Development and verification of saphenous, tibial and common peroneal nerve block techniques for analgesia below the thigh in the nonchondrodystrophoid dog

OBJECTIVE: To document simple and reliable local, infiltrating nerve blocks for the saphenous, tibial and common peroneal nerves in the dog. STUDY DESIGN: Laboratory technique development; in vivo blind, controlled, prospective study. ANIMALS: Twenty canine cadavers and 18 clinically normal, client-owned dogs. METHODS: A peripheral nerve blockade technique of the tibial, common peroneal, and saphenous nerves was perfected through anatomic dissection. Injections were planned in the caudal thigh for the tibial and common peroneal nerves, and in the medial thigh for the saphenous nerve. Cadaver limbs were injected with methylene blue dye and subsequently dissected to confirm successful dye placement. Clinically normal dogs undergoing general anesthesia for unrelated, elective procedures were randomly assigned to treatment (bupivacaine; n = 8) or control (saline; n = 8) nerve blocks of the nerves under study. Upon recovery from general anesthesia, skin sensation in selected dermatomes was evaluated for 24 hours. RESULTS: Cadaver tibial, common peroneal, and saphenous perineural infiltrations were successful in nonchondrodystrophoid dogs (100, 100, and 97%, respectively.) Intraneural injection was rare (1%; 1/105; tibial nerve) in cadaver dogs. In the treatment group of normal dogs, duration of loss of cutaneous sensation in some dermatomes (saphenous, superficial and deep peroneal nerve) was significantly different than control dogs; the range of desensitization occurred for 1-20 hours. No clinical morbidity was detected. CONCLUSIONS: This technique for local blockade of the tibial, common peroneal, and saphenous nerves just proximal to the stifle is easy to perform, requires minimal supplies and results in significant desensitization of the associated dermatomes in clinically normal, nonchondrodystrophoid dogs. CLINICAL RELEVANCE: This technique may be an effective tool for post-operative analgesia to the femoro-tibial joint and distal pelvic limb. Other applications, using sustained-release drugs or methods, may include anesthesia/analgesia in high-risk patients or as a treatment for chronic pelvic limb pain or self-mutilation.     

Electrophysiologic studies of the cutaneous innervation of the pelvic limb of male dogs

The area of skin supplied by the afferent fibers in one cutaneous nerve is called the cutaneous area (CA) for that nerve. The CA of peripheral branches of lumbar and sacral spinal nerves responsive to the stimulation of hair follicle mechanoreceptors were mapped in 27 dogs. The amount of overlap among the CA was similar to that found for other CA of the body. The CA of peripheral branches of the sciatic nerve were restricted to the lateral, cranial, and caudal aspects of the pelvic limb distal to the stifle. The CA of the saphenous nerve was located on the medial side of the limb, except for a small area located on the lateral side of the crus. The distal part of the CA of the saphenous nerve was completely overlapped in the hind paw by branches of the superficial peroneal nerve laterally and the medial plantar branch of the tibial nerve medially. The CA for the deep peroneal nerve was located on the dorsal surface of the webbing between digits 2 and 3 and the adjacent skin of these digits. The CA of the plantar branches of the tibial nerve were small in comparison with the diameter of the nerve, suggesting that these branches contained nerve fibers supplying other, deeper structures in the hindpaw and that damage to these nerves would interfere with cutaneous sensation in only a small region on the plantar surface of the hindpaw. Knowledge of the CA of the various branches of the sciatic nerve allows more accurate localization of injury to the sciatic nerve or its branches by using areas of anesthesia.     

Sensory and motor neuropathy in a Border Collie

A 5-month-old female Border Collie was evaluated because of progressive hind limb ataxia. The predominant clinical findings suggested a sensory neuropathy. Sensory nerve conduction velocity was absent in the tibial, common peroneal, and radial nerves and was decreased in the ulnar nerve; motor nerve conduction velocity was decreased in the tibial, common peroneal, and ulnar nerves. Histologic examination of nerve biopsy specimens revealed considerable nerve fiber depletion; some tissue sections had myelin ovoids, foamy macrophages, and axonal degeneration in remaining fibers. Marked depletion of most myelinated fibers within the peroneal nerve (a mixed sensory and motor nerve) supported the electrodiagnostic findings indicative of sensorimotor neuropathy. Progressive deterioration in motor function occurred over the following 19 months until the dog was euthanatized. A hereditary link was not established, but a littermate was similarly affected. The hereditary characteristic of this disease requires further investigation.     

