Page 3296 - Cote clinical veterinary advisor dogs and cats 4th

Consent to Perform Cranial Cruciate Ligament Repair

VetBooks.ir Patient name:_________________________________
Pet owner’s name:_____________________________ Med rec #____________
Best contact during/after procedure (e.g., cell phone number):____________________

INTRODUCTION be made over your pet’s knee for the procedure. The muscles,
We want to make sure that you understand the planned surgical blood vessels, and nerves overlying the tibia (lower leg bone) will
procedure to be performed on your pet. You should know why be gently moved out of the way so that the bone is exposed.
the surgery has been suggested, what the potential benefits are After measurements are made, a special curved saw blade will
for your pet, and the most common/important risks of the surgery. be used to cut through the tibia. The bone will then be realigned
Alternatives to this surgery, when applicable, will be discussed with at an improved different angle, and a bone plate will be screwed
you. It is also important that you recognize that medicine is not an on to keep the two segments of bone at their new angle. The
exact science, and that the outcome cannot be guaranteed. We overlying muscles and skin will be sutured back together, and
encourage you to ask us as many questions as required for you radiographs (x-rays) will be taken of your pet’s leg after surgery.
to make a well-informed decision. Once your pet has recovered from anesthesia and is ready to go
home, a plan for rest and confinement at home, management of
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE postoperative surgical pain, and controlled exercise with physical
Cranial cruciate ligament injuries are, unfortunately, common in dogs rehabilitation will be discussed with you in detail.
and cats. They involve weakening or rupture of the connections Additional procedures planned for your pet at the same time
within the stifle (knee joint) of the hindlimb. In dogs and cats, several as the cranial cruciate ligament repair:
surgical procedures have been developed to help stabilize the knee
joint over the years. With the exception of ligament grafts, none of ____________________________________________________________
these procedures will fix a damaged cranial cruciate ligament, but
will instead stabilize the knee joint to help decrease pain and slow USE OF SEDATIVES OR ANESTHESIA
development of arthritis. Either surgical procedure requires the use of general anesthesia.
This means that an anesthetic will be given to your pet to cause
EXPLANATION OF THE PROCEDURE him or her to be unconscious while the procedure is performed
The two most commonly performed surgical procedures are briefly so that your pet does not feel pain while in surgery. Although
outlined below. We have explained which procedure is being performed anesthesia is performed routinely with good outcomes, it does
on your pet and why. In order to perform either procedure, your carry risks, including risk of death. These risks may be increased
pet will be anesthetized. Both procedures involve evaluation of the if your pet has other concurrent conditions, such as heart disease,
knee joint either via a special camera called an arthroscope or by respiratory disease, and obesity, among others. We have described
surgically opening the joint for direct visualization, which is called an how other conditions may impact your pet under anesthesia if
arthrotomy. this applies to him/her, and what extra measures will be taken to
• Extracapsular stabilization – Lateral fabellotibial suture reduce these risks.
With your pet under general anesthesia, the inside of the knee This procedure is considered elective, meaning that it is a pro-
joint is examined either with an arthroscope (camera) or by surgi- cedure that is not necessary to keep your pet alive. This procedure
cally opening the joint (arthrotomy).The cranial cruciate ligament, has many benefits for your pet, such as pain relief from an injury
meniscus, and other joint structures will then be examined, and or severe arthritis. The decision to perform this procedure is based
abnormal tissue will be removed as appropriate. An incision will on having assessed that the anticipated benefit is greater than the
be made over your pet’s knee for the procedure. There are two anesthetic risk.
small bones called fabellae located behind the knee and femur
(upper leg bone) within the muscles. A suture (special surgical FORESEEABLE RISKS TO THE PROCEDURE
string) is tied to the muscles just above one of these bones. Complications associated with either procedure include incisional
One to two holes are then drilled into the tibia bone, and the or bone/implant infection, persistent pain and lameness (persistent
suture is passed through these holes. The knot is tied very tightly limping), and future meniscal injuries/tears resulting in pain and
to stabilize the joint, and joint range of motion is tested. The potential need for additional surgery. Excessive bleeding, nerve
muscles and skin are then sutured back into their normal places damage, and damage to surrounding muscles and tendons can
and your pet is awakened from anesthesia. Once your pet has also occur but are rare. All of these complications are uncommon,
recovered from anesthesia and is ready to go home, a plan for but you should know that both infection and meniscal injuries may
rest and confinement at home, management of post-operative require additional future surgeries to correct the problem.
surgical pain, and controlled exercise with physical therapy will Complications specifically associated with an extracapsular repair
be discussed with you in detail. procedure include suture failure, where the suture placed to stabilize
• Tibial plateau leveling osteotomy (TPLO) the knee breaks and is no longer functional, or fracture (breaking)
With your pet under general anesthesia, the inside of the knee of the bone where the holes were drilled.
joint is examined either with an arthroscope (camera) or by surgi- Complications specifically associated with a TPLO procedure
cally opening the joint (arthrotomy).The cranial cruciate ligament, include implant failure (the plate may break, or the screws can
meniscus, and other joint structures will then be examined, and back out of their holes) and either delayed bone healing or failure
abnormal tissues will be removed as appropriate. An incision will of the bone to heal at all.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.