What is the Anterior Cruciate ligament?
The anterior cruciate ligament, or ACL, is one of the two ligaments that hold the femur and the tibia in proper alignment. See drawing to right.
How does it get injured?
These two crossed (cruciate) ligaments prevent forward slipping of the femur over the tibia. When a dog plants his foot and suddenly twists his body, the cranial cruciate ligament can tear or break. This is the same injury often suffered by athletes – such as football players. Once torn, this will cause instability in the knee. That results in pain when walking, and grating of the femur and tibia leading to arthritis and swelling. Left unrepaired, severe arthritis and chronic pain can result.
How is it fixed?
There are many ways to repair the ACL rupture. The two most common are lateral fabellar suture and the TPLO (tibial plateau leveling osteotomy). The procedure performed most commonly and for the longest time is a lateral fabellar suture. In most cases, this provides plenty of stabilization and reduces the formation of arthritis. The recovery time is approximately six to twelve weeks depending on the patient.
The lateral fabellar suture is described later in this article.
What is the other surgery?
The TPLO surgery is a newer procedure and can only be performed by certified veterinarians. These veterinarians are found usually at universities or referral institutions. This procedure involves cutting the tibial plateau loose and leveling it. The bone is then plated to hold it in place. Complications are common and recovery time is between twelve and sixteen weeks. Your veterinarian will be happy to discuss both of these procedures – the pros and cons, to help you choose the best procedure for your pet.
The lateral fabellar suture repair is a commonly used method of repair. The basic premise of this technique is to replace a torn ligament with a nylon suture that mimics its function.
The joint is first opened, and the torn ligament is removed.
The meniscus (cartilage) is checked to be sure it is not also torn.
Then the joint is flushed and closed.
A heavy nylon suture is then placed from the fabella behind the femur, through the tibial crest and patellar ligament and secured. (Securos system).
Once this is tightened, the fascia (muscles over the joint) are imbricated (tightened).
This essentially completes the procedure once the skin is closed. The knee is bandaged with a 3M bandage that is similar to a soft cast.
For ten days the knee and leg is fully bandaged, then the toe is cut out to allow for walking. Walking is encouraged, but running and jumping are avoided for 6-8 weeks. After four weeks the bandages are removed, and physical therapy is continued to restore nearly full function to the knee.
In most cases recovery is nearly 100%, though once the ACL is torn, even with repair, some arthritic changes in the joint are expected.
The following link is to a series of photos taken during a surgical repair of the ACL. The repair features the lateral fabellar suture technique. Viewer discretion is advised. This slide show required 2 minutes to download on a 24,000 connection. The slides are numbered and timed for 15 seconds apiece to allow the reader to read the matching numbered text on the left side of the page that will explain the slides.
lateral fabellar suture repair
If you have any questions regarding lateral fabellar suture repair, Please do not hesitate to contact us at 309-685-4707 We will be happy to answer any questions that you may have and want to ensure that your pet has the best of health.