CRUCIATE DISEASE IN DOGS
Fixed Price TPLO Fee From May 2010 (includes initial consultation, surgery/anaesthetic/imaging/hospitalisation fees and 6-8 week follow-up x-rays)
<20kg: £2500 incl. VAT
20-40kg: £2700 incl. VAT
40-60kg: £2900 incl. VAT
>60kg: £3200 incl. VAT
Background There are two cruciate ligaments in the knee (or ‘stifle’ as we call it in dogs). Disease of the cranial (or anterior) cruciate ligament is one of the most common orthopaedic conditions seen in dogs. In people cruciate ligament (or ‘ACL’) ruptures are typically seen as acute sporting injuries, in footballers and skiers for example. In dogs it is a little different. In most dogs the condition is a more chronic degenerative condition. The ligament degenerates and gets weaker with time and at some point will start to tear. The signs associated with the initial stages of the condition can be subtle and may be missed –signs such as stiffness on rising from rest and mild, occasional lameness. As the ligament continues to tear the signs may become more obvious but it is not uncommon for owners to first realise their dog has a problem when the already weakened ligament finally tears completely, often during relatively normal activity. At this stage the stifle will be unstable –the two bones of the stifle (the tibia and femur) will rock back and forth during walking. This instability will often lead to the menisci (cartilage ‘shock absorbers’ of the knee) being torn, which can cause significant lameness and discomfort unless treated appropriately.
Diagnosis The diagnosis is often made on palpation/manipulation of the stifle, although in some dogs this may require sedation. X-rays will show signs of osteoarthritis (OA or ‘arthritis’). Early cases may be less easy to diagnose, sometimes requiring exploratory surgery/arthroscopy to visually examine the cruciate ligament.
Treatment Small dogs (less than 15kg) may do well with a period of rest and antiinflammatories alone, although surgery may offer a quicker recovery. Larger dogs are less likely to do well without surgery and so surgery is always advised. Surgery involves examination of the menisci, so that any torn pieces can be removed, and stabilisation of the joint. Numerous stabilisation techniques have been described. The most successful techniques involve placing a restraining suture around the outside of the joint to try to replicate the function of the torn ligament (known as extracapsular or lateral retinacular suture stabilisation) or changing the geometry of the tibia to counteract the forces that are responsible for the instability (e.g. tibial plateau levelling osteotomy, or TPLO). Both techniques, in the right hands, can provide good results for dogs of all sizes although most specialist surgeons would agree that techniques such as TPLO offer a quicker and more reliable outcome, especially in larger dogs or very active dogs.
Preoperative x-ray showing the tibial plateau angle (TPA), x-rays following TPLO, TPLO cartoon
Extracapsular suture – Key Points:
- Reliable technique in small/medium dogs, but greater risk of suture stretching/failure as size increases, which can result in recurrent instability
- Postoperative function enhanced through the use of a minimally invasive arthrotomy, isometric suture placement & use of high stiffness nylon and crimps
TPLO – Key Points:
- Very reliable technique even in large/giant breeds of dog
- Early return to limb use (often weight-bearing next day)
- Synthes locking plate technology provides mechanical advantages and reduces risk of complications
- Greater cost than suture stabilisation due to the complexity of the surgery and implant costs
Why choose Anderson Sturgess?
- Unlike some referral centres, we will not dictate to you which procedure we do. The options for your pet will be discussed fully at the time of consultation.
- Our orthopaedic surgeons have a wealth of experience in treating dogs with cruciate disease. They have performed hundreds of these surgeries. Treating dogs for orthopaedic disorders is the only thing we do, every day, all year, and cruciate disease is the most common condition we see.
- We have invested a lot of time and money in state of the art surgical and anaesthetic facilities, which means reduced risk of complications for your pet (see our infection audit page).
- Pain management is a priority of ours, including eipidural pain relief as standard for TPLO surgery. Fully qualified nurses are on-site 24 hours/day to ensure your pet is comfortable through-out the night following surgery.
Sample discharge instructions for TPLO surgery (pdf)
