Tuesday, June 23, 2009

Treatment for ACL injury

So I still haven't mastered posting multiple photos to the blog, but fortunately I do know how I do this surgery. There are many ways to repair an injured ACL in a dog but this is the way I have been doing it for years with very good success. First the meniscus cartilage, which is not visible in this picture, needs to be inspected and removed if damaged. Then the remnant of the ACL is removed along with any cartilage buildup that will interfere with joint function. The joint is flushed, and closed. I then inject some local anesthetic into the joint before we go on to stabilize the knee.

The photo below shows the knee joint closed and the lateral stabilization suture in place. I use a large nylon suture and a crimp instead of a knot to hold it.

You can see the crimp on the suture. In this dog, a large dog, a second suture is place to insure stability. The skin is closed and we use ice and IV pain medication in the immediate post op period to reduce pain and swelling. We also treat the joint with a laser immediately post op and the next day to speed recovery.
There are many different techniques to repair cruciate injury. Many people will advocate one over another. I have found this approach to be straight forward and easy on the patient. It is also less expensive than some of the other repairs. I have tried to balance outcome and cost so that we can help as many dogs as possible. For clients that request it, we are fortunate enough to have many referral hospitals where surgeons can do the more technically difficult procedures such as tibial plateau leveling and tibial crest advancement if it is indicated.
In the next posts, I'll address post op care, rehab for stifle joints and long term treatment of the degenerative disease of the stifle joint.
Keith Niesenbaum, VMD

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