Astonlee Veterinary Hospital and Surgery
Tickford Street, Newport Pagnell, Milton Keynes, Buckinghamshire, MK16 9BA United Kingdom
Tel: 01908 611637
Dr Paul R. Manning, MA, VetMB, MSc (VetGP), DProf, MRCVS
96% return to ‘normal’; ie : the walking/running capabilities the dog had before the rupture of the cruciate ligament. 2% chance of being slightly lame. 2% failure rate.
What are the treatment choices for my dog?
Extracapsular suture
Intracapsular techniques with use of grafts
Bone sawing/osteotomy techniques.
Why do you choose your skin graft technique?
It has a very long track record, the principles of the technique having been invented in Finland in 1952 with modifications since, and I have audited the results of my clinical cases in 100 dogs of many breeds and sizes and ages over a 15 year period (see vets section on this website)
I choose skin as my preferred graft because published papers in the 1960’s and 70’s showed it was better than nylon or fascia (Vaughan 1966 at the Royal Veterinary College).
No other technique replaces the ruptured cruciate ligament in the position in which it achieves re stabilisation of the stifle joint, which I believe is essential to the restoration of normal function in the long term.
Sawing the bone without replacing the ruptured ligament seems to me like an idea that no human patients would contemplate for themselves, so why would they think of doing it for their dogs?
Premiership footballers (humans) have their cruciate ligaments repaired using tunnel and graft techniques, and they can still be playing in the same League 10 years later.
What are the costs of each choice of procedure?
Using a skin graft with 2 bone tunnels in my chosen technique costs about £2000, but can be as little as £1000 depending on size of dog and complexity of the particular case.
Extracapsular suture is likely to cost about £1000.
Bone sawing/osteotomy techniques commonly cost in the region of £4000.
What is the potential for things to go wrong?
My results show that there is only a 2% chance of the operation ‘failing’ which has been judged by myself and my clients in that the operation has failed to restore the leg to normal function with the ability to play, walk and run. When the operation has failed, it is usually within the first 3 months after the operation when perhaps the skin graft has not healed properly or the graft itself failed, or the dog has exercised too violently before the end of the strict 3 months post op period of ‘strict lead exercise only’.
This compares to published results for bone sawing techniques where the quite serious complication rates can be in the range 8% to as high as 25%.
If the operation does fail, what can be done about it?
In the small number of cases where the operation has failed, one was a very old Yorkshire Terrier so it was decided that the old dog should have a choice and not go through another operation, and he was happy to potter around with a limp for his last year or so.
The procedure does not alter the alignment of the leg (bone osteotomy techniques do), and the situation in a failed operation using the tunnel and graft techniques is almost the same as it was before the operation was carried out.
It is a relatively uncomplicated procedure to repeat the operation and insert another skin graft, which is highly likely to succeed.
This compares to very serious potential complications with bone sawing techniques where there have been failures of the stainless steel plates and/or screws, and the potential for arthritis to develop seems to be much higher with the bone sawing which is a much more aggressive technique than using a skin graft.
What are the chances that the opposite leg will need surgery?
My results with my technique show that there is about a 10% chance that the opposite leg will need surgery for the same problem.
This compares to most other published results where the chances range from a minimum of about 50% to 80% chance.
How long have you been using your technique?
Since I qualified in 1979 from Cambridge University where I was taught how to do it.
If you have a question that is not answered above, please contact me and I will try to answer it for you.
Astonlee Veterinary Hospital and Surgery
Tickford Street, Newport Pagnell, Milton Keynes, Buckinghamshire, MK16 9BA United Kingdom
Tel: 01908 611637
Tickford Street, Newport Pagnell, Milton Keynes, Buckinghamshire, MK16 9BA United Kingdom
Tel: 01908 611637
Cruciate Ligament Surgery In Dogs Or Dog Knee Surgery
CRUCIATE LIGAMENT SURGERY IN DOGS
Dr Paul Manning of Astonlee Veterinary Practice and Animal Hospital is a very experienced surgeon, and has a wide range of skills to offer our animal patients.
Cruciate ligament, or dog knee problems are the commonest orthopaedic condition in dogs, and Paul has taken a very keen interest in this ever since being taught by the late Col Hickman (a very well respected surgeon) at the Cambridge Vet School in 1978. It is commonly said at vet conferences and stated in most current vet textbooks that ‘there is no one surgical method that is better than any other’. For many, this means that the surgical techniques have not been advanced very much since cruciate surgery was first pioneered by a Finnish vet (Paatsama) in 1952.
Paatsama invented the idea of drilling two bone tunnels, one through the femur and one in the tibia, through which he threaded a piece if tissue to replace the ruptured cruciate ligament. The principle of this technique has stood the test of many years, and Paatsama is still honoured to this day by having his name attached to an international award given to the vet surgeon who has been considered to have given the most to the field of orthopaedics in any given year.
