Trek Veterinary Surgery
Jeremiah D. Moorer, DVM, Diplomate ACVS
Trek Mobile Veterinary Surgery Services
Veterinary Orthopedic Surgeries
Cranial Cruciate Ligament Rupture
The cranial cruciate ligament is an important stabilizer within the knee joint (stifle) of dogs and cats and is analogous to the human anterior cruciate ligament (ACL). You will sometimes hear these terms interchanged when referring to dogs.
Another important stabilizer in the stifle are the menisci. These also function as “shock-absorbers” in the stifle and are often torn or damaged at the time of the cruciate ligament tear.
Cranial cruciate ligament disease often refers to the process that causes the cruciate ligament to tear or rupture. The underlying reason is not completely understood, but is a multimodal disease process that can include anatomic variations and the slope of the tibial tuberosity. Other contributing factors include; ligament degeneration, obesity, poor physical condition, genetics, conformation, and breed. Cruciate disease is often thought of as a disease of large breed dogs. While it is true that large breed dogs are more prevalent, small and medium breed dogs are often affected as well.
Because this is a degenerative condition, approximately 40-60% of dogs that tear one cruciate ligament, may tear the other side. This occurs, on average, within 2 years.
Cruciate tears can be diagnosed with a combination of physical exam findings as well as radiographs (x-rays) of the knee. The diagnosis is confirmed with surgical evaluation of the ligament. This can be performed via arthrotomy or arthroscopy.
There are several surgical treatment options for dogs with cruciate tears. The one that has shown to have the best short and long term outcome is the Tibial Plateau Leveling Osteotomy (TPLO). This is a procedure that decreases the tibial slope to a point that eliminates the abnormal motion in the knee caused by the cruciate tear.
Medial Patellar Luxation (MPL)
Patellar luxation is a common finding in young small breed dogs but can also be found in large breed dogs. Even though your pet may have patellar luxation it may or may not require surgery.
We recommend correction of patellar luxation in patients that are experiencing consistent pain and lameness secondary to the luxation. You may notice that your dog skips on the affected leg or holds it up when running or walking. They may also stretch the leg backwards in order to replace the patella back in its normal location.
There are 4 procedures that are most often required to correct the luxation.
1. The normal groove that contains the patella often has to be deepened (trochleoplasty) to maintain the patella in the proper location.
2. The attachment of the patellar tendon (tibial tuberosity) may need to be realigned with the remainder of the limb by cutting the bone and moving the tuberosity to a more normal location.
3. When the patellar luxation occurs toward the medial (inward) of the knee this tissue must be released (retinacular release) to allow the patella to return to its normal location and
4. The tissue on the lateral (outward) side of the knee must be tightened (fascial imbrication) to keep the patella in place.
Hip dysplasia is a common problem diagnosed in mainly large breed dogs. It is a developmental disorder that starts with increased laxity in the hip joints which leads to abnormal articulation and wear of the joint surfaces. This leads to the formation of arthritis as the dog ages which can cause it to be painful and difficult for the dog to rise, run, jump, and play like they did before.
There are surgical options for hip dysplasia depending on the age of the dog.
1. Juvenile Pubic Symphysiodesis (JPS) is a procedure that is designed for dogs between 16 weeks and 20 weeks of age. It causes a portion of the pelvis to be fused in a growing dog which causes the pelvis to grow in a way that actually increases the “tightness” of the joint. This decreases the wear of the joint and decreases the risk of arthritis in the future.
2. Double Pelvic Osteotomy (DPO) is a procedure that is performed in young dogs (<1yr) that have laxity but no evidence of arthritis and relatively normal hip conformation. Two cuts are made in the pelvic bone that allow the acetabulum (cup) to be rotated over the femoral head, increasing the coverage and decreasing the progression of arthritis in the future.
3. The best option for dogs with hip arthritis is a total hip replacement (THR). This procedure replaces the acetabulum (cup) as well as the femoral head (ball) to eliminate the pain associated with the cartilage damage and arthritis that has developed. A total hip replacement is as close to a normal hip as possible and can allow dogs to return to normal function after the post-operative recovery period.
