Extracapsular Stabilization Surgery (for Cruciate Ligament Injuries)

By: Brisbane Veterinary Specialist Centre

Extracapsular Stabilization Surgery*

 

Bruce Smith BVSc, MS, FACVSc, Dip ACVS
Lyn Minhinnett BVSc MACVSc
 

 

*Extracapsular Banding may also be referred to as “De Angeles Suture” “Lateral Imbrication Suture” and Fabello-Tibial Banding
 

What is the extracapsular stablisation procedure?

Extracapsular stabilization (ECS) is a surgical treatment for cranial cruciate ligament rupture. The cranial cruciate ligament is a major stabilising ligament in the stifle (knee) of the dog. Rupture of the cranial cruciate ligament results in instability between the femur (thigh bone) and tibia (shin bone). The instability damages the cartilage and menisci which results in pain and arthritis. For more general information on cranial cruciate ligament rupture and treatment, please see our information sheet Cranial Cruciate Ligament Injury on our website.

The ECS procedure involves the placement of a specialised nylon suture across the stifle joint to mimic the direction and function of the cruciate ligament. The suture provides stabilisation of the knee in place of the injured ligament.

 

What are the advantages of extracapsular stabilisation over other surgical and non surgical treatments?

Surgical treatment of cruciate ligament injury is generally required to resolve lameness, especially if meniscal damage has occurred.

The ECS is generally less costly and has less potential for serious complications than surgical techniques that involve cutting the bone of the tibia (Tibial Tuberosity Advancement/ TTA and Tibial Plateau Levelling / TPLO). Clinical evidence suggests, however, that dog’s over 20-25kg may have better outcomes with other surgical techniques ( for more specific information, please see our information sheet Tibial Tuberosity Advancement).

 

Is my dog a candidate for extracapsular stabilization?

Your veterinarian can diagnose ligament injury by a physical examination, and will recommend referral for ECS or further evaluation if appropriate.

While almost any size and shape of dog with cruciate ligament injury can benefit from ECS it is most successful for dogs under 15 kgs weight. For larger dogs, those leading an athletic lifestyle or with “bowl-legged” stance alternative surgical techniques will be discussed with you.

 

How long will my dog be in hospital?

A two day hospital stay is usual. Your dog will be admitted the morning of surgery for preoperative checks, planning and pre-emptive pain control. Continuous through-the-night observation and pain control is provided postoperatively. Most patients are eating and walking within 12 hours of surgery and are sufficiently comfortable to be discharged on the day after surgery.

 

What after-care will my dog need?

Your dog will return home with a narcotic pain control skin patch, and oral anti-inflammatory pain medication will be provided for once or twice daily treatment until suture removal. A plastic collar may be required to prevent wound disruption.

A re-visit is required at two weeks postoperatively for suture removal. Physiotherapy assessment is strongly recommended at this point. A final postoperative review is scheduled at between six and eight weeks postoperatively. To learn more abut Physiotherapy you can visit our physiotherapist’s website www.holisticanimalphysiotherapy.com.au 

Activity restriction is essential for your dog’s comfort and healing. The physiotherapist will guide you on controlled activity and more specific rehabilitation. Typically this means room confinement when not attended and gradually increasing leashed walks over an eight week period.

 

Will my dog return to normal activity?

Return to normal activity is almost always achieved. While recovery is usually slower than for TTA and other osteotomy techniques, recovery is equivalent and complete at six months.

 

Are their any complications with extracapsular stabilization?

While ECS is associated with the least complications of the surgical techniques, it is a complex surgical procedure requiring general anaesthesia and exposure of the stifle joint and bone.

Wound bleeding, swelling and infection may occur as with any orthopaedic procedure but are uncommon and temporary. Movement or loosening of the stabilization may result from early postoperative activity; this is of most concern for larger and very active dogs. On occasion complications may arise that require reoperation of the knee.

 

Financing surgical treatment for your pet

BVSC understands that surgical treatments are both unexpected and costly. To assist you, access to third party external finance companies is available. These companies require a detailed application & credit check. BVSC is not an agent for these companies and may request a deposit to allow treatment to proceed if finance approval is pending.

 

Where is BVSC and how do I make an appointment for my pet?

BVSC is located on Brisbane’s north side on the corner of Old Northern & Keong Roads, Albany Creek 4035.

 

To make an appointment for your pet you will be required to have a referral from your vet, to get a referral contact your veterinarian and request referral to BVSC then contact our friendly reception staff on (07) 3264 3264400