Controlled, clinical trial assessing saphenous, tibial and common peroneal nerve blocks for the control of perioperative pain following femoro-tibial joint surgery in the nonchondrodystrophoid dog

OBJECTIVE: To determine whether bupivacaine peripheral nerve block of the saphenous, tibial and common peroneal nerves proximal to the femoro-tibial joint reduces peri-operative pain following extracapsular surgical stabilization of cranial cruciate ligament rupture in the nonchondrodystrophoid dog. ANIMALS: Forty-one dogs with naturally acquired femoro-tibial joint instability. Study design Randomized, controlled, clinical trial. METHODS: Dogs diagnosed with suspected cranial cruciate ligament injury based on physical and radiographic evidence were randomly assigned to treatment (bupivacaine) or control (saline) nerve blocks before femoro-tibial joint surgery. Pain scores, skin sensation, pain threshold to incisional pressure, time to first systemic 'rescue' opioid analgesic and total analgesic dose were evaluated for 24 hours. p < 0.05 was considered significant. RESULTS: Treatment dogs had a significantly longer period of cutaneous desensitization than control dogs. There were no significant differences between treatment and control groups for pain score, pain threshold to incisional pressure, or time to first-rescue analgesic. The treatment group received significantly more supplemental analgesics than the control group. CONCLUSIONS: These peripheral nerve blocks were easy to perform and resulted in significant desensitization of the associated nerve autonomous zones, but did not improve post-operative analgesia. CLINICAL RELEVANCE: Clinical benefit was not detected when using this technique for peri-operative pain management following extracapsular cranial cruciate ligament surgical stabilization.     

Axial Pattern Flap Based on the Genicular Branch of the Saphenous Artery in the Dog

Axial pattern flaps based upon the genicular branch of the saphenous artery and medial saphenous vein were developed in eight dogs. On one hind limb of each dog, the experimental flap was raised and immediately transferred to a cutaneous defect created over the lateral aspect of the lower limb distal to the stifle. A control flap was elevated and transferred on the opposite hind limb with the genicular branches of the saphenous artery and vein ligated and divided at the base of the flap. Eighty-nine per cent of the length of the flap survived in those flaps in which the genicular vessels were left intact, whereas only 54% of the flap's length survived in the control flaps. Postoperatively, all dogs were bearing weight on the limbs normally. The genicular axial pattern flap may have special clinical application in cases of cutaneous defects involving the lateral aspect of the tibia.     

Incomplete rupture of the gastrocnemius and superficial digital flexor muscles in a Quarter Horse stallion

CASE DESCRIPTION: A 16-year-old 500-kg (1,100-lb) Quarter Horse stallion was examined because of acute severe lameness involving the left hind limb. CLINICAL FINDINGS: Examination revealed signs of failure (concurrent flexion of the tarsus and extension of the stifle [femorotibial] joint) of the caudal component of the reciprocal apparatus. Results of radiographic evaluation ruled out fracture or joint injury as causes of the lameness. During the next 48 hours, the reciprocal apparatus on the left hind limb progressively deteriorated until the horse became non-weight bearing on the limb. TREATMENT AND OUTCOME: The horse wore a full-limb splint over a Robert-Jones bandage on the plantar aspect of the limb for 30 days. Thirty-four days after the initial injury, the horse had weak function of the reciprocal apparatus and limited ability to bear weight. Six days after removal of the splint, laminitis developed in the contralateral hind limb. The horse was managed with a sling for 5 weeks, during which time deep digital flexor tendon contracture developed. Eleven weeks after the initial injury, the stallion was discharged from the hospital and walking comfortably with a 1-cm-high block under the heel of the left hind foot. CLINICAL RELEVANCE: Incomplete failure of the caudal component of the reciprocal apparatus is an unusual injury that likely occurs during a fall with a hind limb extended under the body, resulting in forced extension of the muscle while it is engaged in contraction. Conservative management of this injury in a heavily muscled adult horse is possible.     

