the breeds that may develop partial or complete tears when they are still puppies. When the ligament tears, the “knee” becomes unstable resulting in pain due to the joint capsule being stretched, arthritis and potential damage to the meniscal cartilage. A conformation of the limbs and genetics could be to blame for this condition, but the cause is unknown.  When the ligament partially tears, it can often be hard to diagnose and commonly occurs in both limbs at the same time. In surgery, it will first be determined where the tears are and if the medial meniscus is torn (occurs within 50% of dogs with a cruciate ligament tear) which makes the procedure more difficult. If it is torn then the surgeon will have to go forward and take out, lightly trimming away the damaged portions of the meniscus saving as much as possible. If it is not torn then a pole is placed behind the meniscus to prevent future tearing. After repairing or preventing the meniscus from tearing, the nylon band technique begins. A heavy nylon material is tied from the lateral flabella to the tibial crest, to stabilize the joint. When the scar tissues forms over the nylon, it will stabilize it even further. The success rate after surgery is about 85% of the dogs will show significant improvement. However, 50% of the dogs after surgery will still show some signs of lameness, either mild or only after heavy activity while the other 50% will regain completely normal function of their limb(s). The patient will be administered pain medications to help them through the recovery process, this part of the process is crucial. All dogs are mostly greatly improved after the surgery is performed. The surgery is not a cure for arthritis but supplements can help your dog with joint stiffness and pain, some products that can help your dog recover from Extracapsular repair are.. FREE Informational Booklet A free downloadable information booklet on the surgery and recovery process. A week by week recovery guide, tips for exercise, massage and techniques to help your dog through and after surgery. Glycanaid A joint supplement created to improve and support your dog’s joint health, after surgery or can be used as a preventative. It includes natural anti-inflammatories and powerful chondroprotectants. It contains high quality ingredients such as Glucosamine HCL, Chondroitin Sulfate, Vitamin C, Methylsulfonylmethane, mixed fatty acids and Great Salt Lake Salts. Glycanaid HA-Factor A joint supplement also designed to help your dog through the recovery process by improving joint health and support. Ingredients are the same as the original Glycanaid, but the added ingredient Hyaluronic Acid serves as a lubricant and shock absorber in the synovia fluid, proving to be more effective then the original product. Flexerna Nature’s most powerful Omega-3 naturally reduces inflammation and improves joint health. A patented, research proven powerful and natural anti-inflammatory using the Green Lipped Mussel of New Zealand, nature’s leading source Elcosatetranoic Acid (ETA). It also contains low molecular weight hyaluronic acid, and is available in soft gel capsules or liquid pump.

TPLO- Tibial Plateau Leveling Osteotomy

Similar to the other surgeries, TPLO surgery is meant to stabilize the stifle joint. However, it has it’s advantages over the other techniques. Many owners prefer TPLO because it has a faster recovery rate, development of less arthritis, better range of motion of the joint, and not only will your dog return to normal activity but this procedure is used for athletic dogs. Therefore, owners with hunting dogs, working dogs or show dogs that need their dog to make a more rapid recovery tend to use this technique, also veterinarians will recommend this procedure for the larger breeds of dogs. Like the other techniques, TPLO surgery is used to correct the “drawer motion” or backwards sliding of the femur on the tibia bone. Cranial cruciate ligament rupture is the most common orthopedic condition in dogs. The condition takes time to develop and can usually not be traced back to a single traumatic event. Aging of the dog can be one reason for the development, already existing inflammation, anatomical abnormalities, or an excessive slope at the top of the tibia bone, all of which can cause the ligament to rupture. Becoming educated on the clinical signs