- Your pet will have had a fairly long anaesthetic on the day of surgery. Most of the effects of this will have worn off by the time you collect him, although they will feel sleepy for the rest of that evening and possibly the following day. Offer them a small light meal (e.g. Hills ID) when you get home. Do not worry if your pet does not eat on the evening of the operation. They should be eating within 24 hours.
- Please do not allow any licking at the dressing or stitches. We can provide you with a collar to prevent this. Please follow instructions given for any medication (e.g. painkillers) that you may have to administer to your pet. Usually medication should begin on the morning following the operation. Please finish all courses of treatment. Please come for a check up in 2-3 days, 10 days and then 4-6 weeks. This final visit is for the day, so arrive at 8.30am, with your pet starved, and you will leave him for the day for sedation & X-ray.
- Your pet’s cranial cruciate ligament failure has been treated surgically using either a TPLO (tibial plateau leveling osteotomy) or the Modified Maquet Procedure (MMP). The MMP is based on a technique developed almost 50 years ago for use in human knees by Dr Maquet, a Belgian orthopaedic surgeon. The operation works by redirecting the force generated by the large quadriceps muscles at the front of the thigh to compensate for the failed cruciate ligament. This is achieved by cutting free, and moving forward, the part of the tibia (the tibial tuberosity) attached to the quadriceps muscle. The bone cut is called an osteotomy and it is stabilised using a modern orthopaedic implant material called Orthofoam. The porous titanium Orthofoam promotes remarkably rapid bone ingrowth and healing and this is key to the reduced convalescence and minimal pain seen with MMP surgery. The TPLO procedure involves cutting the tibia and altering the angle of the joint, which is then stabilized with a plate and screws.
- Successful recovery after knee surgery, no matter which procedure has been used, requires a period of controlled activity. Compared to other procedures, MMP causes less discomfort and while a comfortable, pain-free patient is obviously a good thing, many dogs are tempted to use the operated leg too much, too soon. No matter how comfortable and confident your pet is feeling in the days after their MMP operation, it is absolutely essential that running, jumping, and general “rough and tumble” with other pets is avoided for the first 12 weeks. The bone must be given time to heal adequately and too much strain placed on the osteotomy too early can result in stress fracture or implant failure and while this is rarely catastrophic, the ensuing complication may be painful and will certainly delay the recovery.
- We recommend physiotherapy with our qualified Chartered Animal Physiotherapist, Julia Martin, if possible from the week following surgery. There are also several hydrotherapy pools in the area, which enable dogs to exercise in a non weight-bearing environment and could begin as early as 4 weeks after surgery, after the reX-ray has confirmed healing of the bone. Please ask us if you might be interested in this.
First and second weeks
- Bandages are not used following cruciate surgery because it is important that your pet is able to flex and extend the operated knee freely right from day one. A gauze pad may have been sutured over the skin incision to protect the wound. The pad can be removed after 2-3 days or so and the skin sutures are removed 10 days after surgery. During the first 14 days, your pet should be encouraged to take frequent short leash walks: 5-10 minutes six times daily is a good starting point. It is important that the operated knee joint is returned to use as quickly as possible – concentrate on walking relatively slowly as this will encourage the patient to use the leg. Your dog should go outside ON A LEASH, even in the garden, to toilet during the first eight weeks after surgery. Do not swim the dog. No other exercise is recommended for the first 14 days – it is important to not let your pet loose to run freely in the house, particularly up and down stairs.
Third and fourth weeks
- The amount of activity can now be gradually increased but it is essential that the patient is not allowed off the leash until after the first eight weeks. Leash walks can be longer, increasing by an extra 5 minutes every two weeks, though walk slowly and ensure that the patient continues to use the operated limb confidently at every step.
Fifth and sixth weeks
- Check X rays are scheduled for the end of week 4-6 and these should confirm that the osteotomy is healing well. Bear in mind that although bone healing and remodelling will be progressing nicely, full strength will not be established for several more weeks. At this stage, the patient will be capable of frequent (20-30 minutes) leash walks.
Eight weeks onwards
- The key to success is a program of gradually increasing activity. At first, the patient can be allowed off the leash towards the end of the last walk of the day – choose a quiet area with a good surface – a short cut grassy park is ideal – without dogs or other distractions that might encourage your pet to do too much too soon. Five minutes is enough for the first day off the leash. Subsequently, the amount of free running play and exercise can be increased gradually back towards normal pre-injury levels. Most dogs will be capable of full, unrestricted athletic activity at 12 weeks after their MMP operation, 16 weeks for TPLO. Some residual low grade stiffness and lameness may still be seen at twelve weeks but this will resolve completely over the subsequent month or two as the patient regains full fitness and the osteotomy completes its healing process.
- Remember, however, we cannot revert your pet’s stifle to normal. Inevitably, arthritis will occur in time and you may be advised to consider a course of injections (“Cartrophen”) or joint supplements (e.g.glucosamine) long term which may delay the onset of symptoms. There is also a special prescription diet (Hills JD) which has proven benefit for arthritis. Unfortunately, many dogs have a tendency to develop cruciate problems in both knees, so it is possible that surgery may be required on the other leg in the future.
- Problems: Most cases will heal well if the above points are noted. However, with any major operation, complications can occur. Watch for any discharge or increasing swelling around the wound once the dressing has been removed and call us if you are worried. If your pet is using the leg quite well, then suddenly becomes more lame, please call us and we may advise a check X-ray to make sure the all is well. Occasionally, if the cartilage (meniscus) in the stifle becomes damaged, this can cause lameness and can occur sometime after the operation. This may require further surgery to remedy.
- PLEASE TELEPHONE THE SURGERY IF YOU ARE AT ALL WORRIED ABOUT your pet: 01273 737924