Case: Lateral retinacular suture repair for cranial cruciate ligament rupture
29th December 2013
Rupture of the cranial cruciate ligament in the stifle (knee) joint is a very common problem in dog.
Placing a permanent nylon suture when the cranial cruciate ligament fails is still a widely performed procedure, although in recent years the various osteotomy (bone cutting) procedures like tibial tuberosity advancement (TTA), tibial plateau leveling osteotomy (TPLO) and their variants and combinations have been widely used.
We prefer the osteotomy procedures for larger dogs as we feel that they get mobile faster with these osteotomy techniques. There is no clear evidence that the long term outcome, months down the line, is much different.
In small, quiet dogs where a period of a few weeks conservative treatment (rest, anti-inflammatories etc) has proved ineffective, we still find the LRS to be a very useful technique in many of these patients.
A nylon suture of leader line (which will be a familiar material to fishermen) is placed around the lateral fabella, a reasonably firm anchor point just behind the femur and just above the stifle. This suture is passed through a bone tunnel created in the tibia. The positioning of this tunnel is important and easy to get wrong. Accurate positioning of the tunnel ensures that the line of the suture will be best suited to constrain the aberrant motion of the stifle which results when the cranial cruciate ligament is ruptured. The suture is pulled snug and secured with a metal crimp.
The aftercare for LRS surgeries is a little longer than that for osteotomy techniques. Fact sheets for both of these procedures can be found in the section for owners.