of a ruptured ligament or early warning signs can be helpful to your dog when it comes to early diagnoses or just simply catching it in time. Clinical signs include stiffness or very mild lameness, if the ligament is torn then lameness worsens. If the ligament is classified as a complete tear, the dog will not put any weight on the affected limb, but eventually he/she will start to use the limb again. However, lameness is rare in large breed dogs that have not had surgery. If a dog has a ruptured ligament in one knee, it is common to find the other knee ruptured as well. One third of the dogs with a cruciate ligament rupture will develop a rupture in their other limb as well. In surgery, the surgeon will first remove any pieces of torn cruciate ligament. Like the other surgeries, after that is performed the lateral and medial meniscus needs to be examined for tears in the cartilage, which about 50% of dogs will have torn. The meniscus being torn will be much more painful to the dog then the cranial cruciate ligament rupture. If the meniscus is torn, the surgeon will try to remove as little pieces of torn meniscus as possible because the less removed, the less arthritis will develop. To view the severity of the tear an arthroscope, a kind of endoscope, can be used and inserted into a joint through a small incision. The advantage of an arthroscope over traditional open surgery is that the joint does not need to be opened all the way, and the entrance site is much smaller. This reduces recovery time and can increase the rate of surgical success due to less trauma to the connective tissue. This tool is used in humans, especially professional athletes who require fast healing time. With TPLO, the surgeon will make a curved cut in the top of the tibia bone (osteotomy) to include the tibial plateau, which is then rotated along the curve. This will level the slope, as a plate and screws are used to hold the plateau in place so the bone can heal at the new slope. Pain medications will be administered to your dog to help them through the recovery process.  One veterinary surgeon recorded that about 50% of dogs that received TPLO surgery started to walk on the limb 24 hours after surgery, and within 5 days began to put weight on it. Restrictions on exercise were enforced for the recovering dogs until 4 months after surgery, and 6 months into the recovery process the dogs could return to their athletic activities such as hunting, agility etc. About 90% of dogs that receive TPLO surgery will regain normal or near to normal function of the limb. Tibial Tuberosity Advancement (TTA) surgery is a new procedure that is said to be even more affective when it comes to recovery time, however your surgeon will determine whether TPLO or TTA is best for your dog. Joint supplements will help your dog through the pain and arthritis that will follow surgery, and improve their quality of life. Some of our products that will guide you and your dog through surgery and the after effects are as follows.. FREE Tibial Plateau Leveling Osteotomy (TPLO) Booklet A free downloadable information booklet on TPLO surgery and it’s recovery process. A week by week recovery guide, tips for exercise, massage and techniques to help your dog through and after surgery. Glycanaid A joint supplement created to improve and support your dog’s joint health, after surgery or can be used as a preventative. It includes natural anti-inflammatories and powerful chondroprotectants. It contains high quality ingredients such as Glucosamine HCL, Chondroitin Sulfate, Vitamin C, Methylsulfonylmethane, mixed fatty acids and Great Salt Lake Salts. Glycanaid HA-Factor A joint supplement also designed to help your dog through the recovery process by improving joint health and support. Ingredients are the same as the original Glycanaid, but the added ingredient Hyaluronic Acid serves as a lubricant and shock absorber in the synovia fluid, proving to be more effective then the original product. Flexerna Nature’s most powerful Omega-3 naturally reduces inflammation and improves joint health. A patented, research proven powerful and natural anti-inflammatory using the Green Lipped Mussel of New Zealand, nature’s leading source Elcosatetranoic Acid (ETA). It also contains low molecular weight hyaluronic acid, and is available in soft gel capsules or liquid pump.

