Anterior Cruciate Ligament Surgery

1. 1. The ACL drawing. This is a drawing of the inside of the knee. Note the anterior cruciate ligament is one of the two ligaments that cross inside the knee.
   Photo 1
   
2. 2. The leg is clipped of all fur for sterility. Then the leg is scrubbed to remove dirt and bacteria.
   Photo 2
   
3. 3. Once the patient has been moved into the surgery suite, the leg is draped and toweled to cover all but the surgical areas.
   Photo 3
   
4. 4. A skin incision is made over the knee (the stifle).
   Photo 4
   
5. 5. The fascia (tissue covering the knee and joining muscles together) is incised to expose the fabella, a small bone behind femur.
   Photo 5
   
6. 6. Using a cruciate needle, a large size of surgical nylon is passed between the femur and the fabella.
   Photo 6
   
7. 7. The tibial crest is drilled to allow passage of the nylon suture through the bone.
   Photo 7
   
8. 8. The suture is passed under the patellar ligament and back through the tibial crest.
   Photo 8
   
9. 9. The joint capsule is opened to expose the torn ligament.
   Photo 9
   
10. 10. Shown here is the torn ligament running over the instrument. This ligament is normally very thick and sturdy.
    Photo 10
    
11. 11. The forcep is holding the part of the ligament that has torn free of the femur. Notice how thick it is.
    Photo 11
    
12. 12. Once the torn pieces are removed, the joint is flushed to remove any remaining particles and blood clots.
    Photo 12
    
13. 13. This is the inside of the joint. The meniscus (cartilage), is examined. In many cases, the medial meniscus is also torn and must be removed. You can also see the place the anterior cruciate ligament (ACL) should have attached.
    Photo 13
    
14. 14. The joint capsule is then closed.
    Photo 14
    
15. 15. The large nylon suture is then brought together and Securos clips are placed to help with tightening.
    Photo 15
    
16. 16. The clips are in place; note the middle clip has both ends of the suture crossing through it.
    Photo 16
    
17. 17. A special instrument is then used to tighten the suture to the proper tension to mimic the torn ACL.
    Photo 17
    
18. 18. Notice how far the clips are apart now.
    Photo 18
    
19. 19. A special instrument is then used to crimp and tightened the middle clip. This securely holds the suture without a large knot. This is more comfortable for the patient as it remains in the body. The other two clips are snipped off.
    Photo 19
    
20. 20. The fascia (muscle layers) are imbricated which means tightened. This will add additional support to the knee.
    Photo 20
    
21. 21. Bupivicaine, a pain reliever, is injected into the joint to assist with postoperative comfort.
    Photo 21
    
22. 22. The subcutis (area under the skin) is closed.
    Photo 22
    
23. 23. Then the skin is closed.
    Photo 23
    
24. 24. A 3M. bandage which is similar to a cast is applied. This is layer one.
    Top photo.
    A layer of cast material is applied in the Bottom Photo.
25. 26. A covering is placed over the cast.
    Top Photo
    The 3M bandage is complete. In three weeks the patient will return to have the foot freed from the cast. The rest of the dressing will remain on for a total of six weeks. Shown in the Bottom Photo.

    If you have any questions regarding Anterior Cruciate Ligament Repair, Please do not hesitate to contact us. We will be happy to answer all of your questions in person, or call 309-685-4707 We want to ensure that your pet has the best of health.