Commonly Asked Questions Regarding Cruciate Disease

What are the indications for cruciate surgery?

• Surgery is indicated for any dog or cat with lameness, pain, or disability secondary to a partial to completely ruptured cruciate ligament. Signs of cruciate injury include:
  
  1. Limping on one hind leg, shifting weight away from the affected leg during standing or walking (often more pronounced after exercise).
     
  2. Popping or snapping sounds heard from the knee during walking.
  3. Reduced range of motion and stiffness in the knee often resulting in a dog that sits with the leg extended to the side instead of flexed and under their body.
     
• In small patients less than 20 lbs., conservative management may be considered for 6-8 weeks before re-evaluation for surgery. For patients greater than 20 lbs., surgery is the treatment of choice as non-surgical treatment generally produces an unfavorable outcome.
  

What is the difference between a tibial plateau leveling verses other repair techniques?

• Repair methods for cruciate disease can be divided into traditional repairs (imbrication suture, fascial strip, fibular head transposition, etc) and plateau leveling. Plateau leveling is performed either by tibial plateau leveling osteotomy (TPLO) or tibial wedge osteotomy (TWO). The basic difference between traditional repairs and plateau leveling is the method for restoring stability to the joint. Cruciate disease is complex, but is fundamentally a disease secondary to instability caused by partial to complete rupture of the cranial cruciate ligament. Traditional methods restore stability through soft tissue reconstruction techniques that mimic or replace the function lost by the injured cruciate ligament. Plateau leveling restores functional stability by changing the geometry of the joint. There are pros and cons to every method of repair. Recent evidence, and our experience at the VMTH, indicates that plateau leveling techniques may be more effective than traditional procedures. Further research is necessary to document the benefit of plateau leveling. We currently recommend plateau leveling for patients greater than 35 lbs. In general, results are good to excellent with all repair methods. The method recommended for your pet will be based on specific features of their injury.
  

How do I make an appointment for cruciate surgery?

• Appointments for an orthopedic evaluation to determine if your pet is a candidate for cruciate surgery are scheduled by referral only with the Orthopedic Surgery Service (530-752-1393).
  

My appointment is not for several weeks; can an earlier appointment be scheduled?

• Earlier appointments are scheduled based upon the emergent, life threatening needs of the patient. Cruciate disease is not life threatening and therefore requests for earlier appointments are considered only in extreme cases. While cruciate disease is a painful injury, most patients are effectively managed with crate rest and anti-inflammatory/anti-pain medication such as Rimadyl until the appointment time.
  
• You may leave a message on our voice mail waiting list if you wish to be contacted if an earlier appointment becomes available.
  
• You may also choose to consult with a private surgery referral practice. To locate a board-certified veterinary surgeon in your area log on to www.acvs.org.
  
• Early appointments are considered for patients with bilateral cruciate rupture that are not capable of standing. This is a very small number of patients and your veterinarian must contact us directly by speaking with the resident on duty, or one of the orthopedic service coordinators.
  
• Voice mail messages are generally returned in 24-48 hours. For more urgent circumstances, you must request to have the surgical resident on duty paged or may seek consultation with the general emergency service.
  

What information should I bring to my appointment?

• Bring a copy of the medical record and any pertinent radiographs (X-rays) associated with the problem. Your veterinarian should provide you with a copy of the record upon request. If possible, a cover letter summarizing the problem is appreciated. Medical X-rays are legally a vital part of the medical record that must be maintained by your veterinarian. Most veterinarians will loan the X-rays to you but these must be returned once the assessment is completed. X-rays that are left at the VMTH will be mailed back to your veterinarian.
  

What should I expect the day of my pet’s exam?

• A senior student will evaluate your pet followed by a consultation with the resident or faculty surgeon. The objective of the consultation is to review pertinent history, conduct a thorough general and orthopedic examination, review previous radiographs, obtain or repeat additional radiographs if needed, confirm the diagnosis, and discuss treatment options. With cruciate disease there are several options for repair. The pros and cons of applicable repair methods will be discussed and recommendations for treatment will be based on your pet’s specific condition.
  
