Why we don’t perform this method of Cruciate Ligament Repair

Not all Canine Cruciate Surgeries are the Same.

First of all it’s important to know that there are several methods of treating cruciate disease – and just like any problem for which there may be different solutions, some will be better than others.

So – if your dog has been diagnosed with cruciate disease – expect a conversation about the different options (surgical or non – surgical) that are available and be guided towards the one that will give your dog the best possible chance of a return to normal activity.

Yes, your vet may not be able to perform some of the different procedures but you can certainly be referred to someone who can.

Rosie’s Story

Rosie’s owners came to us just recently because they were concerned that she was still considerably lame 8 months after having the Modified De’ Angelis (Lateral Suture) cruciate surgery. After reviewing Rosie’s X-Rays both before and after the procedure we could see that this method of repair was simply not the best option for her specific condition, explaining why she has never returned to normal pre-injury activity.

Sadly – Rosie’s owners were never given any information about other repair methods and trusted that this surgery would solve her problem. Now her owners are saving up to have Rosie undergo a more suitable procedure to restore normal limb function. It’s fair to say – they’re not very happy. Mostly because they feel cheated. They would never have opted for this method had they been made aware of its limitations.

The goal of any Cruciate Ligament Surgery should be to return the dog to full function or near as possible to full function. i.e. – to be able to do what they were able to do before the injury – Not just do “O.K.”

A bit of Canine Cruciate Surgery History

Prior to the 1980’s the main option for cruciate repair was known as the “De ’Angelis” or Lateral Suture Method. Even back then, it was recognised that that dogs undergoing this procedure would never return to full normal activity. For example – Working dogs would still be able to work however, not in the same pre- injury capacity.

In the late 1980’s a new technique – the TPLO (known as a mechanical, modifying osteotomy) was developed. This method aimed to alter the biomechanics of the joint rather than trying to stabilise the joint such as in the De ‘Angelis method.

The introduction of this procedure enabled dogs to return permanently to full athletic ability.

Over the last 30 years, other methods of geometric / mechanical modification repair methods have emerged, most resulting in similar outcomes as the TPLO. One of these was the TTA procedure introduced during the early 2000’s.

There is widespread universal agreement amongst veterinarians that currently the Mechanical Modifying Osteotomies (MMO) and Geometric Modifying Osteotomies (GMO) offer the best chance for dogs to return to normal or near normal function.

So why are so many dogs still having the outdated De ‘Angelis (Lateral Suture) procedure?

Quite simply – because it is cheap.

It is cheap because it requires less expertise and no expensive equipment to perform, meaning most vets can perform this procedure. While certainly a compromise in favour of doing nothing if cost is an issue, it is not right when it becomes the only offer on the table without explanation of limitations – Especially in large breed dogs.

As vets we have a duty of care to you and your pet to inform you of all possible treatment options regardless of whether we can perform the treatments or not. Remember – referral is always an option and your right to request if you are not satisfied with an opinion.

Phone Shopping for Cruciate Repair Prices – Don’t fall into this trap!

Modified De’ Angelis or Lateral Suture Method of repair is always cheaper than the advanced Geometric / Mechanical Modifying methods.

This is because they require a higher level of expertise as well as specialised equipment. Make sure when ringing around for quotes – you compare the same methods as you can easily be misled if you don’t. We see this happen all the time, the outdated lateral suture method being chosen over other methods because their difference is not explained.

We would never perform the Lateral Suture Method on any of our own dogs which is why we certainly wouldn’t recommend it for yours.

The latest Technique to add to your options

One of the latest GMO techniques is the “MMP” or “Modified Maquet Procedure.”

We are very pleased with the outcomes of this procedure now having performed this on many dogs of all sizes. (Previously we have performed TPLWO, CBLO and TTA procedures – all with good results.)

The MMP is a new take on the TTA procedure and uses a Titanium Foam Wedge implant that stabilises the osteotomy site. It causes less soft tissue damage, therefore producing less postoperative pain and a much faster recovery.

The orthofoam wedge provides a robust fixation without the need for support bandages and a lengthy period of rest. This means a shorter confinement period for your dog after surgery.

Finally – Don’t ask your neighbour!

If your dog has been diagnosed with Cruciate Disease, ask your vet to explain the different repair methods available and get an informed opinion on the one that’s best for your dog’s specific condition. The procedure your next door neighbour’s dog had may not be the right one for yours.

Disclaimer: This subject is based on over 25 years experience in performing various cruciate surgery techniques in dogs of all sizes as well as ongoing further professional education in this area. Our opinions are our own.