Advances in the Canine Cranial Cruciate Ligament, 2nd edition

(Wang) #1
Caudal Cruciate Ligament Rupture 125

damage or rupture is present during surgery,
as this is a contraindication for the TPLO pro-
cedure. TPLO increases CaCL loading, and the
joint-stabilizing effect of TPLO depends on
a biomechanically intact CaCL being present
(Warzeeet al. 2001; Zachoset al. 2002).
In dogs with avulsion fractures, if the fracture
fragment is sufficiently large, fracture repair
with a lag screw is recommended (Reinke 1982;
Harari 1993). In patients where the fracture frag-
ment is small, debridement of the fragment is
indicated. Again, the need for a stifle stabi-
lization procedure in these patients is unclear
(Harari 1993).
In dogs with multiple ligamentous injury,
surgical treatment for CrCL rupture, medial
collateral ligament rupture, and menisci injury
should be a priority. Menisci and their sup-
porting structures should be preserved where
possible. Collateral ligament rupture should be
repaired with sutures if possible. A number
of procedures are available for stifle stabiliza-
tion to protect reconstructed ligaments, includ-
ing extracapsular stabilization and the use of a
transarticular external skeletal fixator.


Conclusions


In conclusion, in dogs affected with CR, fiber
damage in both the CrCL and the CaCL is often
found during arthroscopy or arthrotomy (Sum-
neret al. 2010). Fraying of the CaCL is under-
appreciated unless a probe is used specifically
to examine the ligament during surgery. Occa-
sionally, substantial damage to the CaCL will
be identified in dogs diagnosed with CR. This
is important, as substantial disruption of the
CaCL is a contraindication for TPLO.


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