• The length of the appointment ranges from 1-6 hours depending on the need for sedation, additional diagnostics, and recovery from sedatives. Anticipate spending most of the day in Davis before your pet’s evaluation is complete. We advise you arrange your schedule accordingly and bring books or materials to entertain yourself. Many clients will be seen in the morning and may be asked to return later following completion of the evaluation. Drop-off appointments are not available unless previous arrangements have been made.
  
• Please anticipate leaving your dog for surgery. In general, we avoid consultation visits followed by surgery at a later date as this delays necessary surgery and makes scheduling more complicated.
  

How long will my pet be in the hospital?

• Hospitalization for patients with cruciate disease typically ranges from 3-5 days including the day of the appointment, surgery, and recovery. In general, most patients are discharged 1-2 days after their surgical procedure, but extended hospitalization may be required if there are unanticipated complications.
  

What is the prognosis following surgery?

• Prognosis is contingent upon a variety of factors such as the overall health of the patient, presence of obesity, pre-existing arthritis, orthopedic or neurologic disease in other regions of the body, etc. In general, surgically treated dogs and cats have a good to excellent prognosis for adequate return to function. The objective of surgery is to allow your pet to run, jump, and exercise without significant limitations on activity. Most dogs are free of pain medication following surgery, however, depending on the degree of pre-existing arthritis and the rate of progression of arthritis following surgery, some patients may require adjunctive medication for joint stiffness on an "as needed" to "regular" basis.
  

What are the complications or risks associated with cruciate surgery?

• Overall, complications with cruciate surgery occur in approximately 5 to 10% of patients. Complications can range from mild and easily resolved, to more severe complications requiring additional surgery, expense and disability. With any surgical procedure there are risks associated with anesthesia. Prior to anesthesia, your pet will be evaluated by the surgeon and anesthesia service to assess risks and make recommendations to maximize the safety of anesthesia. Fortunately, most patients with cruciate disease are otherwise healthy and anesthetic complications are rare. Mild complications associated with the surgical procedure include post-operative bleeding, bruising, reaction to suture material, irritation associated with implants, seroma formation, and superficial infections of the incision. More severe complications may include implant failure, deep infections of the joint, bone, or implants, meniscal tearing, patellar luxation, slow or inadequate healing of bone (plateau procedures), and angular / torsional limb deformity (plateau procedures). Severe complications may require additional surgery to resolve and/or minimize the effect of the complication on long-term outcome. Fortunately, adequate post-operative care and strict adherence to discharge instructions will dramatically decrease the risk of such complications.
  
• If you feel your pet has developed postoperative complications, or have specific questions regarding postoperative care, please contact the resident on duty, or one of the orthopedic service coordinators.
• It is important to note the VMTH is not financially responsible for complications that may occur following surgery unless the complication is related to an error in administering the procedure.
  

What is involved with the post-operative care of a pet following cruciate surgery?

• In general, 6-8 weeks of strict confinement followed by 6-8 weeks of progressive, controlled, leash walks are required to complete the physical rehabilitation. Patients will continue to improve on their own after this time, with most patients reaching peak recovery 5-6 months following surgery.
  

How many follow-up appointments are required during the post-operative rehabilitation?

• Cases will vary, but general recommendations are for suture removal 10-14 days following surgery. This may be performed at the VMTH or by your regular veterinarian. To assess progression of healing, we recommend recheck examinations at the VMTH 6-8 weeks and 10-12 weeks after surgery, or until healing is complete. Most patients will require 2-3 recheck examinations unless there are complications requiring additional care and follow-up.
  

What are the anticipated surgical and follow-up costs associated with cruciate surgery?

• Estimates will vary depending on specific details of each case. The estimate for routine traditional extracapsular repair is $1,500 for surgery, with 1-2 recheck exams at $50-110 per visit. Plateau procedures (TPLO/TWO) are more labor and equipment intensive. The estimate for routine Plateau procedures is $2,200-2,400 for surgery, with 2-3 recheck exams at $100-150 per visit. A 100% deposit is required when your pet is admitted to the hospital.
  
• The above estimates are for uncomplicated work-up, surgery and recovery. Patients with operative or post-operative complications may require additional hospitalization and follow-up care at additional expense to their owner. The surgery fee does NOT include follow-up examinations; there is no charge for suture removal, but other recheck visits typically cost $100-150 per visit.