Pet Owners

So many different techniques are advocated for the management of cruciate disease it can sometimes be overwhelming. At VetFix we keep things simple and stick to techniques that have been widely reported in peer reviewed literature to offer the best outcome with minimal complication rates.

Decision making and planning are critical for each individual case. No one option is suitable for all patients or all clients.

TTA is a procedure to advance the point of insertion of the ligament connecting the knee cap to the tibia forward. This brings the pull of the quadriceps muscle parallel to the central joint force stabilizing the knee when the dog walks. There are biomechanical and clinical studies showing this works. As you can see there is a cage at the top to allow the advancement and a plate to stabilize this. At VetFix we use titanium implants to ensure the bone grows into the cage to stabilize it.

A good to excellent outcome can be expected in more than 90% of cases. Regardless of technique, late meniscal tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

TPLO, CCWO and TTA are dynamic cranial cruciate ligament repair techniques with the lateral suture extracapsular repair a static system. The TPLO procedure is essentially a curved osteotomy of the proximal tibia intended to neutralize instability caused by cruciate tearing within the joint. This is achieved by flattening the tibial joint angle and providing a stable platform for the dog to walk on. At VetFix we stabilize this rotation with a locking TPLO plate. This provides an angle stable construct with robust fixation. Selection of TPLO or CCWO versus TTA continues to be surgeon preference. However, recent evidence does suggest long-term outcome may be improved with the TPLO technique. I have written an article summarising recent advances in cruciate surgery – Read full article here.

Regardless of technique, late cartilage tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

Steep tibial plateau or joint angles can preclude sufficient advancement of the tibial tuberosity for successful TTA. This can be seen in small breed dogs such as the West Highland White Terrrier. In some other terrier breeds insufficient space on the bone makes placement of the TTA plate difficult. In these cases CCWO can be extremely useful.

Regardless of technique, late cartilage tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

The lateral suture system (LSS) is a static cruciate repair technique. There is little evidence that the LSS is any worse than TTA or TPLO for management of cruciate disease in the dog. Anecdotally there is feeling amongst most surgeons that TTA and TPLO produce a better outcome. It may be that a big enough study with good outcome measures just hasn’t been performed yet! LSS is a good option when circumstances dictate TTA or TPLO are not possible. In cats I prefer it as a treatment option. I became very familiar with LSS during my work with the PDSA and there have been advances in how we now perform this useful technique. A good to excellent outcome can be expected in more than 90% of cases.

Regardless of technique, late meniscal tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

VetFix have the equipment and implants to manage both simple and complex fracture repairs. We try to work with local practitioners to provide an option that works for both your pet and you. As well as a full range of the standard plating (DCP) systems we also use the polyaxial (PAX) locking plate system. Locking plates can be extremely useful for a variety of fracture types but in particular in regions where plate contouring can be difficult and time consuming. Repairs using the PAX plate system are more expensive.

With my clinical experience at the PDSA, I also try to offer cost sensitive solution for some fractures. In some cases, fractures are beyond what we can manage at VetFix and tertiary referral for further diagnostic imaging or surgery with a specialist is necessary.

TTA is a procedure to advance the point of insertion of the ligament connecting the knee cap to the tibia forward. This brings the pull of the quadriceps muscle parallel to the central joint force stabilizing the knee when the dog walks. There are biomechanical and clinical studies showing this works. As you can see there is a cage at the top to allow the advancement and a plate to stabilize this. At VetFix we use titanium implants to ensure the bone grows into the cage to stabilize it.

A good to excellent outcome can be expected in more than 90% of cases. Regardless of technique, late meniscal tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

TPLO, CCWO and TTA are dynamic cranial cruciate ligament repair techniques with the lateral suture extracapsular repair a static system. The TPLO procedure is essentially a curved osteotomy of the proximal tibia intended to neutralize instability caused by cruciate tearing within the joint. This is achieved by flattening the tibial joint angle and providing a stable platform for the dog to walk on. At VetFix we stabilize this rotation with a locking TPLO plate. This provides an angle stable construct with robust fixation. Selection of TPLO or CCWO versus TTA continues to be surgeon preference. However, recent evidence does suggest long-term outcome may be improved with the TPLO technique. I have written an article summarising recent advances in cruciate surgery – Read full article here.

Regardless of technique, late cartilage tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

Steep tibial plateau or joint angles can preclude sufficient advancement of the tibial tuberosity for successful TTA. This can be seen in small breed dogs such as the West Highland White Terrrier. In some other terrier breeds insufficient space on the bone makes placement of the TTA plate difficult. In these cases CCWO can be extremely useful.

Regardless of technique, late cartilage tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

The lateral suture system (LSS) is a static cruciate repair technique. There is little evidence that the LSS is any worse than TTA or TPLO for management of cruciate disease in the dog. Anecdotally there is feeling amongst most surgeons that TTA and TPLO produce a better outcome. It may be that a big enough study with good outcome measures just hasn’t been performed yet! LSS is a good option when circumstances dictate TTA or TPLO are not possible. In cats I prefer it as a treatment option. I became very familiar with LSS during my work with the PDSA and there have been advances in how we now perform this useful technique. A good to excellent outcome can be expected in more than 90% of cases.

Regardless of technique, late meniscal tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

Decision making is critical to ensure individualized treatment is provided for each patient. The degree of skeletal deformity, associated pain and the potential for progression of osteoarthritis help dictate when surgical management is appropriate. We will always offer advice on when conservative management might be preferred over surgical intervention. At VetFix we tend to avoid deepening the groove for the knee cap unless essential. That is to say we often perform a tibial tuberosity transposition (moving the insertion of the knee cap) without a groove deepening procedure unless the knee cap is still unstable. This approach minimizes disruption of the cartilage unless necessary.