Tibial Tuberosity Advancement (TTA)

Tibial Tuberosity Advancement is a relatively new procedure, even more advanced then the TPLO technique. The recovery process is said to be more rapid then the TPLO as it is less invasive, meaning the incision site is smaller. The cranial cruciate ligament (CCL) plays an important role when it comes to stabilizing the stifle joint. When it ruptures, it can result in lameness, the “drawer motion”, pain and arthritis. 50% of dogs with a CCL rupture, have a torn meniscus as well. This can be suspected by a “clicking” sound when a dog walks. The long-term change in the joint when the CCL is torn is the development of arthritis, the severity will vary for each individual case. If they have a complete tear of the CCL, immediate lameness will occur while a partial tear will only show mild lameness but both types of tears are painful. The treatment for this condition can be solved by the use of nylon bands, such as the other techniques like the extracapsular repair. However, in larger breeds of dogs the nylon cannot always stand the amount of weight put on it, therefore the two types of surgeries recommended for medium to large breeds of dogs are TPLO and TTA, depending on the preference of your surgeon. If the injured dog has a steep tibial plateau, the veterinary surgeon will not recommend the TTA surgery. In surgery, the surgeon will make a cut in the front part of the tibia bone (tibial tuberosity) and advancing this portion of bone forward so the patellar ligament is realigned. This will rid the knee joint of the abnormal sliding movement (drawer motion). To secure the bone in place, a bone spacer that is specialized for the patient and screws and a plate are used. Where the gap in the bone is located, bone graft (bone material from other parts of the dog’s body) is placed in it to stimulate healing. After surgery, pain medications should be administered to the dog to help them heal and remain pain-free after surgery. Professional physical therapy is recommended to speed up and produce better results after surgery, but limiting at-home activity and exercise level post-procedure. The dog should typically begin putting weight on the affected limb about 2-4 weeks after surgery, 16 weeks after surgery the dog should be fully weight bearing on the limb and exercise limitations can be lifted (consult veterinary for individual case recommendations however). Four months into the recovery process the results typically are the same as the TPLO recovery rate. The TTA surgery however is not always recommended for show dogs because the tibial crest may protrude more so a dog with a short-coat may have a noticeable difference between the two limbs. Secondly, the dog’s walk may be slightly altered, which may affect it’s career as a show dog. To better assist your dog through surgery, joint supplements are recommended to speed up the process, and improve your dog’s quality of life. Some of the products we offer to assist you through the recovery process are as follows… FREE Tibial Tuberosity Advancement (TTA) Booklet A free downloadable information booklet on TTA surgery and it’s recovery process. A week by week recovery guide, tips for exercise, massage and techniques to help your dog through and after surgery. Glycanaid A joint supplement created to improve and support your dog’s joint health, after surgery or can be used as a preventative. It includes natural anti-inflammatories and powerful chondroprotectants. It contains high quality ingredients such as Glucosamine HCL, Chondroitin Sulfate, Vitamin C, Methylsulfonylmethane, mixed fatty acids and Great Salt Lake Salts. Glycanaid HA-Factor A joint supplement also designed to help your dog through the recovery process by improving joint health and support. Ingredients are the same as the original Glycanaid, but the added ingredient Hyaluronic Acid serves as a lubricant and shock absorber in the synovia fluid, proving to be more effective then the original product. Flexerna Nature’s most powerful Omega-3 naturally reduces inflammation and improves joint health. A patented, research proven powerful and natural anti-inflammatory using the Green Lipped Mussel of New Zealand, nature’s leading source Elcosatetranoic Acid (ETA). It also contains low molecular weight hyaluronic acid, and is available in soft gel capsules or liquid pump.
* Glycanaid A joint supplement created to improve and support your dog’s joint health, after surgery or can be used as a preventative. It includes natural anti-inflammatories and powerful chondroprotectants. It contains high quality ingredients such as Glucosamine HCL, Chondroitin Sulfate, Vitamin C, Methylsulfonylmethane, mixed fatty acids and Great Salt Lake Salts. * Glycanaid HA-Factor A joint supplement also designed to help your dog through the recovery process by improving joint health and support. Ingredients are the same as the original Glycanaid, but the added ingredient Hyaluronic Acid serves as a lubricant and shock absorber in the synovia fluid, proving to be more effective then the original product. * Flexerna Nature’s most powerful Omega-3 naturally reduces inflammation and improves joint health. A patented, research proven powerful and natural anti-inflammatory using the Green Lipped Mussel of New Zealand, nature’s leading source Elcosatetranoic Acid (ETA). It also contains low molecular weight hyaluronic acid, and is available in soft gel capsules or liquid pump.