Sunday, January 13, 2008

Tyson's Recovery


Tyson, a staff member of our affiliate the Dog Cabin is recovering from a recent ACL surgery. This painful injury was recently diagnosed and repaired at this hospital by our consulting board certified surgical specialist last week.
Tyson is a 3 year old playful large boxer. Kevin and Nelly Reed, Tyson's parents are nursing him back to health. He's a real trooper and is convalescing well. Feel free to pay him a visit at the Dog Cabin. Flowers are not necessary, but a milk bone might be well received. Here is some info about canine ACL injuries.

Anterior Cruciate Ligament (ACL) Repair In The Dog

ACL (Anterior Cruciate Ligament) surgery in dogs is a commonly done surgical procedure in veterinary practice. When the anterior cruciate ligament is torn or stretched, instead of moving like a hinge, the knee joint will actually make a sliding motion. This Healthy, strong dogs can tear an ACL...abnormal motion and instability creates trauma within the joint that leads to wearing of cartilage, increased synovial fluid production and inflammation. Eventually, DJD... degenerative joint disease... results.

A torn cruciate ligament can occur in any dog if just the right (or wrong!) forces impact the knee joint. Most commonly seen in larger breeds of dogs and in dogs that are overweight, the ACL surgical procedure does not actually repair the torn ligament but rather replaces the ligament with artificial material that takes over the function of the Anterior Cruciate Ligament. In the case presented below, nylon strands of 80 pound tensile strength are utilized to restabilize the kneeA radiograph of a normal knee... (stifle) joint.

The veterinarian may tell the dog's owners that the dog has a torn Anterior Cruciate Ligament and one of the best ways to get him back to full function would be to do a surgical procedure where an artificial ligament is placed along the side of the knee joint; we don't try to fix the torn ligament because that particular one just won't heal properly. So we fool the knee into thinking that there is a ligament. After a few weeks of confinement, and then controlled activity, the fibrous connective tissue buildup along the artificial strands implanted along the knee joint stabilize the joint during activity. Then your dog can begin using the leg properly.

Another procedure is called the TIBEAL PLATEAU LEVELING OSTEOTOMY or TPLO surgery. This requires specialized instruction, special bone saws and metal implants. This procedure can be particularly useful when working with large breeds of dogs where forces on the knee and surgical sutures are high. There will be more about the TPLO procedure presented here soon.

In the case presented here the patient had a stretched cruciate ligament for a number of weeks before the ligament finally tore. Even though originally the limping was not severe, degenerative changes were going on in the knee joint. Even a slight stretching of the ACL can lead to joint instability... which then promotes arthritic changes. The photos below reveal the substantial degeneration in the patellar groove under the knee cap and cartilage buildup along the condyles. Once the intra-articular (inside the joint space) surgery is completed, where the ligament remnants are removed, loose meniscus is excised, and cartilaginous overgrowth is shaved away, the joint is then closed. Next the surgeon places the nylon sutures that will stabilize the joint just as if the anterior cruciate ligament was still present.

Click on a photo to
enlarge in a new window

Surgery To Repair a Torn
Anterior Cruciate Ligament

Click on (Zoom view) to
magnify

ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com
An incision is made in the lateral side of the right knee extending from above the Fabella down to just below the tibial tuberosity. (Zoom view) The tibial tuberosity is located below the patellar tendon (just under the surgeon's thumb) so that a hole can be drilled through the tuberosity. Below the knee joint at the top of the tibia where the patellar tendon inserts on the tibia, a hole is drilled through the bone. This hole is used as an anchor point where heavy nylon strands are passed through the hole so that tension can be applied to keep the upper part of the knee joint (the Femur) from sliding backward.
ACL Surgery ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com

(Zoom view) An incision is made into the joint capsule slightly rearward of the patella. The incision is long enough to allow the kneecap to be moved aside for close inspection of the stifle joint.

(Zoom view) The Trochlea, also called the Patellar Groove, is rough, pitted and has cartilage deposits. The Trochlear ridges on either side of the groove have extensive arthritic buildup. (Zoom view) The surgeon is looking for any other damage such as a torn meniscus which can create further arthritis. Pain and reduced motion result from these arthritic deposits. In this view of the opened knee joint the arrow points to the remnant of the torn anterior cruciate ligament. Degenerative joint disease has affected all surfaces of the joint tissues.
Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com
(Zoom view) The surgeon uses a scalpel to slice away any exuberant cartilaginous buildups and to smooth the Trochlear groove so that the Patella can slide freely over the groove. New cartilage will regrow and assist in a smoother action under the knee cap. (Zoom view) A bone chisel is used to remove the bony and cartilaginous buildups along the Trochlear ridges. This will allow smoother movement of the Patella and greatly reduce the dog's discomfort and increase mobility. The joint capsule is closed and the deeper tissues are sutured together. Now, on the outside of the joint, a large needle is passed behind a small bone (called a Fabella) above and behind the knee. The fabella is one anchor point for the nylon suture material that takes the place of the original cruciate ligament.

(Zoom view) Here the needle and nylon suture material has just been passed through the hole in the front of the tibia bone. The heavy suture material will serve as a new ligament and stabilize the knee.
ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com ACL Repair Surgery in ThePetCenter.com
(Zoom view) In this view we see the heavy suture material being drawn tight and a tool is used to crimp the nylon suture. This suture will act as a new ligament, essentially fooling the knee into thinking there is still an original ligament present. (Zoom view) Two strands of 80# test nylon are used on this large dog. Now the knee is stable again and there is much less risk of additional arthritis. Then the skin is closed and the incision area is cleaned up. This image shows the basic crimping materials and the nylon strands that are used an "artificial" ligament. There is surprisingly little bleeding in this procedure. Skin sutures are removed in 8 to 10 days. (Zoom view) These images show some of the exuberant cartilaginous and calcified material that builds up along joint surfaces whenever arthritis is present. Remodeling the joint to approach more normal anatomy will benefit the patient and promote normal joint use.
Return to the
SURGERY ROOM
See another ACL Surgery Learn about
Arthritis Supplements
Go to the
RADIOLOGY DEPARTMENT

Be sure to tell other pet lovers about ThePetCenter.com


3 comments:

  1. Cole says send Tyson some recovery love! He needs him back in action for play day!

    ReplyDelete
  2. Nellie and Lucie wish Tyson a speedy recovery!!!

    ReplyDelete
  3. After a few weeks of confinement, and then controlled activity, the fibrous connective tissue buildup along the artificial strands implanted along the knee joint stabilize the joint during activity.

    ReplyDelete