Over the Top Stabilization in Dogs

Cruciate ligaments are ligaments that cross over to support the knee, referred to as the stifle, in dogs. In humans, the main supporting cruciate ligament of the knee is referred to as anterior cruciate ligament, or ACL. In dogs it is referred to as the cranial cruciate ligament; CrCL or CCL. This ligament stabilizes the stifle and connects the femur, or thigh bone, to the tibia, the shin bone in your dog. Rupture or disease of this ligament is one of the most common causes of lameness in dogs and CrCL failure affects many of the supporting structures in your dog's stifle, causing pain and severe lameness. Several surgical techniques are available to your veterinarian to repair and stabilize this ligament and the surrounding structures if the cranial cruciate ligament fails. One of these techniques is the “Over-the-Top” surgical technique which can be performed by open or laparoscopic methods in a dog under general anesthetic. The over-the -top technique involves the harvesting of patellar tissues, patellar ligament tissue, and quadricep tendon tissue to effect repair of the cruciate ligament. This type of repair tends to be used in large or active dogs to return the joint to adequate weight bearing function and allow for the return of as much normal functionality as possible in active dogs. A veterinary orthopedic surgeon may be recommended to provide their expertise to this procedure.

Several surgical procedures are available to your veterinary surgeon to achieve intra articular stabilization of the cranial cruciate ligament. Over-the-top stabilization, involving the harvesting of quadriceps tendons and patellar tissue to repair the ligament, can be performed either laparoscopically, using a small key hole incision and guided by special surgical cameras, or by open surgery, exposing the stifle joint to effect repair. Your dog will be required to fast prior to surgery, then will be sedated, an intravenous line will be set up, and anesthetic administered by IV, followed by the insertion of a breathing tube and gaseous general anesthetic. Your dog's vital signs will be carefully monitored while under general anaesthetic. The area above the stifle where incision or incisions are to be made will be clipped and cleaned and isolated with surgical drapes. If laparoscopic surgery is being performed, small incisions are made to access the joint with a laparoscopic camera and specialized surgical tools. If an open surgery approach is being used a larger incision will be made, subcutaneous tissue incised, and muscles, tendons and vessels moved aside to expose the stifle and damaged cruciate ligaments. Graft tissue is harvested from the stifle region including patellar tissue, patellar ligament, and quadricep tendons by excising the required tissues and grafting them to the damaged cruciate ligament. Sutures are placed to affix grafted tissues. Incisions are closed and your dog will be supported while they recover from anesthetic. Analgesics and anti-inflammatories will be administered at the time of surgery.

The prognosis and recovery of functioning for dogs undergoing cruciate repair surgery is good, with significant recovery and function being regained in most dogs. Arthritis can occur regardless of procedure, and CrCLD in the alternate stifle can occur in many dogs, requiring further treatment.

Medications such as analgesic, anti-inflammatories and antibiotics should be administered as prescribed post-surgery. If bandaging is present it will need to be kept clean and changed as directed. Surgical wounds will need to be monitored to check for wound dehiscence or signs of infection. An e-collar to prevent your dog from interfering with the surgical wound may be required. 

Limiting activity post-surgery is very important to allow the repaired cruciate ligament time to heal. Premature stress could cause the repair and grafted tissues to fail and rupture. Your dog may require cage rest post-surgery for several days, and have activity restricted for several weeks. Your dog should be kept on a leash when outside, and modifications made in the home such as secure footing with carpets and inaccessibility to stairs or furniture they may jump on.

Physical rehabilitation may be recommended to improve your dog's recovery, your veterinarian can recommend a practitioner and an appropriate regime.

The cost of CrCL repair with over-the-top stabilization includes the cost of radiographs for diagnosis and planning, medications, anesthetic, procedure, and hospitalization. In addition, a specialized orthopedic veterinary surgeon with special training and experience can contribute to the cost of this procedure. The cost ranges from $1,000 to $5,000 depending on the cost of living in your area and special or expert resources used.

Rupture of grafts is the most common complication seen with over-the-top stabilization. Ensuring that activity is restricted and the use of an experienced surgeon will minimize the risk of this occurring.

If muscular injury occurred with ligament rupture, lameness may continue post surgery. 

Regular veterinary care and adequate exercise in a safe environment with secure footing and healthy diet will reduce the likelihood of CrCLD occurring. Obesity is a major contributing factor to this condition and maintaining a healthy weight in your pet will reduce the risk of over-the-top cruciate ligament repair being required for your dog.