Prof Vaughan at the Royal Veterinary College achieved a very high level of success with the Paatsama technique, modified to use skin as the graft material rather than fascia (grissle), achieving success in 28 out of 30 cases in a series studied over a period of 1 year.
In 1994, a new technique was invented by a vet in the USA Barclay Slocum called the TPLO (Tibial Plateau Levelling Operation). This technique was claimed to have merits because it did not introduce foreign material into the joint of the dog. It was based on the principle that sawing the tibia and rotating it, fixing the then broken bone with a large plate and screws, would help to prevent the sliding of the unstable joint with the ruptured cruciate. However, in this technique, there was no replacement of the ruptured ligament as with the graft technique, and the joint was only stable in one position of the gait at full extension of the leg. This technique has been followed by many vets and veterinary specialists around the world, including the UK, ever since……except by Dr Paul.
Dr Paul studied the technique using the skin graft over a period of 15 years, following cases in many breeds of dog, some for over 10 years, and over 50% of the cases were followed for more than 2 years. Measuring the success rate by simply assessing whether the dogs were a)slightly lame, b) slightly lame, c) severely lame; the success rate achieved was 96% returned to zero lameness, only 2 returned to ‘slight lameness’, and only 2 failed but for reasons of being severely obese or aged.
Dr Paul is very keen to restore as many dogs to normal lives as possible through cruciate ligament surgery in dogs, believing in the audited results, so if your dog has a problem with a hindleg, it might be a cruciate ligament problem so make an appointment to see Dr Paul. Paul is also very happy to see cases from clients of other practices by referral from their veterinary surgeon.
Commonly asked questions about cruciate ligament surgery
What is the likely success rate with your operation in your hands?96% return to ‘normal’; ie : the walking/running capabilities the dog had before the rupture of the cruciate ligament. 2% chance of being slightly lame. 2% failure rate.
What are the treatment choices for my dog?
Extracapsular suture
Intracapsular techniques with use of grafts
Bone sawing/osteotomy techniques.
Why do you choose your skin graft technique?
It has a very long track record, the principles of the technique having been invented in Finland in 1952 with modifications since, and I have audited the results of my clinical cases in 100 dogs of many breeds and sizes and ages over a 15 year period (see vets section on this website)
I choose skin as my preferred graft because published papers in the 1960’s and 70’s showed it was better than nylon or fascia (Vaughan 1966 at the Royal Veterinary College).
No other technique replaces the ruptured cruciate ligament in the position in which it achieves re stabilisation of the stifle joint, which I believe is essential to the restoration of normal function in the long term.
Sawing the bone without replacing the ruptured ligament seems to me like an idea that no human patients would contemplate for themselves, so why would they think of doing it for their dogs?
Premiership footballers (humans) have their cruciate ligaments repaired using tunnel and graft techniques, and they can still be playing in the same League 10 years later.
What are the costs of each choice of procedure?
Using a skin graft with 2 bone tunnels in my chosen technique costs about £2000, but can be as little as £1000 depending on size of dog and complexity of the particular case.
Extracapsular suture is likely to cost about £1000.
Bone sawing/osteotomy techniques commonly cost in the region of £4000.
What is the potential for things to go wrong?
My results show that there is only a 2% chance of the operation ‘failing’ which has been judged by myself and my clients in that the operation has failed to restore the leg to normal function with the ability to play, walk and run. When the operation has failed, it is usually within the first 3 months after the operation when perhaps the skin graft has not healed properly or the graft itself failed, or the dog has exercised too violently before the end of the strict 3 months post op period of ‘strict lead exercise only’.
This compares to published results for bone sawing techniques where the quite serious complication rates can be in the range 8% to as high as 25%.
If the operation does fail, what can be done about it?
In the small number of cases where the operation has failed, one was a very old Yorkshire Terrier so it was decided that the old dog should have a choice and not go through another operation, and he was happy to potter around with a limp for his last year or so.
The procedure does not alter the alignment of the leg (bone osteotomy techniques do), and the situation in a failed operation using the tunnel and graft techniques is almost the same as it was before the operation was carried out.
It is a relatively uncomplicated procedure to repeat the operation and insert another skin graft, which is highly likely to succeed.
This compares to very serious potential complications with bone sawing techniques where there have been failures of the stainless steel plates and/or screws, and the potential for arthritis to develop seems to be much higher with the bone sawing which is a much more aggressive technique than using a skin graft.
What are the chances that the opposite leg will need surgery?
My results with my technique show that there is about a 10% chance that the opposite leg will need surgery for the same problem.
This compares to most other published results where the chances range from a minimum of about 50% to 80% chance.
How long have you been using your technique?
Since I qualified in 1979 from Cambridge University where I was taught how to do it.
If you have a question that is not answered above, please contact me and I will try to answer it for you.
Additional reading can be done by visiting our Vets section
Astonlee Veterinary Hospital and Surgery
Tickford Street, Newport Pagnell, Milton Keynes, Buckinghamshire, MK16 9BA United Kingdom
Tel: 01908 611637
 
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