Extracapsular CCL [cranial cruciate ligament] repair: how to make your technique perfect
2012
Aisa Roig, J., University College Dublin (Ireland). School of Veterinary Medicine. Veterinary Hospital
In patients with cranial cruciate ligament disease the decision to perform surgery, and which technique to use, should be made on a case-by-case basis. Some aspects to take into consideration include: client compliance and expectations, patient age, size, anatomy (i.e. tibial slope and presence of concurrent anatomical abnormalities), level of activity and function; cost, individual expertise and available facilities, etc. In this lecture we are going to review the evidence-based management of CCL disease using the fabellotibial suture (FTS) technique. However, there are other alternative extracapsular repair techniques available for the management of this condition (i.e. TightRope® technique). Some of the factors to be considered to maximize a good outcome when an extracapsular technique is used for management of CCL disease are: 1) identification and presurgical planning of concurrent conformational abnormalities (i.e. medial patella luxation); 2) exploratory arthrotomy; 3) use of appropriate suture material; 4) method of sterilization; 5) method of securing the prosthesis; 6) location of anchorage points; 7) position of the stifle at the time of securing the prosthesis; 8) loop configuration; 9) postoperative management. Up to date, there is no evidence of better long-term outcome of tibial osteotomies over extracapsular techniques. However, patients treated with extracapsular techniques tend to take longer to regain normal (or near normal) function of the limb. Owners should be warned on progression of osteoarthritis regardless of the surgical technique used.
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