Orthopedic Surgery

When your furry loved one needs orthopedic surgery, you can rely on our team at Makawao Veterinary Clinic to make things right. Dr. Matchett can take care of dogs, cats, and other pets with orthopedic surgery that treats injuries, as well as a variety of conditions affecting the musculoskeletal system.

Types of Orthopedic Surgery Available

Dr. Clayton Matchett, uses advanced orthopedic surgery techniques that take care of most needs for animals of all kinds. Advanced techniques include:

• Fracture Repair
• Ligament reconstruction
• Tendon reconstruction
• Correction of limb deformity

Medial Patella Luxation (MPL) and Lateral Patella Luxation (LPL)

One of the most commonly diagnosed orthopedic conditions in small dog breeds is patella luxation.  Although it primarily affects small breeds, it can also affect large and giant breeds.  This dislocation can be medial or lateral, depending on which side the kneecap falls to.

Medial patella luxation (MPL) is a frequent cause of orthopedic lameness in both small and large breed dogs.  This condition is when the patella, or “knee cap”, slips in and out of its natural position.  Normally the patella sits in a groove in the femur and does not move side to side.  However, sometimes the patella will be pulled out of this groove, or luxate.  The image below illustrates the comparison between the normal canine stifle (knee) and one with a patella luxation.

Lateral luxation is most common in giant breeds, and more often both knees are affected, but it can also be unilateral. Mild cases might not have a symptom in the affected limb, while more severe cases can result in pain and loss of function.  Lateral patella luxation refers to a dislocation away from body, while medial is a displacement closer to the body. As the kneecap dislocates it erodes cartilage and exposes the bone, leading to instability, pain and arthritis.

Cruciate Ligament Repair (CBLO)

Dr. Matchett is trained and certified in the CBLO (CORA Based Leveling Osteotomy) technique.  CBLO is a state-of-the-art cruciate ligament repair based on the Tibial Plateau Leveling Osteotomy, (TPLO).  The CBLO has many advantages, however, over the TPLO and other procedures, which include:

• With a CBLO, the osteotomy site does not involve cutting into the joint, unlike the TPLO.
• There is potentially less articular cartilage damage over time.
• There are excellent short and long-term functional results.
• Healing is more rapid compared to other CCL stabilization procedures, which can take several months of healing time.
• There is excellent stability.
• It may be performed on a young/juvenile patient because the procedure does not involve the growth plate.

Our goal is to have your four-legged family member capable of returning to what he/she loves to do as soon as possible, and the CBLO is the best option in most cases.

The cranial cruciate ligament (CCL) is one of the main stabilizers in the canine or feline stifle (knee) joint. Its purpose is to help maintain a normal relationship between the femur (thigh bone) and tibia (shin bone) in all angles and ranges of motion. To be more specific, the CCL prevents the tibia from sliding forward. The cranial cruciate ligament also prevents excessive internal rotation of the tibia and helps in limiting hyper-extension of the stifle.

Rupture of the CCL in the knees (stifles) of dogs is common. It is the equivalent of a person tearing their ACL (anterior cruciate ligament), or "blowing out their knee”.  It is often related to significant trauma in humans. In dogs it is thought to be a degenerative condition of the soft tissue with the slope of the tibial plateau exacerbating the problem.  If the slope is excessive, the femur slides back off the tibia during extension, putting significant strain on the cranial cruciate ligament. 

When the CCL ruptures, (or tears), the stifle becomes unstable and the relationship between the femur and tibia is changed leading to inflammation (arthritis) and pain. If the instability is left untreated, lameness frequently persists and arthritis will progress.  Due to the instability in the stifle caused by the ruptured CCL, the medial meniscus can be pinched between the femur and the tibia causing irreparable damage.  Subjectively, it appears that patients with CCL ruptures and meniscal damage have more pain and more lameness than patients without meniscal damage.

TPLO VS. CBLO

The TPLO procedure was developed over 30 years ago to correct the anatomic issue that predisposes to cruciate rupture by reducing the tibial plateau angle.  TPLO is meant to work by rotating the slope of the joint surface at the top of the tibia.  With this, the forces that are typically counteracted by the cranial cruciate ligament will be reduced or even eliminated.  It is a procedure that works, but because it does not stabilize the back and forward motion of the femur on the tibial plateau, long-term follow-up studies have shown that the joint cartilage breaks down.  

CBLO was created as a refinement of the concepts of TPLO and it helps to address some of the issues that could cause future complications with TPLO.  One of those issues with TPLO is the load bearing axis of the tibia is moved further away from the anatomical axis of the tibia in dogs.  CBLO remedies this by inverting the rotation which results in the weight bearing axis being brought into alignment with the anatomical axis.  All sizes of dogs and cats can be candidates for CBLO.

Progression of healing with CBLO:

Rehabilitation after Surgery

Rehabilitation following a CBLO can start as soon as the pet goes home. The surgical area can be chilled with an ice pack for 10 minutes a few times daily. (Never attempt to make up for a skipped treatment by icing the area longer, as prolonged cold exposure can cause injury).  Passive range of motion exercise where the knee is gently flexed and extended can also help. It is important not to cause any pain when moving the limb. Let the pet guide you and always avoid twisting the leg. After the stitches or staples are out, increased leash walking is helpful for strengthening the back legs. No running, jumping, or other excessive types of exercise should be performed for a full two months after surgery.

Meniscal Injury

The meniscus as part of the knee joint.  The bones of all joints are capped with cartilage and provide a slippery surface where the bones contact each other.  They grind each other down if the bones contact each other without cartilage. In addition to the cartilage caps, the stifle joint has two “blocks” of fibro-cartilage in between the bones. These blocks are called the menisci and serve to distribute approximately 65% of the compressive load delivered to the knee. The only other joint with a meniscus is the jaw (tempero-mandibular joint).

When the cruciate ligament ruptures, the medial meniscus frequently tears and must either be partially or completely removed. Meniscule assessment is usually done at the time of cruciate ligament surgery.  Pets with meniscal damage may have a clicking sound when they walk or when the knee is examined.  For a definitive diagnosis the menisci must actually be inspected during surgery.  

What Medical Conditions Can Orthopedic Surgery Correct?

When your animal companion needs orthopedic care, consider contacting Makawao Veterinary Clinic to find out if orthopedic surgery is a treatment option.  We commonly repair the following:

Fractures and Breaks

If your animal companion suffers any kind of fracture from an accident or other injury, it’s essential to get them to your veterinarian as soon as possible. The sooner that orthopedic surgery can be performed, the better the possible outcome.

Rupture of Ligaments

Rupture of ligaments can cause your furry loved one to become lame. When this type of injury occurs in both legs, the level of lameness can be devastating, impacting your pet’s emotional well-being and overall physical health.  Fortunately, there are often surgical solutions or regenerative medicine techniques that can help heal the injury.