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The cranial cruciate ligament (CCL) is the main stabilization component in the knee of a dog. To treat damage of this ligament, the dog may be required to lose weight and be given medication for pain and inflammation. In cases where the ligament rupture is severe enough, reconstructive surgery will likely be recommended.
A fibular head transposition changes the positioning of the CCL by moving the fibular head. This can help decrease the amount of damaging movement that occurs when the ligament is torn. Usually, only one leg is affected, however, both legs can require repair at the same time. This procedure is used more commonly on large dog breeds. It should be performed by an ACVS board-certified veterinary surgeon.
Before surgery can be booked, full blood work will need to be run to determine if the dog is healthy enough to undergo general anesthesia. X-rays can be used to visualize joint damage, however, an MRI or arthroscopy will reveal more diagnostic information if the cause of damage is not known.
Before the operation commences, the dog will need to fast for several hours. To begin the procedure, a sedative will be given to the dog. The knee area will then be clipped and cleaned. An intravenous catheter will be administered and general anesthesia will be given. An incision will be made down the affected leg. Once the tissue is opened, all damaged and diseased ligament pieces will be excised. The joint will be washed out to remove all remaining fragments. The joint capsule can then be closed. The collateral ligament will then be moved forward and the cranial cruciate ligament will be aligned as well as possible. Once this is complete, the leg tissue will be close and the skin sutured shut.
There are many different CCL reconstructive techniques. Fibular head transpositions are only beneficial in specific circumstances. Fascial strip techniques may also be used, however fibular head transpositions tend to have more success. This surgery leaves the joint fairly unstable, and requires other procedures to reinforce the limb. A cranial cruciate ligament excision is also needed to remove damaged tissue before the transposition can begin.
The dog will need to be closely monitored as the general anesthesia wears off. Pain medication will be administered as the dog regains consciousness. All activity will need to be decreased throughout the healing period. Any outdoor time should be spent on leash. For the procedure to be successful, further tearing before the joint heals must be prevented. An Elizabethan collar can be used to keep the dog from licking or biting at its incision. Physiotherapy and laser therapy treatment should begin as soon as possible to help increase the amount of movement the affected joint has.
This surgery often ranges in price from $1,000 up to $3,000. If advanced imaging or exploratory surgery is needed for the diagnosis, the overall cost will increase. Physiotherapy and other rehabilitation treatments can cost up to $75 per session. In mild cases, medication alone may be used to address the issue. This may become quite expensive over time and will not likely be effective long-term.
As with all surgeries, the use of general anesthesia brings serious risks. Many dogs who undergo a fibular head transposition develop meniscal damage within the first year after surgery. The tibia may abnormally rotate, leading to further complications. All dogs who receive this surgery experience articular cartilage deterioration. In general, this procedure does not restore a substantial amount of limb function.
The best preventative measure you can take against CCL damage is to keep your dog's weight down. Excess weight causes severe wear on the legs of a dog. If your dog has already been injured, weight loss can increase the likelihood of recovery. Repetitive injuries may be avoided by not letting your dog jump up onto things. Vigorous play should also be discouraged.
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