Advances in the Canine Cranial Cruciate Ligament, 2nd edition

(^25) Extracapsular Stabilization
Selena Tingaand Stanley E. Kim
Introduction
Extracapsular stabilization (ES) encompasses
a number of different surgical techniques
designed to stabilize a cranial cruciate ligament
(CrCL)-deficient stifle. Biological or synthetic
materials are placed superficial to the joint cap-
sule, spanning the area lateral and/or medial to
the stifle joint. From the original extracapsular
repair introduced during the 1960s to the cur-
rent modifications of the technique, the general
theoretical goal is to counteract the translational
and rotational instability that is present when
the CrCL is damaged. The possible advantages
of ES over other stifle stabilization procedures
include the safety of the procedure, the poten-
tial for reduction of abnormal internal rotation,
lower technical difficulty, minimal required
inventory, and lower cost. The reported disad-
vantages include abnormal biomechanics such
as excessive constraint, higher infection rate,
and poorer long-term stability.
Case selection
As with any surgical treatment, correct case
selection is important for optimizing success
rates. Increased body weight has been asso-
ciated with an increased risk of postopera-
tive complications after ES (Casale & McCarthy
2009). Therefore, body weight and body condi-
tion score should be taken into account when
considering surgical options for dogs with cru-
ciate ligament rupture (CR). Younger age has
also been associated with an increased risk
of complications after ES (Casale & McCarthy
2009), and while the cause of this was not spec-
ulated, it is assumed that it may be related to
a higher activity level. ES is likely at high risk
of failure in dogs with a steeper tibial plateau
angle (TPA). However, the TPA did not influ-
ence outcome (forceplate measures, osteoarthri-
tis progression, and orthopaedic examination
findings) at 48 weeks after surgery in 34 dogs
with TPAs ranging from 19◦to 35◦(Haviget al.
2007), though it is notable that dogs with TPAs
over 35◦were not included.
General surgical approach
Before definitive stifle stabilization, intra-
articular inspection should be performed using
stifle arthroscopy or arthrotomy. Joint assess-
ment is recommended to confirm the diagnosis
Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.
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