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 CONS:• Moreexpensivethanthelateralsutureduetothecostofimplantsrequiredaftercuttingthebone • ProcedurerequiresmorealterationstotheanatomyMODIFIED MAQUET PROCEDURE (MMP)The MMP is a variation of the tibial tuberosity advancement (TTA) procedure, another of the high tibial osteotomies. This procedure involves movement of the tibial tuberosity in a forward direction. Because the patellar ligament inserts on the tibial tuberosity, this also results in a change in the orientation of the patellar ligament. As a result, the patellar ligament takes on the job of resisting tibial thrust, reducing or eliminating the need for the cranial cruciate ligament. The healing process post-surgery involves encouraging controlled leash activity, limiting this activity to 5-10 minute walks several times a day, and building up gradually.(Images provided by Dr. Eric Rowe) PROS:• TimeforMMPactivityrestrictionisshorterwhencomparedtotheTPLO(sixweeksvs.eightweeks)• LessexpensivethantheTPLO• NewerprocedureshowingbetterresultsandalowercomplicationratethantheTTA(TibialTuberosityAdvancement)duetothe use of a void-filling bone ingrowth implant. This porous foam-like implant encourages deep penetration of bone into theimplant so that it remains viable, self-sustaining, and resistant to infection.• Fastsurgicalprocedure• Theosteotomyisperformedalongratherthanacrosstheweight-bearingaxis,whichcouldallowforanearlierreturntofunction CONS:• Newerprocedure,sonotastimetestedasthelateralsutureorTPLO.(Asof2014therehavebeenabout20,000casesperformed worldwide.)• ProcedurerequiresmorealterationstotheanatomyEXTRACAPSULAR REPAIR/LATERAL SUTUREA strong suture material is placed between the femur and the tibia on the outside of the joint capsule, parallel to the orientation of the cranial cruciate ligament inside the joint. Over time, fibrous (scar) tissue will form around the suture, permanently stabilizing the joint. The healing process post-surgery involves allowing the body to develop this fibrous tissue. Rehabilitation for this surgery allows for short controlled walks within 10-14 days, and limiting activity building up strength gradually and at the dog’s pace. PROS:• Simpleandfastsurgery• Verycosteffectiveforclientswhocan’taffordotherprocedures • Goodforsmallbreeddogs• Longtermresultsaregood CONS:• SuccessinlargebreeddogsismoreoperatordependentCare Center’s goal is to serve the needs of the patient, the owner, and the primary care veterinarian. We want to help you make sure your clients are making the best decisions for advanced care. All of the above procedures have their pros and cons and, with proper owner compliance, all of them yield similar long-term results. Our surgical team will make sure your clients have options that will provide the best outcome for their pet, their lifestyle, and their pocketbook.Here’s to healthy knees!Drs. Muldoon, Schrader, Rowe, and KraunFor additional information on cranial cruciate ligament disease and treatment options, please visit the American College of Veterinary Surgeons website: small-animal/cranial-cruciate-ligament-disease.Copyright © 2015 Care Center. All Rights Reserved.

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