Front Matter

Chapter 14 Disorders of the Pelvic Limb: Diagnosis and Treatment 369

recommended. If the hip is severely dysplastic,
a THR or FHO is advised.
Numerous techniques for open reduction
and stabilization of the hip have been described.
These can be extra‐articular or intra‐articular
repairs. The most common techniques are
reconstruction of the joint capsule with suture
and bone anchors, or the use of a synthetic
material to replace the ligament of the femoral
head, termed toggle rod stabilization (Figure
14.19). Both procedures provide immediate
stability to the hip. However, long‐term stability
is achieved from joint capsule healing and
periarticular fibrosis, as all synthetic materials
will eventually cycle and break.

Postoperative care and prognosis

Limb use following surgical repair is often
immediate. However, restricted activity is man­
datory for 8–12 weeks following surgery to allow
for the joint capsule and surrounding muscu­
lature to heal. Rehabilitation therapy, including
a home exercise program is strongly encour­
aged. Initially, static weight‐bearing exercises are

introduced along with short‐leash walks on even

terrain. Hill work and greater intensity strength

training is reserved until sufficient healing

occurs, usually about 6–8 weeks following

repair. The patient can return to full activity level

once range of motion of the hip joint and muscle

mass of the limb return to normal.

Repeat luxation is the most common compli­

cation. Until recently, this rate has been cited as

11–25% (Duff & Bennett, 1982; Bone et al., 1984;

Evers et al., 1997; Demko et al., 2006). Advances

in suture material have reduced the reluxation

rate following toggle rod stabilization to less

than 5% (Ash et al., 2012; Kieves et al., 2014).

Cranial cruciate ligament insufficiency

Anatomy

The CCL is composed of two bands, the smaller

craniomedial band that is taut in all phases of

flexion and extension of the stifle, and the cau­

dolateral band that is taut in extension, but lax

in flexion (Figure 14.20). Together, these bands

Figure 14.19 Example of one of the most common
techniques for repair of hip luxation: reconstruction of
the joint capsule with suture and bone anchors, or use of
a synthetic material to replace the ligament of the
femoral head, termed toggle rod stabilization.

Patellar ligament

Caudal

cruciate

ligament

Cranial

cruciate

ligament

Lateral meniscus

Medial

meniscus

Figure 14.20 The cranial cruciate ligament (CCL) and

the caudal cruciate ligament restrict cranial and caudal

translation, respectively, of the tibia on the femur. The

CCL also resists hyperextension and internal rotation and

is the most commonly damaged stifle ligament in dogs.

Source: Illustration by Marcia Schlehr.