Use of a TTA plate for correction of severe patella baja in a Chihuahua

A 7 yr old spayed female Chihuahua presented for right hind limb lameness and reduced stifle range of motion. Radiographs showed a marked patella baja of the right stifle and evidence of a previous surgery to correct a medial patellar luxation. A tibial tuberosity osteotomy was performed to allow proximal translation of the tibial tuberosity, which was stabilized with a tibial tuberosity advancement plate. Four weeks postoperatively, lameness and articular range of motion were improved, and the use of anti-inflammatory and analgesic medications was discontinued. The dog was still ambulating well and had no lameness 12 mo postsurgically.     

Neurophysiologic maps of cutaneous innervation of the hind limb of sheep

The area of skin supplied by afferent fibers in a peripheral nerve is called the cutaneous area (CA) of that nerve. The CA of hind limb nerves that were responsive to movement of wool/hairs were mapped neurophysiologically in 25 barbiturate-anesthetized sheep. The CA of the dorsal cutaneous branches of the caudal lumbar spinal nerves and of the sacral spinal nerves extended over the lateral aspect of the thigh. The CA of the lateral cutaneous femoral nerve was restricted to the stifle region, that of the saphenous nerve did not reach the digits, that of the deep peroneal nerve lay between the 3rd and 4th digits, and that of the lateral plantar nerve was confined to the lateral aspect of the 4th digit. The CA of the superficial peroneal nerve enveloped the dorsal, medial, and lateral aspects of the distal portions of the hind limb. In some sheep, the boundaries of the CA of the superficial peroneal nerve were juxtaposed caudally in such way that the medial plantar nerve did not have an autonomous zone. Differences in sizes of the CA resulted in corresponding differences in the overlap between adjacent CA and concomitant differences in the sizes of autonomous zones.     

Vertical position of the patella in the stifle joint of clinically normal large-breed dogs

OBJECTIVE: To define the vertical position of the patella in clinically normal large-breed dogs. SAMPLE POPULATION: Cadavers of 13 clinically normal large-breed dog. PROCEDURE: Both hind limbs were harvested with intact stifle joints and mounted on a positioning device that allowed full range of motion of the stifle joint. Lateral radiographic views were obtained with the stifle joints positioned at each of 5 angles (148 degrees, 130 degrees, 113 degrees, 96 degrees, and 75 degrees). Vertical position of the patella through a range of motion was depicted on a graph of mean stifle angle versus corresponding mean proximal patellar position (PPP) and distal patellar position (DPP) relative to the femoral trochlea for each dog. Ratio of length of the patellar ligament to length of the patella (L:P) was determined for each dog. Overall mean, SD, and 95% confidence intervals for L:P were calculated for all dogs. RESULTS: Evaluation of vertical position of the patella through a range of motion revealed a nearly linear relationship between joint angle and PPP and joint angle and DPPF Evaluation of L:P results did not reveal significant differences between limbs (left or right) or among joint angles. Overall mean +/- SD L:P for all dogs was 1.68 +/- 0.18 (95% confidence interval, 1.33 to 2.03). CONCLUSIONS AND CLINICAL RELEVANCE: The L:P proved to be a repeatable measurement of vertical patellar position, which is independent of stifle angles from 75 degrees to 148 degrees.This measurement could be used as a quantitative method for diagnosing patella alta and patella baja in large-breed dogs.     

Are sound dogs mechanically symmetric at trot? No, actually.

A two-year-old, sound Labrador Retriever was determined to be 'right hind limb dominant' by comparison of total hind limb moments of support using inverse dynamics. Net joint moments at the hip, tarsal and meta-tarsophalangeal joints were larger on the right side. Vertical joint reaction forces at the stifle were larger on the right, and horizontal stifle joint reaction forces were smaller on the right. The crus segment was more cranially inclined on the right side through most of stance, but the angle of the resultant stifle joint reaction force vector against the long axis of the crus segment was identical between the right and left sides. The cranially inclined crus segment orientation on one side, coupled with the larger vertical joint reaction force, may result in an internal asymmetry in stifle joint mechanics, although the effects of this on cruciate ligament stresses remain to be determined.     

