As a veterinarian, I’ll start with a disclaimer: I’m not an orthopedic surgeon, nor do I aspire to be one. My perspective on surgery is pragmatic, perhaps even cautious. I don’t view surgery as a magical fix; rather, I see it as an intervention that carries risks alongside its potential benefits. While surgery can save lives and improve quality of life, it rarely restores patients—human or canine—to their pre-injury state. The goal, instead, is to make them better than they were before surgery, even if “better” doesn’t mean “good as new.”
This mindset frames my evolving opinions on stifle (knee) surgery. Over my career, I’ve witnessed advances in veterinary medicine shift my recommendations, particularly concerning cruciate ligament disease. While non-surgical options can be effective for conditions like chronic Achilles, elbow, or shoulder issues in older dogs, cruciate ligament injuries often demand surgical intervention. In many cases, especially for dogs with lifelong cruciate issues, post-surgery outcomes can be better than they’ve ever been.
The Importance of Choosing the Right Surgeon
One crucial point often misunderstood is that not all veterinarians performing cruciate surgeries are equally skilled. If you want your dog to return to a high level of athletic performance, you need a surgeon with a proven track record. Unfortunately, convenience, cost, and location often drive decisions, but these factors don’t always align with expertise, passion, or experience.
Finding a skilled surgeon requires research. In these cases, you may not be able to rely solely on your veterinarian’s recommendation or a friend’s anecdote. Outcomes can vary widely based on the surgeon’s experience. Some vets perform a handful of cruciate surgeries annually, while others have done thousands. For example, our retired surgeon had completed over 8,000 TPLO (Tibial Plateau Leveling Osteotomy) procedures by his early 50s. Conversely, I once interviewed a veterinarian who was also trained in the procedure. He very confidently, and arrogantly, explained how good he was at the procedure, how quickly he could train the staff in case management and refined his technique was and on and on. When I finally got a chance to get a word in and ask just how many of the procedures he had performed the answer was two.
Confidence doesn’t always equal skill, so dig deeper.
The Difference Between Canine and Human Knee Surgery
When I tore my own cruciate ligament and meniscus 26 years ago, I initially managed to live a fairly normal life. It had been misdiagnosed, and I was able to continue to run, bike and perform other athletic tasks. The occasional “trick knee” moments only became debilitating after my meniscus flipped forward two years after the original injury. My surgery aimed to stabilize the joint, reconstructing the cruciate with part of my patellar tendon. Today, I could likely get by with just cleaning up the joint. In the human knee joint the bones are aligned one on top of the other and we don’t have angles acting on our geometry.
Dogs, however, are built differently. Their rear legs are angled, meaning a damaged cruciate causes sliding forces even when they’re just standing. This is why affected dogs often toe-touch rather than fully weight-bear. External braces typically fail to counteract these forces, and intra-articular ligament reconstructions haven’t shown success in canines. Surgical options focus on structures outside the joint to restore function.
Extra-Capsular Technique vs. TPLO
Early in my career the extra-capsular repair was the most common approach, but the TPLO was quickly gaining momentum and eventually became the procedure of choice. While I won’t cover every possible technique, these two remain the most significant. Before diving into the methods, let’s address an important surgical consideration: the meniscus.
To Release or Not to Release the Meniscus?
Debate surrounds whether surgeons should release the meniscus even if it’s undamaged. Critics argue this causes unnecessary damage and accelerates arthritis, while proponents contend it prevents future meniscal tears requiring additional surgery. Based on experience, I’m firmly in the release camp. I’ve seen too many frustrated owners return for a second surgery to address meniscal tears that could have been avoided.
Ultimately, what matters is that your surgeon has a well-reasoned approach. If they dismiss the topic or avoid inspecting the meniscus entirely, consider it a red flag.
Looking Ahead
In future posts, I’ll explore the extra-capsular technique and the TPLO in detail. These discussions aim to help you make informed decisions about your dog’s care. Cruciate surgery is a significant step, and choosing the right surgeon and technique can make all the difference in your dog’s recovery and quality of life.
Stay tuned for more insights on navigating the world of canine stifle surgery.
