Commonly Asked Questions Regarding Cruciate
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:
- Limping on one hind leg, shifting weight away from the affected leg
during standing or walking (often more pronounced after exercise).
- Popping or snapping sounds heard from the knee during walking.
- 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
- 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 pets 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 pets 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 pets 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
- 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
- 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.