4. The second option for dogs with severe hip arthritis is a Femoral Head and Neck Ostectomy (FHO). This is a procedure where the femoral head and neck are removed from the socket joint. Scar tissue forms a “false joint” that eliminates the bone on bone contact associated with severe arthritis. This procedure is better tolerated in cats and small dogs (<20 pounds). Hip luxations can also be treated with an FHO or total hip replacement. More commonly we treat hip luxations with a Toggle Pin repair technique that allows your dog to maintain their own hip joint.
Elbow dysplasia is a condition commonly diagnosed in large breed dogs (Labrador retriever, Golden retriever, Rottweiler, German Shepherds, Newfoundland, Bernese Mountain dogs) and is composed of several different components (Medial Coronoid Disease (MCD), Osteochondritis Dessicans (OCD), and Ununited Anconeal Process (UAP).
Dogs can be affected by one or multiple components of this condition. In most cases it can be treated arthroscopically which minimizes surgical trauma associated with a large incision into the joint and decreases post-operative pain and recovery time.
The elbow is a very tight and congruent joint and any abnormality present can lead to the progression of arthritis. Some dogs diagnosed with this condition will require treatment of arthritis as the dog ages. This may be as simple as giving fish oil and joint supplements or as complex as requiring joint injections and rehab therapy.
The most common condition that is treated with the shoulder of dogs is Osteochondritis Dessicans (OCD). This is often found in young, large breed dogs and is caused by an abnormality of the growth of the cartilage within the shoulder joint. This abnormal growth causes the cartilage to become thickened and eventually loosen from the underlying bone creating a flap of cartilage.
This condition is treated by removing the fragment and debriding the underlying bone to allow fibrocartilage formation. This procedure is most often performed arthroscopically which decreases surgical time, post-operative pain, and recovery time.
Most patients can be discharged the same day as surgery.
There is a very good prognosis for patients treated for shoulder OCD.
Biceps tenosynovitis is also a painful condition of the shoulder that can be diagnosed and treated arthroscopically. It may result from trauma to the joint or from a soft tissue injury after strenuous activity. It is typically painful on palpation over the biceps tendon and can often be diagnosed on physical examination.
Fractures (broken bones) are often suffered by dogs and cats after some degree of trauma (falls, hit-by-car, etc.). The most common bones affected are the radius, tibia, humerus, femur, and pelvis.
Some fractures in young animals can be treated with a cast or splint for several weeks. More complex fractures in adults often require surgical stabilization. This can be accomplished by numerous methods including plate/screw fixation, pins, wire, interlocking nail, and linear or circular external fixation. The method of repair will be determined by the location and severity of the fracture as well as patient and owner factors.
Healing time for most fractures ranges from 4-6 weeks in young animals to 8-10 weeks in adult animals.
PennHIP is a radiographic screening method used by PennHIP-certified veterinarians to assess, measure and interpret hip joint status.
Performed on dogs as young as 16 weeks of age, PennHIP’s primary objective is to reduce the frequency and severity of hip dysplasia in all breeds of dogs. Stored in and compared to an extensive collection of PennHIP data containing over 100,000 patients, PennHIP x-rays allow pet owners the ability to obtain an estimate of their dog’s risk for developing hip dysplasia and, if necessary, make lifestyle adjustments for their dog to enhance the quality of their pet’s life.
PennHIP x-rays also allow breeders to confidently identify the members of their breeding stock with the best breeding potential.
PennHIP was established in 1993 after 10 years of research by Dr. Gail Smith in evaluating a technique that quantified hip laxity. PennHIP has published more than 40 manuscripts over the past 20 years.
Arthrodesis is another term for fusion of a joint. This is needed when there is significant damage to a joint, either from trauma or from severe arthritis. It prevents the joint from moving and therefore eliminates the pain associated with the painful condition in that joint.
Depending on the condition the entire joint may need to be fused (pan-’joint’ arthrodesis) or only part of the joint may need to be fused (partial ‘joint’ arthrodesis).The most common joints that are fused are the carpus (wrist) and tarsus (ankle). The shoulder, elbow, and knee can also be fused but the need is much less common.
Soft Tissue Surgeries
Abdominal surgery consists of procedures on numerous different organs within the abdomen. These include the liver, gall bladder, stomach, small intestines, colon, pancreas, adrenal glands, bladder, urethra, kidneys, and ureters.