Kinetic and kinematic analysis of the right hind limb during trotting on a treadmill in Labrador Retrievers presumed predisposed or not predisposed to cranial cruciate ligament disease

Objective-To identify gait characteristics during trotting on a treadmill in nonlame Labrador Retrievers presumed predisposed or not predisposed to cranial cruciate ligament disease (CCLD). Animals-Clinically normal Labrador Retrievers presumed predisposed (n = 10) or not predisposed (7) to CCLD. Procedures-The right hind limb of each dog was classified by use of a predictive score equation that combined tibial plateau angle and femoral anteversion angle as presumed predisposed (high score [> -1.5]) or not predisposed (low score [≤ -1.5]) to CCLD. Tarsal joint, stifle joint, and hip joint kinematics, net moments, and powers were computed. Results-The stifle joint was held at a greater degree of flexion in limbs presumed predisposed to CCLD (130.9° vs 139.3°). More power was generated by muscles acting on the stifle joint in the early stance phase of limbs presumed to be predisposed to CCLD (2.93 vs 1.64 W/kg). The tarsal joint did not reach the same degree of extension in limbs presumed predisposed to CCLD, compared with that in limbs presumed not predisposed to CCLD (179.0° vs 161.0°). Velocity, stance time, vertical and craniocaudal forces, angular velocities, and net joint muscle moments did not differ between groups. Conclusions and Clinical Relevance-Gait mechanics of dogs with high (> -1.5) and low (≤ -1.5) tibial plateau angle and femoral anteversion angle scores were characterized on a treadmill, which may help in the identification of dogs predisposed to CCLD.     

Long-term temporal evaluation of ground reaction forces during development of experimentally induced osteoarthritis in dogs

OBJECTIVE: To describe changes in vertical ground reaction forces (GRF) over 48 months in dogs with osteoarthritis (OA) of the stifle joint induced by transection of a cranial cruciate ligament (CCL). ANIMALS: 12 clinically normal adult dogs. PROCEDURE: Vertical GRF (eg, peak force and impulse) were determined prior to and 1, 2, 3, 6, 10, and 12 months after transection of the right CCL. In 7 dogs, data were also collected 24, 32, 38, 42, and 48 months after transection. RESULTS: Vertical peak force and impulse were significantly decreased in the right hind limb at all times after transection, compared with baseline values. From 10 through 48 months after transection, vertical GRF remained essentially static. Ground reaction forces in the unoperated (left) hind limb also changed significantly during the study. Left vertical impulse significantly increased 3 months after transection, whereas at 24, 38, 42, and 48 months after transection, left vertical peak force was significantly decreased, compared with the baseline value. Mean intradog coefficients of variation (CV) for peak vertical force and impulse ranged from 738 and 9.32, respectively, 1 month after transection to 1.96 and 2.76, respectively, at 42 months. CONCLUSIONS AND CLINICAL RELEVANCE: Vertical GRF in the affected hind limb equilibrated approximately 10 months after CCL transection. Prior to this, force transmission across the affected stifle joint changed significantly over time. Intradog CV were small, indicating that GRF may be an appropriate outcome measurement for evaluation of OA development induced by CCL transection in dogs.     

Comparison of arthroscopic approaches and accessible anatomic structures during arthroscopy of the caudal pouches of equine femorotibial joints

OBJECTIVE: To (1) describe a caudal approach to equine medial and lateral femorotibial (FT) joints and (2) illustrate the complex anatomic detail of the caudal compartments of the lateral FT joint. STUDY DESIGN: Prospective experimental study. ANIMALS: Cadaveric equine hindlimbs (n = 36; 26 horses) and 6 horses (11 hind limbs). METHODS: Stifles (n = 8) were dissected and 10 FT joints were injected with silicone. Arthroscopic exploration (n = 29) was performed, followed by dissection to determine sites and structures penetrated during entry. RESULTS: A more caudal approach to the caudal pouch of the medial FT improved anatomic observation. A more caudal approach to the caudal pouch of the lateral FT joint occasionally caused damage to the common peroneal nerve; however, after reverting to the previously described approach, damage was avoided. CONCLUSION: Arthroscopy of the caudal pouch of the medial FT joint was facilitated using a more caudomedial approach, which improved observation of intrasynovial structures, most importantly, the caudal cruciate ligament and caudal horn of the medial meniscus. A more caudal approach to the caudal pouch of the lateral FT joint cannot be safely performed without risk to the common peroneal nerve and therefore the standard caudal approach is described in detail. CLINICAL RELEVANCE: A caudomedial arthroscopic approach allows improved surgical assessment of meniscal or caudal cruciate ligament injury. Care should be exercised when exploring the caudal pouch of the lateral FT joint because the common peroneal nerve is variably located and could easily be damaged during arthroscope or instrument insertion, especially if the limb is minimally flexed.     

