Joint Surgery

Cranial Cruciate Ligament Surgery (CCL)

Rupture of the Cranial Cruciate Ligament (CCL) is a common orthopaedic injury that occurs in our canine patients.

This is referred to as the ACL or Anterior Cruciate Ligament in humans and is almost always caused by acute trauma.

In dogs, CCL injury can occur as an acute trauma or more commonly, is the result of a degenerative process that leads to early and progressive arthritis.

CCL causes pain and lameness, and increases the risk of injury to other structures of the knee, such as the meniscus.

Techniques used to repair this injury in humans do not work well for dogs because of factors such as conformation.

In dogs, the CCL cannot be repaired or reattached.

Surgical options for dogs with this injury are based on stabilising the joint by dynamically altering the biomechanics of the joint using the TPLO or TTA.

Arthroscopic surgery is a key investigative tool in due to its minimal disruption of the joint structure and visualisation of the meniscus.

Elbow Surgery

Canine elbow dysplasia is a main cause of canine forelimb lameness. Elbow dysplasia is a set of diseases that include osteochondrosis (OCD), fragmented coronoid process (FCP) and united anconeal process (UAP). There are many different genes that contribute to elbow dysplasia with both environmental and hereditary influences. Degenerative joint disease can lead to decreased range of motion in the elbow and paw in immature large dog breeds, this usually indicates the presence of elbow dysplasia. Surgery of traumatic luxation can involve the open reduction of the elbow luxation or elbow arthrodesis.

If either the ulna or the radius does not grow to its expected length due to the closure of a growth plate too early, it can lead to deformity. This can be due to either trauma to the immature bone causing the growth plate to close early or it can be in chondrodysplastic breeds due to asynchronous growth causing incongruity. If untreated, the elbow joint would be painful and will lead to degenerative joint disease. Surgery can include ulnar lengthening osteotomy, ulnar shortening or radial lengthening.

Dr William McCartney of NOAH (North Dublin Orthopaedic Animal Hospital) was the first veterinary orthopaedic surgeon in Ireland to do total elbow replacements, PAUL procedure, sliding humeral osteotomy, arthroscopy, and arthroscopic surgery for medial compartment disease.

Hip Surgery

Many humans will be familiar with hip osteoarthritis due to either development issues or trauma. The hip is a versatile joint that provides much of the power of the hind limb, whilst having the biggest range of motion of any joint in the body.

Painful osteoarthritis can be particularly difficult to treat. The first route of treatment is to administer pain-relieving anti-inflammatories, which can be hugely successful in managing the pain. But there are problems with using long term medicine to control pain and gastrointestinal ulceration can occur, and eventually they may not work.

As well as that, some dogs simply cannot tolerate anti-inflammatories.

In these cases, the dog can have either a triple pelvis osteotomy (if less than 12 months) for hip dysplasia, femoral head and neck excision, or total hip replacement.

Triple pelvic osteotomy is a major operation to rotate the pelvis outward to cover the femoral head better than before by creating a virtually normal joint. It has its limitations in that it must be performed before 12 months for best results. Femoral head and neck excisions may be used in some cases and can provide a pain-free scar joint. Although reduced in total range of motion, it can be successful in certain cases. Total hip replacement is a very successful surgery in some dogs. Dr McCartney has a long experience doing hip replacements and even has performed the operation on cats.

Knee Surgery

The knee joint in dogs (known as the stifle) is similar to humans. Because we stand upright, there is differentstress to the ligaments in our knee compared to dogs. Dogs, however, stand with the ankle elevated and the knee forward. The top of the dog’s tibia (tibial plateau) is sloped and weight-bearing creates a force that pushes the femur down the slope of the tibia. This force is called ‘tibial thrust’ and it is the job of the CCL to prevent this motion. Each time the dog bears weight, the CCL is under tension. When the ligament is ruptured, each time the dog bears weight this motion occurs and causes discomfort. When the CCL is ruptured (even partially), there will be inflammation and swelling, referred to as synovitis and effusion. The two menisci are the ‘shock absorbers’ of the knee and are located between the femur and the tibia. When the knee is unstable due to a CCL rupture, either complete or partial, the menisci are at risk for injury.