Ligament Surgery in Dogs

Extracapsular Repair

• Extracapsular repair provides the quickest and easiest surgical treatment for a ligament injury, although it does not provide a long-term solution in larger breeds. This type of surgery doesn't require any specialized equipment and can be performed in a shorter amount of time than other procedures. The surgery involves removing the torn ligament, damaged portions of the meniscus, or cartilage, and large bone spurs. A suture that passes around the small fabella bones behind the knee and enters the tibia, or shinbone, through a drilled hole in the front tightens the knee joint and prevents the tibia from sliding forward. Dogs usually avoid using the leg for at least two weeks after the operation, but normal knee use should return within two months. Limited exercise for eight weeks following surgery includes gentle knee flexing and extending, no running and using a leash, even in the backyard. An ice pack can be placed on the knee twice a day for 10 minutes at a time. Healed tissue holds the knee together after the suture breaks, which can take up to one year after surgery.

Tibial Plateau Leveling Osteotomy

• Large breeds weighing over 50 lbs. benefit the most from tibial plateau leveling osteotomy, although the surgery can be performed on dogs of any size. This complex procedure, which requires a specialist, involves cutting and repositioning the tibia so that the dog's natural weight-bearing keeps the knee joint stable. Determining the best angle to make the tibia cut requires several radiographs, or X-rays. Damaged meniscus will also be removed, along with the torn ligament remnants if damage is severe. The recovery process includes icing the knee and allowing plenty of rest. Most dogs begin using the leg again between ten days to three weeks after the procedure. Full use generally returns within four months. Exercise restrictions must be followed for two months after surgery, although light activity can be gradually increased at three to four weeks. The tibia can take up to six weeks to fully heal.

Tibial Tuberosity Advancement

• Tibial tuberosity advancement, which was originally introduced in 2002, involves repositioning the patellar ligament and the top of the tibia, or tibia plateau, to stabilize the knee joint. Separating the tibia tuberosity, which connects the tibia to the patellar ligament, allows the ligament and tibia plateau to be repositioned at a 90-degree angle to each other. A cage made of steel or titanium, plate and fork hold the tibia tuberosity in place when it is reattached. Bone grafts help the healing process. A specialist must perform this type of surgery, due to its complexity. The leg remains bandaged for one week following surgery. Care at home following this procedure includes limited activity for three to four months, icing and rest.

Intracapsular Repair

• Intracapsular repair creates a new ligament using connective tissue. After the removal of damaged cartilage and ligament fragments, a dissected piece of connective tissue replaces the ligament. The new ligament can be sewn in place or held in place by an implant. Recommended care after surgery includes bandaging the leg for two weeks. Use of the leg often resumes after two weeks and returns to normal within two months. Recovery at home includes icing, rest and restricted exercise for two months. According to the Mar Vista Animal Medical Center, surgeons in the U.S. do not perform this surgery often since extracapsular repair works just as well and requires less time to perform. Rehabilitation following intracapsular repair also takes longer.

Warning

• Dogs with a torn ligament often show signs of improvement within two weeks after the injury when it is left untreated. Despite this appearance, degenerative damage from arthritis and the formation of bone spurs, or osteophytes, occurs as early as one week after the rupture. Osteophytes and arthritis severely limit joint motion and cause chronic pain. Although surgery can be performed to stop osteophytes from developing or provide relief for arthritis, these conditions are irreversible.