Mycobacterial neuritis in a cat

A 2-year-old spayed female domestic shorthair cat was referred for evaluation of rapidly progressive lameness of the right hind limb, which was paralyzed. Histologic examination of biopsy specimens revealed pyogranulomatous inflammation affecting the sciatic, common peroneal, and tibial nerves, and slender, beaded, acid-fast bacilli within macrophages, nerve fibers, and degenerate axons. A diagnosis of mycobacterial neuritis was made and the cat was treated with clofazimine and enrofloxacin for extended periods. Treatment was partially effective; the goal of returning normal function to the limb was not achieved, but disease progression was halted and the cat remained a viable pet.     

Proximal tibial intraarticular ostectomy for treatment of canine cranial cruciate ligament injury

OBJECTIVE: To report a technique for surgical alteration of the slope of the tibial plateau by a proximal tibial intraarticular ostectomy (PTIO) after injury to the canine cranial cruciate ligament (CCL) and to determine the outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=52) with CCL injury in 60 stifle joints. METHODS: CCL injury was treated by lateral stifle arthrotomy, removal of CCL remnants, and appropriate meniscal surgery. PTIO was performed to remove a wedge of bone from the proximal aspect of the tibia. The ostectomy site was reduced and stabilized using a bone plate and screws applied to the medial surface of the tibia as well as a craniocaudal positional screw. Dogs were evaluated at 6 weeks, 6, and 12 months by complication assessment, lameness scores, stifle range of motion (ROM), thigh circumference, radiographic assessment, degenerative joint disease (DJD) scores, and surgeon and owner evaluation of function. RESULTS: Lameness scores improved by 6 and 12 months in all but 1 dog. Thigh circumference and DJD were increased at 6 and 12 months. Complications occurred in 20% of dogs with all but 1 occurring perioperatively or within 6 weeks; most common were injury to the long digital extensor tendon (4 dogs) and plate failure (3); 2 other dogs required surgery to treat complications. Most owners (98%) reported that lameness had improved by 12 months; 90% were extremely or very satisfied with the procedure and 90% would have the same procedure performed on another dog. CONCLUSION: PTIO to level the tibial plateau provided a satisfactory clinical outcome in dogs >20 kg with CCL injury and the complication rate was similar to tibial plateau levelling osteotomy (TPLO). Stifle osteoarthritis continued to progress radiographically. CLINICAL RELEVANCE: PTIO represents an alternative to TPLO that does not require specialized surgical equipment.     

Inclination of the patellar ligament in relation to flexion angle in stifle joints of dogs without degenerative joint disease

OBJECTIVE: To measure the angles between the patellar ligament and the tibial plateau and between the patellar ligament and the common tangent at the tibiofemoral contact point (TFCP) throughout the full range of motion of the stifle joint in dogs and determine the flexion angles at which the patellar ligament is perpendicular to the tibial plateau or to the common tangent. SAMPLE POPULATION: 16 hind limbs from cadavers of 9 adult dogs without radiographically detectable degenerative joint disease. PROCEDURES: Mediolateral radiographic views of the stifle joints from full extension through full flexion were obtained (10 degrees increments). Angles between the tibial and femoral long axes (beta), between the patellar ligament and the tibial plateau gamma), and between the patellar ligament and the common tangent at TFCP (alpha) were measured. Data were analyzed via simple linear regression. RESULTS: In canine stifle joints, angles gamma and alpha decreased linearly with increasing flexion (angle beta). The patellar ligament was perpendicular to the tibial plateau and perpendicular to the common tangent at the TFCP at 90 degrees and 110 degrees of flexion, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: By use of the conventionally defined tibial plateau, data suggest that at approximately 90 degrees of flexion in stifle joints of dogs, shear force in the sagittal plane exerted on the proximal portion of the tibia shifts the loading from the cranial to the caudal cruciate ligament. Analyses involving the common tangent at the TFCP (a more anatomically representative reference point) identified this crossover point at approximately 110 degrees of joint flexion.     