We perform a clinical audit of outcomes to ensure we continue to provide the best possible treatment for your pet.

This is the grading system that may be used by your vet to help VetFix know more about your pets disease:

Grade 1

The knee cap can be popped out with the knee is in full extension.

Grade 2

spontaneous popping out of the knee cap occurs.

Grade 3

The knee cap is always out but can be reduced manually.

Grade 4

This is a severe condition with permanent, nonreducible popping out of the knee cap.

TPLO, CCWO and TTA are dynamic cranial cruciate ligament repair techniques with the lateral suture extracapsular repair a static system. The TPLO procedure is essentially a curved osteotomy of the proximal tibia intended to neutralize instability caused by cruciate tearing within the joint. This is achieved by flattening the tibial joint angle and providing a stable platform for the dog to walk on. At VetFix we stabilize this rotation with a locking TPLO plate. This provides an angle stable construct with robust fixation. Selection of TPLO or CCWO versus TTA continues to be surgeon preference. However, recent evidence does suggest long-term outcome may be improved with the TPLO technique. I have written an article summarising recent advances in cruciate surgery – Read full article here.

Regardless of technique, late cartilage tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

Steep tibial plateau or joint angles can preclude sufficient advancement of the tibial tuberosity for successful TTA. This can be seen in small breed dogs such as the West Highland White Terrrier. In some other terrier breeds insufficient space on the bone makes placement of the TTA plate difficult. In these cases CCWO can be extremely useful.

Regardless of technique, late cartilage tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

The lateral suture system (LSS) is a static cruciate repair technique. There is little evidence that the LSS is any worse than TTA or TPLO for management of cruciate disease in the dog. Anecdotally there is feeling amongst most surgeons that TTA and TPLO produce a better outcome. It may be that a big enough study with good outcome measures just hasn’t been performed yet! LSS is a good option when circumstances dictate TTA or TPLO are not possible. In cats I prefer it as a treatment option. I became very familiar with LSS during my work with the PDSA and there have been advances in how we now perform this useful technique. A good to excellent outcome can be expected in more than 90% of cases.

Regardless of technique, late meniscal tears can be expected in 5-10% of dogs and post-operative infection in around 5% of cases.

Dislocated hips can be a common problem in small animal practice. With vehicular trauma, forces are thought to transfer through the femur driving the femoral head up and over the hip joint often tearing important joint stabilisers.

Closed reduction is the initial treatment of choice with success rates of 50% to 60%. If unstable following initial reduction, surgical treatment is often necessary. A success rate of 70-80% is reported following open reduction and surgical stabilization.

The wide variety of options for open reduction can be broadly separated into intra-articular and extra-articular stabilization. The Iliofemoral suture is an extra-articular technique and offers the advantage of avoiding cartilage damage that could occur with placement of a transarticular pin or toggle. VetFix favour the iliofemoral suture when the hip is stable following reduction and internal rotation of the limb during surgery ie a good fitting joint.

With transarticular pinning a pin is inserted through the femoral head and neck and acetabulum to provide temporary joint stability. This is an intra-articular stabilization technique and poses a risk of articular cartilage damage. It is however a very useful technique with an overall 80% success rate reported in dogs. Heavier dogs and those with hip dysplasia carry a worse prognosis for successful open reduction.

Total hip replacement is advocated for recurrent cases of hip luxation or severe cases of hip dysplasia. VetFix can offer advice on possible THR candidates and assist with tertiary referral. Dogs often do extremely well with a THR and it is well worth considering before a femoral head and neck ostectomy (FHNO) is performed.

Femoral head and neck ostectomy (FHNO) should be considered if open reduction techniques are unsuccessful or if severe articular damage is present and THR is not an option. In cats FHNO typically leads to full return to function though there is an argument for avoiding this if possible.

Hagrid 30 days following FHNO for a slipped capital femoral physis:

Pain management and immediate physiotherapy are important in the immediate postoperative period to encourage early weight-bearing and preservation of range of motion.

At VetFix we are always keen to hear of any orthopaedic cases via your primary vet. Often we can arrange to perform a full orthopaedic examination or review radiographs. This can be a critical part of any lameness workup. In addition we offer advice on the medical management of osteoarthritis. Angular limb deformities often benefit from a CT scan and again we can advise on when best to take this extremely useful step.

The wide variety of options for open reduction can be broadly separated into intra-articular and extra-articular stabilization. The Iliofemoral suture is an extra-articular technique and offers the advantage of avoiding cartilage damage that could occur with placement of a transarticular pin or toggle. VetFix favour the iliofemoral suture when the hip is stable following reduction and internal rotation of the limb during surgery ie a good fitting joint.

With transarticular pinning a pin is inserted through the femoral head and neck and acetabulum to provide temporary joint stability. This is an intra-articular stabilization technique and poses a risk of articular cartilage damage. It is however a very useful technique with an overall 80% success rate reported in dogs. Heavier dogs and those with hip dysplasia carry a worse prognosis for successful open reduction.

Total hip replacement is advocated for recurrent cases of hip luxation or severe cases of hip dysplasia. VetFix can offer advice on possible THR candidates and assist with tertiary referral. Dogs often do extremely well with a THR and it is well worth considering before a femoral head and neck ostectomy (FHNO) is performed.

Femoral head and neck ostectomy (FHNO) should be considered if open reduction techniques are unsuccessful or if severe articular damage is present and THR is not an option. In cats FHNO typically leads to full return to function though there is an argument for avoiding this if possible.

Hagrid 30 days following FHNO for a slipped capital femoral physis:

Pain management and immediate physiotherapy are important in the immediate postoperative period to encourage early weight-bearing and preservation of range of motion.