July 9, 2020

CCL surgeries

I think I discovered the entire alphabet learning about CCL (canine crutiate ligament) surgery repairs. There's the TTA, MMP, TPLO, and CBLO for STARTERS. And apparently each orthopedic surgeon has his favorite. So what the heck will they be doing with each surgery?

Suturing techniques - EXTRACAPSULAR STABILIZATION/LATERAL SUTURE (ECLS)- the least invasive of the surgeries, the surgeon inserts a suture that will act like the CCL ligament. It will eventually loosen, but scar and fibrous tissue will build around it and start to act like a natural new CCL. With TIGHTROPE (TR), the surgeon uses a flexible tape to go around the joint to stabilize it. These surgeries have been around the longest, but are recommended for dogs under 40lbs with low activity levels. These types of surgeries are also the least expensive costing less than $2K in Indianapolis.

Tibial Plateau Leveling Ostomy (TPLO) - this one seems to be by far the most common repair for larger dogs. It has been practiced since the 90's, so it's also tried and true. With most of these surgeries, the surgeon is actually changing the dynamics of the knee. The surgeon cuts the top of the tibia (tibial plateu) and rotates it a pre-determined amount so that the load applied to the knee is at a lesser angle. The surgeon will also implant a surgical plate between the cut bone and the tibia to stabilize the bones while they heal. This surgery is the most invasive with the largest incision.
Healing time: 10-12 weeks, Cost: $4k-6k (Indianapolis)

CORA-based Leveling Ostomy (CBLO) - CORA means center of axis rotation. This procedure is a newer form of the TPLO, but involves less of the articular cartilage and does not involve the growth plate of the leg (for young dogs not done growing). The cut into the bone is less, so the healing time is less as well.
Healing time: 6-7 weeks, Cost: unknown

Tibial Tuberosity Advancement (TTA) - this procedure uses the patellar tendon to stabilize the knee by sectioning into the tibia and moving the tibial tuberosity anteriorly so that the tendon inserts at 90 degrees. The surgeon will place a titaniam cage in the bone cut so that bone can grow around it as well as insert a metal plate to stabilize the joint. These surgeries are good for dogs with a certain degree of tibial slope and have been around since 2005
Healing time: 10-12 weeks, Cost: $3.5k-4.5k (Indianapolis)

Modified Maquet Procedure (MMP) - this procedure has been around since 2014 (but over 50 years for human knees) and it is similar to the TTA procedure because the surgeon will cut into the tibia to move it to be 90 degrees to the patellar tendon, but instead of a cage or plate, the surgeon inserts a titanium wedge to fill in the void within the bone. Bone tissue can then grow through the wedge and make the tibia stronger. This procedure uses smaller hardware and a smaller incision site which leads to faster healing times.
Healing time: 6 weeks, Cost: $3k-4k (Indianapolis)

I am a medical professional, but definitely not a veterinarian or orthopedic surgeon. The type of surgery your dog may need will vary based on age, weight, activity level, and the tibial plateu angle of the dog. So most of that stuff is out of your control anyway. What I've read has stated that it is mostly surgeon preference and that the TPLO vs TTA-type surgeries fair about the same. It appears that that the TPLO procedured is the one taught/practiced in veterinarian school so it seems to be more prevalent than some of the newer surgeries.

I personally have decided for Aspen to undergo a MMP procedure. I trust the surgeon (friend of a friend basically) and think Aspen will do best with a shorter recovery period. For some crazy reason, I am actually thinking about getting BOTH KNEES done at the same time. As previously mentioned in my first post, 50-70% of dogs will tear their opposite CCL. Aspen is already showing some effusion in his other knee due to putting 109lbs on his good knee for almost 2 weeks. Of course, the ultimate decision will be made once the orthopedic surgeon gets complete x-rays and examines Aspen himself. I won't know until I get that call Friday if Aspen is getting both knees, one knee, or no knees done (if he suggests Aspen would be better off with a TPLO surgery over the MMp... ya know, tibial plateau stuff). So of course, the anxiety monster is running rampant over at my house.

Aspen does have a WISH LIST of goodies to help him get through his surgery. Other than that, please wish us luck!


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