Bacterial infective arthritis following a penetrating stick injury of the stifle joint in a dog

An eight-year old, Rottweiler was presented with a chronic non-weight bearing right pelvic limb -lameness and a discharging sinus at the right stifle joint. Fifteen weeks previously a diagnosis of bacterial infective arthritis had been made, presumed attributable to haematogenous spread. Failure to respond to appropriate surgical and medical management resulted in severe joint dysfunction. The poor prognosis for restoration of limb function resulted in limb amputation. Subsequent exploration of the sinus tract and the stifle joint revealed a stick within the craniolateral aspect of the joint. This penetrating stick injury had been responsible for the persistent bacterial infective arthritis.     

Peroneal nerve paralysis in the cat and dog: an experimental study

The effects of peroneal neurectomy at different nerve levels in the dog and cat are described. The resultant limb paralyses were considerably improved by the application of a muscle relocation technique, transferring either the long digital flexor or caudal tibial muscle. The results of combined peroneal and tibial neurectomy as well as nerve root sectioning (L6, L7) are also described.     

Prevalence of cranial cruciate ligament rupture in a population of dogs with lameness previously attributed to hip dysplasia: 369 cases (1994-2003)

OBJECTIVE: To determine the prevalence of cranial cruciate ligament rupture (CCLR) in dogs with lameness previously attributed to canine hip dysplasia (CHD). DESIGN: Retrospective study. ANIMALS: 369 client-owned dogs. PROCEDURES: Hospital medical records from 1994 to 2003 were reviewed for dogs in which the referring veterinarian had diagnosed hip dysplasia or hip pain. Dogs were designated as having hind limb lameness because of partial or complete CCLR or CHD. RESULTS: 8% of dogs were sexually intact females, 43% were spayed females, 14% were sexually intact males, and 35% were castrated males. Mean age was 3.8 years (range, 3 months to 15 years). The most common breeds were the Labrador Retriever (21%), German Shepherd Dog (13%), and Golden Retriever (11%). The prevalence of CCLR as the cause of hind limb lameness was 32% (95% confidence interval, 27.2% to 36.8%). The distribution of CCLR among hind limbs was left (29%), right (28%), and bilateral (43%). Of 119 dogs with CCLR, 94% had concurrent radiographic signs of CHD, 92% had stifle joint effusion, and 81% had a cranial drawer sign. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of the high prevalence of CCLR in dogs referred for lameness because of CHD, it is important to exclude other sources of stifle joint disease before making recommendations for treatment of CHD.     

Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment

Cranial cruciate ligament (CCL) disease in the dog is a multifactorial complex problem that requires a thorough understanding of the biomechanics of the stifle joint to be understood. Successful treatment of rupture of the CCL should be based on managing underlying anatomical and conformational abnormalities rather than attempting to eliminate the tibial cranial drawer sign. The cranial and caudal cruciate ligaments, the patella ligament and quadriceps mechanism, the medial and lateral collateral ligaments, the medial and lateral menisci and the joint capsule provide stability of the joint and load-sharing. The function of the stifle is also significantly influenced by the musculature of the pelvic limb. An active model of biomechanics of the stifle has been described that incorporates not only the ligamentous structures of the stifle but also the forces created by weight-bearing and the musculature of the pelvic limb. This model recognises a force called cranial tibial thrust, which occurs during weight-bearing, and causes compression of the femoral condyles against the tibial plateau. In middle-aged, large-breed dogs, forces acting on the CCL together with conformation-related mild hyperextension of the stifle and slightly increased tibial plateau slopes are suspected to cause progressive degeneration of the ligament. Palpation of craniolateral stifle laxity has become pathognomonic for CCL rupture; however, chronic periarticular fibrosis, a partial CCL rupture, and a tense patient, may make evaluation of instability of the stifle difficult. Surgical treatment is broadly separated into three groups: intracapsular, extracapsular, and tibial osteotomy techniques. Tibial osteotomy techniques do not serve to provide stability of the stifle but rather alter the geometry of the joint to eliminate cranial tibial thrust such that functional joint stability is achieved during weight-bearing. Visualisation of both menisci is a critical aspect of CCL surgery, irrespective of the technique being performed. Regardless of the surgical technique employed, approximately 85% of dogs show clinical improvement. However, many of these dogs will demonstrate intermittent pain or lameness. Post-operative management is an integral part of the treatment of CCL rupture, and significant benefits in limb function occur when formalised post-operative physiotherapy is performed.