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Knee Repair Surgery

Common Knee Conditions

In a dog or cat’s knee joint there are two cruciate ligaments that cross, forming an X shape. If either ligament is torn, the knee is unstable and painful. It is most common for the front (cranial) ligament to rupture – this is similar to an ACL tear in humans. These ligaments can be damaged by a single acute event, such as landing at a poor angle after a jump. They can also degenerate slowly over time – a case made more likely when patients are overweight.

In the case of a luxating patella – most common on smaller dogs – the knee cap tends to escape its groove and shift inward toward the opposite leg, stopping the affected leg from fully extending. There are varying degrees of luxation, the less severe of which can typically be managed without surgical intervention. More severe luxations tend not to return to their normal position on their own and require surgical repair.

Knee Treatments

MPL (Medial Patellar Luxation) Repair – The patella (knee cap) rides in a groove at the bottom of the femur (thigh bone). When this groove is shallow, it allows the patella to slip. If the groove is deepened, the patella stays where it belongs. In this procedure, the cartilage lining the femur groove is peeled or cut away, the bone underneath is sliced out to form a deeper groove, and the cartilage is replaced.

Extracapsular Repair – This procedure utilizes a synthetic ligament made out of monofilament nylon to replace the damaged ligament and eliminate instability in the knee joint. This suture material essentially takes over the job of the torn cruciate, keeping the joint in place. This procedure is most commonly performed on cats and smaller dogs.

TPLO (Tibial Plateau Leveling Osteotomy) – This procedure stabilizes the knee using a bone plate and screws after cutting the tibia (osteotomy) and modifying the tibial plateau angle so that the way the patient naturally bears weight on the leg stabilizes the joint. This procedure is most commonly performed on larger dogs. Looking for more information on what is involved in a TPLO surgery? Check out this informative video by Dr. Michael Bauer as he explains the nature of a cruciate rupture and how this surgery can repair the injury.

What to Expect

After your initial consultation with our surgeon, if you decide to go ahead with surgical repair for your companion’s condition, there are some details to consider in order to make the surgery and recovery process as smooth as possible for yourself and your companion. Below you will find a collection of key information to help you understand exactly what to expect. Once you have had a chance to review this information, we are happy to answer any questions or concerns you may have – please feel welcome to ask!

Typical Treatment Schedule

  • Surgery Day! – Generally a full day in hospital, with a morning drop-off and late afternoon discharge (plan about half an hour to discuss homecare details with our rehabilitation technician).
  • 2 Weeks Post-Surgery – Initial Progress Check – The opportunity for the surgeon to check on how the surgical site is healing, spot potential issues or concerns, remove sutures if needed, and answer any questions you might have about the recovery process.
  • 6-8 Weeks Post-Surgery – Radiographs and Assessment – This longer appointment will include progress x-rays that will allow the surgeon to confirm that the surgical repair has been successful and that the site is healing appropriately. Sometimes these x-rays can be taken without sedation, but your companion may need to be sedated if they’re a little wiggly! Because of this, we typically ask that patients be fasted ahead of this appointment, just like on surgery day. This appointment also allows time to discuss ongoing homecare as your companion continues to recover, to ensure they are able to return to their best possible condition.

Preparing for Surgery

Take the time before Surgery Day to prepare your home to welcome your companion back after their procedure. It’s much easier to make sure your space is prepared ahead of time, rather than struggling to sort things out with a groggy companion on your hands. Because you will need to restrict your companion’s movement after surgery so they can rest and heal, make sure you have an enclosed area of your home set up for them. You might want to move their crate or bed into the area, getting them used to where they will be spending most of their time.

One of the most important instructions to follow when preparing for Surgery Day is to stop offering your companion access to food about 12 hours before the procedure (but in most cases they should retain access to water). We generally flag 10 PM the night before as the cut-off time for food, although your vet will let you know if they recommend any changes to this. The reason it is so important to fast animals before surgery is to prevent them from accidentally inhaling any regurgitated food into their lungs while they are under anesthetic. Sometimes the anesthetic drugs can cause vomiting; because your companion’s muscles will be relaxed under sedation, their swallowing reflex is suppressed and it is easy to choke or inhale material into the lungs. For this reason, it is much safer to enter surgery with an empty stomach.

As the day of the procedure approaches, maintain your regular routine as much as possible so that your companion feels settled and secure. The day before, make sure to take them for a good walk or have a good play session so that they have a chance to burn off some extra energy, but avoid excessive roughhousing to make sure they’re not starting their day with sore muscles. Feed them their dinner at a regular time, and allow them to settle down for the evening as normal.

