Cranial Cruciate Ligament Repair (Extra-Capsular Suture Stabilization)

It’s a lazy, sunny Saturday afternoon. The most important thing on your list for the day is playing with the dog. You throw the frisbee, Buddy jumps into the air to catch it and falls to the ground. He gets back up on his feet, but he has a limp.

Of course, he has a limp! He just hit the ground pretty hard! But a few days go by and the limp is still present. So, you load him up and drive to your local veterinarian. After examining Buddy, your veterinarian informs you that Buddy is suffering from a torn cranial cruciate ligament.

So where do you go from here?

Will you ever get to throw the frisbee with your furry friend again?

Will he ever walk without a limp?

Cranial Cruciate Ligament Injuries: The Basic Facts

To better understand the condition and process of correction, let’s lay out the basics.

Much like humans’ anterior cruciate ligament (ACL), a dog’s cranial cruciate ligament (CrCL) acts as the main support for the knee joint (stifle).

Figure 1: Comparison of normal cruciate (first image) to a torn cranial cruciate ligament (second image)

Red: meniscus; Purple: cranial cruciate ligament; Green: caudal cruciate

As shown in the picture above, the meniscus lies between the femur and tibia bones and acts as a cushion. When the CrCL is ruptured, the meniscus becomes damaged as well.

Cranial cruciate ligament disease (CrCLD) is one of the leading causes of hind limb lameness in canines. The tear of the CrCL can be partial or complete. However, a partial tear will most certainly become a complete tear if the condition is not corrected. Cruciate tears, partial or complete, will cause pain and eventually arthritis.

It is rare, but very possible, for a cruciate ligament to result from acute injury. Mostly, the ligament degenerates over a period of time.

Are Certain Dogs Predisposed to CrCLD?

Big or small, old or young, any dog can tear the CrCL. It is very rare in cats. However, studies have shown that certain factors do play a role in this disease.

• Aging of the ligament
• Obesity
• Genetics
• Breed
• Physical condition
• Body conformation

Studies have also shown that 40-60% of dogs that tear one CrCL will tear the other one at some point in time.

Unfortunately, keeping your dog in the best shape is the only way of prevention.

Signs/Symptoms of CrCLD

• Limping (severity varies)
• Stiffness
• Reluctance to jumping/playing
• Difficulty rising from sit/lay position
• Swelling or pain around the stifle
• Muscle atrophy
• Pain
• Popping sounds from the stifle

What Are My Treatment Options?

If found in time, a CrCL that is partially torn may be corrected with prolotherapy. This should only be considered on a case to case basis, as it is not always the best choice.

Surgery is the recommended treatment. Furthermore, stabilizing the joint may only be achieved via surgery. Until stability is achieved, the pain will continue. There are several different methods to surgery, including:

• Tibial Plateau Leveling Osteotomy (TPLO)
• Tibial Tuberosity Advancement (TTA)
• Suture-based Techniques
  • Extra-capsular Suture Stabilization
  • Tightrope®

All three methods have different approaches and, of course, different costs. According to recent studies, however, all of these methods have comparable outcomes approximately one-year post-surgery. The differences may be discussed with your veterinarian, as some methods require special training.

The Extra-Capsular Suture Stabilization Method

Here at White Oak Animal Hospital, we most commonly use the extra-capsular suture stabilization method, which is what we will cover in this article.

This procedure may also be referred to as the lateral suture method, ex-cap suture method, lateral fabellar suture stabilization or the fishing line technique.

Figure 2: Representation of Extra-capsular Suture Stabilization Method

As illustrated in the picture above, this method requires that a heavy, sterile suture be placed on the outside of the joint. The suture is positioned in a way to mimic the action of the CrCL. Over time, this method causes a buildup of scar tissue around the stifle joint, which provides stability for when, or if, the suture deteriorates.

As mentioned above, all possibilities should be discussed with your veterinarian to find the best method for your dog.

Are There Options Other Than Surgery?

Yes. Sometimes there are cases that are not fit for surgery! The non-surgical treatments are:

• Pain medicine/supplements
• Restricted activity
• Rehabilitation therapy
• Custom knee braces

Great care should be taken when treating with pain medicine. Long-term use may cause severe liver/kidney damage. Routine blood work may be required.

Custom knee braces are new to the veterinary world. Because of this, there is a lack of evidence of this method working as it does in humans.

Aftercare

Postoperative care is just as important as the surgery itself! No matter how great your pup seems to feel after surgery, he/she must be under restricted activity for several weeks after surgery. This could mean kenneling your dog when unsupervised and leash-walking for bathroom breaks.

Rehabilitation therapy has been proven to speed recovery AND improve the final outcome. Therapy should only take place under a licensed veterinary physical therapist.

It is recommended to keep your furry friend on a glucosamine supplement as arthritis is very likely to develop, with or without surgery. The physical condition of your pup, including weight, is very important to keep in check!

In most cases, of the dogs that undergo CrCL repair, 85-90% show significant improvement, provided that the correct post-surgical care is closely followed.