Dog Knee Ligament (CCL) Repair

Lateral Fabellar Technique (Extracapsular Technique) - Cranial Cruciate Ligament Repair

The Lateral Fabellar Technique, or Extracapsular Technique, is a common surgery performed on dogs to stabilize the stifle (knee) joint after a tear or rupture in the cranial cruciate ligament (CCL; misspelling cranial crucial ligament). Normally, the cranial cruciate ligament (CCL) prevents backward-forward movement (drawer movement) of the stifle joint. Untreated instability in the knee/stifle joint due to a turn/ruptured CCL can result in a tearing of the meniscus as well. When it tears/ruptures, the stifle joint becomes unstable and the dog suffers lack of mobility, lameness or loss of use and is subject to chronic and progressive arthritis in the stifle if untreated.

In a Lateral Fabellar (Extracapsular) procedure, heavy suture material (monofilament nylon cord) is passed from the lateral fabella to the tibial crest in order to eliminate joint instability (drawer movement). It is this nylon cord that will act as the CCL ligament in the future by holding the joint together and keeping it stable.

The lateral fabellar surgery will not stop the progression of arthritis that is already present in the joint. Your dog may have some stiffness of the limb and may have some lameness after heavy exercise.  Chondroitin sulfate and glucosamine may be given to help with stiffness.

Typical downtime and rehab:

• First 2 weeks, dog should be crated and only let out on a leash to go to the bathroom.
• After about 2 months, lameness should decrease significantly, but it was recommended by our veterinarian to keep our dog crated still.
• After 3 months, our dog had regained full use of her leg.

Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs

When our dog tore her CCL, she imediately came up lame and was unable to put any weight or pressure on her right hind leg. She had minor hip problems previously, so at first we thought that she just overdid it while playing at the beach, so we took her home, gave her some MetaCam and let her rest overnight. When nothing had changed the next day (Sunday), we decided to take her to the pet Emergency Room.

At the ER, they told us that to diagnose the problem with her knee they were going to have to do 2 things:

1. Take x-rays of the stifle (knee) joint to make sure that there is no bone damage and/or arthritis.
2. Manipulate the joint while the dog is sedated to check for instability (drawer movement)

So we left our dog at the emergency clinic so that they could sedate and diagnose her injury, and when we next heard back from them, they told us that she most likely has a torn cranial cruciate ligament (CCL; misspelling: cranial crucial ligament) and that we should take her to her primary care veterinarian to discuss repair options.

Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)

When it comes to caring for our pets, we all want the best possible option, however, most veterinarians will have a single method that they prefer to perform, thus leaving you to find another vet if you do not agree with having a specific CCL surgery. Prior to committing your dog to a surgery, you’re going to want to find out what option your veterinarian will perform, the recovery time, what percent of normal activity level will the dog return to when fully recovered, etc. Of all the surgery options, I’d say that any would be better than going without the surgery (see my post on my friend who did not get the surgery for his dog), but in the end, the choice is going to be up to you - the dog owner. Without the surgery, your dog will have an unstable stifle (knee) joint, and will probably show lameness terminally.

Cranial Cruciate Ligament (CCL) Surgery Options

• Traditional Repair – Lateral Fabellar Technique
  This technique is typically recommended for smaller dogs (we went with this option on our 60lb pit bull). With this technique, a monofilament nylon cord of about 80-100lb tensile strength is passed from the lateral fabella to the tibial crest, in what was explained to me as a figure 8 pattern, basically wrapping the knee joint to eliminate and prevent joint instability (drawer movement). Scar tissue will, over time, develop around the joint, which will further stabilize the joint, but will also begin to restrict range of motion.
• Tibial Plateau Leveling Osteotomy (TPLO)
  The TPLO CCL repair technique is generally recommended for larger breeds of dogs, as well as active dogs, such as agility dogs. This technique is also thought to cause less degenerative arthritis around the stifle joing. Key things to note about the TPLO surgery are a quicker recovery time, better range of motion, less arthritis and a return to athletic (working) activity levels. TPLO surgery involves cutting the bone and slightly rotating it before re-attaching it with a plate. By rotating the top of the bone, less pressure is put on the joint.
• Tibial Tuberosity Advancement (TTA)
  This is a new, less invasive option to the TPLO surgery, but will not be an option for all dogs. Since this surgical option is less invasive, it allows for a quicker recovery time. TTA also puts a cut in the tibial bone, however it shaves off the front of the bone and extends it with a spacer. Also like the TPLO surgery, the TTA option depends on the angle of the stifle joint and is not recommended for dogs with a steep angle in the stifle.

As you can probably tell, each option has advantages and disadvantages, and all options should be discussed with your veterinarian after x-rays are taken of your dogs knee joint.