• Hernia – Diaphragmatic hernia, body wall hernia, hiatal hernia, peritoneal-pericardial hernia, perineal hernia
• Liver – Liver lobectomy for abscess or tumor removal, Liver biopsy (open or laparoscopic), Portosystemic shunts
• Gall bladder – Cholecystectomy, Cholecystoenterostomy
• Stomach – Gastropexy (open or laparoscopic), Gastrotomy (foreign body), Gastric Biopsy, Gastric Dilation and Volvulus (GDV)
• Small intestines – Biopsy, Enterotomy or Resection and Anastomosis for foreign body removal, tumor removal
• Colon – Tumor resection, Megacolon
• Pancreas – Biopsy, Tumor Resection, Abscess Drainage
• Adrenal glands – Adrenal mass removal, Adrenalectomy
• Bladder – Cystotomy (bladder stones), Biopsy
• Prostate – Prostatic biopsy, prostatic abscess, prostatic cysts
• Urethra – Urethrotomy (urethral stones), perineal urethrostomy (Feline Lower Urinary Tract Disease)
• Kidneys – Nephrectomy (tumor, trauma), Nephrotomy (Kidney stones)
• Ureter – Ureterotomy (ureteral stones), Neoureterocystostomy (ectopic ureter)
• Ovaries and Uterus – Ovariohysterectomy (pyometra), Ovariectomy (open or laparoscopic)
• Perianal – anal sacculectomy, perianal mass removal
Thoracic surgery consists of procedures on numerous different organs within the thoracic cavity. These include the lungs, heart, great vessels, and general thoracic cavity. Some of these procedures may be able to be performed minimally invasively with laparoscopy to decrease post-operative pain and the recovery time associated with the procedure.
• Lungs – Lung lobectomy- tumor, foreign body, Lung biopsy
• Heart – Heart based mass resection, Pericardectomy
• Great vessels – Patent Ductus Arteriosus (PDA), Persistent Right Aortic Arch (PRAA)
• Thoracic cavity – Chylothorax, Pyothorax, Mediastinal tumor resection
Upper Airway Surgery
Upper airway surgery consists of surgical procedures performed on the larynx, the trachea, nose, and soft palate. The most common upper airway conditions that are treated with surgery include; brachycephalic syndrome which includes elongated soft palate, stenotic nares, and everted laryngeal saccules (English bulldogs, Pugs, French Bulldogs, etc.), laryngeal paralysis (Labrador retrievers) which is treated with arytenoid laterlization, and tracheal collapse (small and toy breed dogs).
Surgery is often only one component of treating cancer, which is why our surgeons work closely with Medical Oncologists on patients diagnosed with cancer. Once your pet is evalauted we will make our treatment recommendations to allow the best care for your pet. Conditions treated can range from benign skin tumors, amputation of a digit or limb, to large malignant thoracic or abdominal tumors.
Head and Neck Procedures
Head and neck surgery consists of procedures performed on the ears, throat, and mouth of dogs and cats. Dogs and cats may suffer from tumors in the neck (thyroid tumors) which may require surgery. The most common procedure performed on the ear is a total ear canal ablation (TECA) which is used to treat chronic ear infections. It eliminates any infected tissue and allows your pet to live a more comfortable life without the pain associated with chronic ear infections.
Minimally Invasive Surgery
For minimally invasive surgery, we create small incisions through the skin to allow for access to the surgery site through skin ‘portals’. Through these portals, we can insert a small camera into different body cavities including the abdomen, chest and even joints.
Though small incisions give a small working area, we are able to work with a magnified high-definition image that can often make the surgery easier and allow us to find problems that we might miss with a regular open surgery. Additional portals can easily be created to allow the surgeon to utilize specialized instruments to perform different procedures.
The smaller incisions often allow for a faster recovery with less post-operative pain and a smaller incision for your pet.
Veterinary Laparoscopy involves surgery with a small camera and scope placed in the abdomen. Procedures that are commonly performed laparoscopically or laparoscopic-assisted include; ovariectomy, liver biopsy, and gastropexy.
Veterinary Arthroscopy utilizes a camera in joints with small portals for placement of instruments. Arthroscopy can be used to assist in the treatment of cruciate ligament and meniscal tears in the knee as well as most other joints in dogs.