In the morning, plan ahead to make sure you’ve got a bit of extra time. Make sure that your wake-up time allows for morning medications to be given three hours before your appointment time. Take your companion for a short walk so they have a chance to go to the bathroom – if this isn’t successful, let the team know when you drop your companion off so we can make sure that they have another chance to go out before their procedure. Also allow plenty of travel time to get to the hospital, helping to minimize stress for everyone involved.

When you arrive, please feel welcome to ask us any final questions. We are happy to clarify anything, and will be looking forward to connecting with you after the surgery to let you know exactly how things went.

Pre-Visit Pharmaceuticals (PVPs)

PVPs are medications chosen to address specific neurotransmitters associated with fear, stress, and anxiety. They can have a sedating and anxiety-reducing effect, helping to keep your companion calm and comfortable on surgery day. Giving these medications before anesthesia also often reduces the volume of sedation drugs used during the surgery. We also typically prescribe a medication that helps to reduce any nausea they may feel from the anesthetic drugs, and can help them with their appetite when they return home.

Ahead of your appointment, the surgical team will discuss any ongoing medications or supplements your companion is taking, to evaluate if they will have any impact on the surgical protocol. It may be the case that you will need to stop giving some medications (such as those that impact circulation, for example) ahead of the procedure day.

On your admission form, you’ll also be asked to confirm the medications and dosages you are giving your companion – this information is very important, as having a full picture of the pharmaceuticals your companion is taking can help the surgeon create the safest and most effective anesthesia protocol possible.

Post-Surgical Care

Depending on the nature of your companion’s knee injury and the type of repair surgery required, the details of your post-surgical care may vary – during your discharge appointment, one of our veterinary technicians will go over exactly what you’ll need to do to support your companion. There will be a variety of medications to manage pain, prevent infection, and help keep them quiet during their initial recovery phase. Below you will find information on the key aspects of post-surgical care – please read through this information before Surgery Day, so that we can help answer any questions or concerns you may have.

POST-SURGERY MANAGEMENT & HOMECARE: DOGS OR CATS

A significant factor in ensuring a successful surgery is what happens after the main event – the lengthy and sometimes challenging recovery process. Fortunately there is plenty you can do to help your companion heal safely and rebuild their strength in the weeks and months post-surgery.

E-COLLAR TIPS FOR DOGS OR CATS

Sometimes called a cone or lampshade, an Elizabethan collar is a plastic device that fits around your companion’s neck and is designed to keep them from licking, biting, or pawing at their surgical sites. Essentially, its purpose is to keep your companion from hurting themselves during their recovery – here’s how to help them stay safe and comfortable along the way.

PROTECTIVE MEDI SLEEVE

Protective medical sleeves are a great strategy to keep surgical sites clean and dry in the days and weeks after your companion’s procedure. These sleeves are made out of soft, sturdy, stretchy and machine-washable material, and are meant to be straightforward to take on and off as needed – but just by humans, not by patients!

Recovery and Rehabilitation

Once your companion starts to feel better, they will likely be tempted to resume their usual range of activities – running, jumping, and playing. It is very important to keep them calm and quiet during the days after their procedure to prevent them from re-opening their surgical site and to make sure they have the opportunity to heal completely. Once they have recovered from the surgical procedure, there will be a longer period of rehabilitation – with a gradual increase in their activity level and duration – to help them return to their full capacity.

LASER THERAPY – TREATMENT AND BENEFITS

Laser therapy assists in tissue repair by encouraging blood vessels to dilate – this increases the blood flow to the tissue, bringing in oxygen and the cells involved in the healing process. The main benefits of Laser therapy include decreased inflammation, decreased pain, and improved wound healing.

HELP ‘EM UP HARNESS – DOGS

The purpose of the harness is to provide extra stabilization and support for your dog (and to save your own back some strain as well!). The harness is designed to lift your dog from below (beneath the chest and pelvis), distributing their weight over the padded surfaces. The ‘Hip Lift’ at the back allows you to lift the complete pelvic floor while supporting the spine – this reduces strain on joints, ligaments, and arteries that can occur when pulling or lifting from the legs.

BENEFITS OF POST-SURGICAL REHABILITATION

Rehabilitation goals will be specific to your pet, their condition, and their lifestyle. Individualized treatment plans typically evolve over the healing process, so that the treatment will continue to meet your companion’s needs. For example, this could look like a rehabilitation program that begins with a focus on weight bearing, progresses to muscle strengthening, and then works toward a return to full function.