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Tel +44 0845114 130258 9596 8530info@vetinst.com info@vetinst.com Dental Equipment & Instrumentation Joint Surgery15 5 Management of Cranial Cruciate Disease Cruciate Training The best training in any of the available techniques is by attending an organised training course ideally involving hands on training in the company of an experienced surgeon.Veterinary Instrumentation run some labs as do our training partners. Please check our training page on the website www.vetinst.com for available courses. BSAVA, ECVS, ESVOT and other bodies also run cruciate labs. Rupture of the Canine Cruciate Ligament (CrCL) remains, by a significant margin, the most commonly encountered veterinary orthopaedic condition in both general and referral practice. It is now generally agreed that most ruptures of the Cranial Cruciate Ligament (CrCL) in the dog are part of a degenerative process rather than a purely traumatic condition. Trauma may be involved at the point of rupture but the ligament is largely degenerate at this stage. This is particularly true of young, large and giant breeds. This is a very different situation to cruciate ligament rupture in man and how things used to be in veterinary surgery 30 years ago when a cruciate rupture was something which occurred when a dog caught its hind leg in a hole whilst running. However, we do appreciate that access to courses is not always possible and we therefore offer a training DVD free of cost to provide guidance. Included on each technique is: Video. This change in circumstance makes it difficult for us to compare outcomes of the various techniques which have been practiced for the past 50 years. The choice of techniques is huge, suggesting that none are perfect. They may be divided broadly into two groups. Those which attempt to replace the anatomy or function of the original ligament and those which seek to moderate the effects of a cruciate deficient stifle. A colour pictoral Step by Step Guide. Frequently asked questions on the technique. Instrument and implant check lists. All are very much a personal view but may be of interest. In addition hard paper copy guides are also available for most techniques. Again see below for availability. Most videos are also available via the web at www.vetinst. com but the quality will be lower than the disc version. It is recommended that cadaver work or further observation is carried out prior to performing any new technique on clinical cases. Techniques which replace either the physical ligament or its function include: When we have updates they will be posted on www.vetinst.com • Patsaama • Over the Top Technique • DeAngelis lateral suture and derivatives • TightRope and similar techniques. All of the above attempt to stabilise the stifle by replacing the ligament or its function. Techniques which moderate the effects of the cruciate deficient stifle by altering the dynamics of the forces acting on it include: • Tibial Plateau Levelling Osteotomy (TPLO) Radial cut • Tibial Plateau Levelling Osteotomy (TPLO) Wedge cut • Tibial Tubercle Advancement (TTA) • Triple Tibial Osteotomy (TTO) CRANIAL CRUCIATE LIGAMENT LATERAL SUTURE SYSTEM • MMT DVDALL • TTA Rapid. Surgical Management of Canine CCL Disease - covers OTT, Lateral Suture, TPLO, TTA, & TTO £FOC All of the above alter the forces acting on the stifle to make it stable under ‘load’. Normal canine activity creates a huge variety of loads and these techniques do not create stability in all circumstances, leaving the meniscus vulnerable. Which is the best? On the basis of published work to date, there are few scientific grounds, in terms of outcome, to choose between any of the available techniques. In the hands of a competent surgeon the likely outcome is ‘good’. It seems that the differences between surgeons is as great as the difference between techniques. However, there are many differences between the various techniques in terms of expertise required, necessary equipment and cost. Without the relevant data many surgeons elect to have ‘faith with the theory’ pending definitive results. Some small dogs appear to respond well to extra-capsular techniques whereas some kind of tibial geometry altering technique is perhaps preferable to a lateral suture in large and working dogs. Having said that, the techniques are not mutually exclusive. An indication for a tibial plateau technique is a failed lateral suture. The reverse is not true. A failed tibial plateau technique is unlikely to respond to a lateral suture. Currently there are no published techniques which combine a tibial plateau altering procedure with one which stabilises the stifle. Late meniscal injuries are always a risk in an unstable stifle. CRUCIATE MANAGEMENT TRAINING MATERIAL Ultimately it will be a decision for the individual surgeon as to which techniques will be offered to the client. The client will make their choice based on their own circumstances. We have taken the view that until there is evidence to the contrary we will support all the available techniques by the provision of training materials, instrumentation and implants. 157 DVDALL DVD includes information on Over the Top, Lateral Suture System, TPLO by Closing Wedge, FiberWire, TTA, TTO. BR LATSUT Step by Step Guide to CCL Lateral Suture BR LBS Step by Step Guide to Lateral Button Suture BRLIGAISO Step by Step Guide to LigaFiba Iso Toggle Suture BRTTA Step by Step Guide to TTA BRTTARAP Step by Step Guide to TTA Rapid BRTPLO Step by Step Guide to TPLO by Radial Cut BRTTO Step by Step Guide to TTO £FOC £FOC £FOC £FOC £FOC £FOC £FOC £FOC BRPAT £FOC Step by Step Guide to Patella Luxation