In this section we hope to answer the questions you have about our operations. Our veterinarians are highly skilled, and have performed this procedure successfully on countless occasions. We hope that these answers put you at ease, and allow you to see the benefits of our pioneering treatment.
96% of the dogs we’ve treated have regained the walking and running capabilities they had before the injuries. A further 2% retained slight injuries, with the final 2% being unsuccessful.
There are 2 main options for you to choose from, intracapsular and extracapsular. The intracapsular technique uses a series of grafts to repair ligament, whereas the extracapsular treatment uses sutures. Both are effective in treating your dog, and the only difference is how they’re applied.
It has a long track record, and we have audited the results of our clinical cases in 100 dogs of various breeds, sizes, and ages over 15 years. We chose skin as our preferred graft because published papers from the 60s and 70s showed it was better than nylon or fascia. No other technique replaces the ruptured cruciate ligament in the same way we do. We believe that this is essential to the restoration of normal function in the long term.
Sawing the bone without replacing the ruptured ligament isn’t something that humans would contemplate for their legs, so why think of doing it for your dog? Footballers have their cruciate ligaments repaired using tunnel and graft techniques, and they still play in the same league 10 years later. The Biomet™ website and OrthoAssociates site show how this treatment is approached for humans.
Using our chosen technique, and creating a skin graft with 2 bone tunnels costs between £1500 and £2500, depending on the size of the dog and the complexity of the case. This is an all-inclusive price including the x-rays, anaesthetics, and post-operative medication.
An extracapsular suture is likely to cost around £1000. Bone sawing or osteotomy techniques commonly cost in the region of £4000. There is variation between surgeons and practices, and variation in the incidence of complications and extra costs that can be invoiced on top of the basic price, plus many osteotomy techniques are advised to have further follow up radiographs to check on bone healing, whereas this is very rare following graft replacement surgery.
There is an 80% chance of the other leg needing the same operation if a
bone-sawing technique is used; compared to only 10% if the natural graft technique is chosen. This makes a big difference to the costs involved.
We have been frustrated for more than 30 years by the refusal of other vets to accept or recognise the value of this technique. But more importantly by the widespread acceptance of a highly invasive surgical technique without really evaluating the previously respected and widely used technique to see if reports of success could actually be improved on or needed to be improved on. There is an insistence on or lack of awareness of the graft technique, whilst much more
radical techniques, which we do not believe are recommended as necessary.
I have carried out extensive literature searches and found no evidence in the
published literature that the more radical techniques are justified, except in
perhaps some cases which are small in number. One published paper often
quoted compares 3 different surgical techniques which were a TPLO (form of
osteotomy), lateral suture and an intra-articular technique called ‘over the
top’. The conclusion the author Conzemius (2005) was that the over the top technique was not as successful as the other two techniques, but there was no inclusion of the skin graft replacement technique in this work, so it is incorrect to assume that all intraarticular techniques are comparable to the one in the study. Dog owners are able to change this by asking about the graft technique as a natural solution to the problem, and referring to the literature and this website. The other reason why other vets do not use this graft replacement technique is because they have either not heard of it or have become unfamiliar with it and not practiced in it because they have not used it for many years.
Our results show that there is only a 2% chance of the operation failing. Our clients and our practice together have classified failing as an operation which 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 3 months of the operation. Perhaps the skin graft has not healed properly, or the graft may have failed. A dog that has been exercised too violently before the end of the strict 3-month period of ‘strict lead exercise only’ is also susceptible. This compares to published results for bone-sawing techniques where the complication rates range from 8% to 25%.
In more than 35 years of practising, we have never had a case where
we have had to operate on the cartilage at the same time, and have never had to re-operate because of cartilage problems.
However, it is widely reported that 50% of cartilage problems either are already present, and that up to 28% of the time there is a need to re-operate sometime after cruciate surgery, using other techniques.
Some dogs have an audible click or clunk after rupturing their cruciate ligament, and sometimes this happens after cruciate surgery. In our experience, all clinks and clunks have disappeared after the 2 months, following surgery. It appears not to be a problem following the graft technique. Although we have not proved it, we believe that this is due to a settling down of the cartilages in the knee after surgery. The important point is that the graft enables the other structures to settle down and restabilise without further intervention.
The non-invasive nature of this procedure means that there are minimal adverse effects if the procedure fails. One instance was an old Yorkshire terrier, who came for cranial cruciate ligament surgery. Unfortunately, the surgery didn’t work out, but the old dog was happy to just potter around with a slight limp.
There is an option to repeat the procedure, which we have done in the past. Each time that we’ve re-applied a skin graft the process has been successful. As with the initial surgery, the procedure was non-invasive, and was much less risky than bone-sawing techniques that are used by other veterinarians.
We are confident in our ability to diagnose the majority of ruptured cruciate ligaments by observation and feeling the joint. Some dogs are difficult to examine, and sometimes sedation or anaesthesia is needed for them to relax. This requires skill and experience, and it’s not always easy to make this diagnosis accurately, especially when the decision on if we take the dog to surgery is critically important.
X-rays are important because of conditions which occur at the same time as a ruptured cruciate. These include the occasional presence of a bone tumour in Rottweilers, or osteoarthritis in the hips. The x- rays help in gaining a more complete understanding of the problems involved and the likely outcomes in the event of concurrent problems.