Canis ISSN: 2398-2942

Stifle: extra-articular stabilization

Synonym(s): Extra-capsular stabilization, fabellotibial suture

Contributor(s): Joseph Harari, Toby J Gemmill

Introduction

  • Aim of procedure is to increase the tension in the peri-articular soft tissues and limit abnormal craniocaudal instability and excessive internal tibial rotation.
  • Sutures are usually applied on the lateral aspect of the stifle, but some techniques involve both aspects of the joints.
  • A number of techniques are commonly used.
  • All techniques will limit normal joint motion to some degree.
  • Most suture materials eventually fail and in the long term joint stability is provided by peri-articular fibrosis. Dynamic stability from the hamstring muscles may also play a part in joint stability in the long term.

Uses

Advantages

  • Provides immediate joint stability.
  • Foreign material placed outside the joint.
  • Relatively straightforward surgery.
  • Little specialized equipment needed.
  • Well established and tested technique.

Disadvantages

  • Dogs often relatively uncomfortable for first 1-2 weeks following surgery.
  • Permanent peri-articular foreign material may increase risk of infection.
  • Sutures generally fail within 6-8 weeks, and hence permanent joint stability is not restored.
  • Can prevent normal internal rotation of the joint, especially during flexion.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Favorable - around 90% of dogs will significantly improve following surgery and regain good use of the operated limb.
  • Some future osteoarthritis is inevitable and will require long term management.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dunn A L, Buffa E A, Marchevsky A M et al (2012) Inter- and intra-operator variability associated with extracapsular suture tensioning. An ex vivo study. Vet Comp Orthop Traumatol 12 (6), 472-477 PubMed.
  • Tonks C A, Lewis D D, Pozzi A (2011) A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle. Vet Comp Orthop Traumatol 24 (3), 167-177 PubMed.
  • Cook J L, Luther J K, Beetem J et al (2010) Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 39 (3), 315-323 PubMed.
  • Roe S C, Kue J, Gemma J (2008) Isometry of potential suture attachment sites for the cranial cruciate ligament deficient canine stifle. Vet Comp Orthop Traumatol 21 (3), 215-220 PubMed.


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