External Fascial Strip – EFS

a method for repairing ruptured cruciate ligaments in dogs.

This condition affects dogs of all breeds and sizes, and can occur at any stage in life. There is no single cause for cruciate ligament rupture, and it can occur due to physical injury or deterioration of the ligament over a period of time. Regardless of the reason, the condition causes stifle instability which can lead to a variety of other orthopedic problems if not corrected, including cartilage degeneration, meniscus injury, and the progression of degenerative joint diseases. If the cruciate ligament is repaired soon after symptoms present, the possibility of further injuries to the joint can be reduced or eliminated.

The diagnosis of a ruptured cruciate ligament can be suggested by your general practice DVM, and ultimately determined by consulting with a specialist, who will physically manipulate the joint and evaluate radiographs to determine whether the ligament is ruptured.

Symptoms:

- Lameness upon injury

- Crepitus

- Decreased Range of Motion (ROM)

- Hind leg outstretched while sitting

- Weight shift while standing

Procedure:

The fascial strip surgery is a method designed to use fascia, which is the strong connective tissue that envelopes muscles, to stabilize the stifle (or knee). The fascia is a thin but very strong connective tissue that when placed properly can restore proper placement of the stifle and prevent further degenerative joint disease from occurring.

Most cruciate ligament procedures that use the fascia to repair cruciate ligament rupture place the strip of fascia through the joint to stabilize the stifle. The joint is actually an inhospitable environment for any material that does not belong in it. With this method, the joint can weaken the fascia and fail to prevent further degeneration of the joint. Ultimately, the procedure repairs the instability but has little probability for preventing further injury.

Dr. Dew has developed an alternative method for fascial strip repair of cruciate ligament rupture. With this method, the fascia is placed around the fibula, which is a small bone that resides behind the lateral condyle of the femur. This keeps the fascia outside the joint, which is the naturally preferred environment for connective tissue. The likelihood of damage to the fascial strip from the joint is virtually eliminated, and this method allows for tissue regeneration as well as increased joint strength over time.

In a study of the cruciate ligaments being repaired using Dr. Dew’s fascial strip method, 94% returned to what the pet owners considered to be excellent or good function in the joint. None reported that the dog had poor function, and the other 6% considered the function adequate. Overall, success following cruciate ligament surgery tends to be around 90% on the national average for all types of repairs, so the numbers clearly show that this method produces far better than average results. Additionally, Dr. Dew’s method has proven 110% of original cruciate ligament strength to be recovered, as opposed to the 30% that can be recovered using a procedure that places the fascia within the joint.

Following the fascial strip procedure, optimal function will be reached at about 26 weeks after surgery on average. During this time, activity restriction plays a crucial role in the healing of the stifle. As there are a variety of procedures that can be used to repair cruciate ligament ruptures, your options can be explained in a surgical consult.

After Care:

Hospitalization:

- Your pet will need to stay overnight one night and a pick up can be scheduled during our regular business hours, 7:30 am to 5:00 pm the day after surgery.

- When you get your pet home, place your pet in a cool/warm (season dependent), quiet and dark room. If you leave your pet alone, he/she will sleep and be comfortable. You can increase your pet’s anxiety by doting. Your pet will have adequate medication for pain so you do not need to worry about discomfort.

Medication:

- A transdermal pain patch will be sutured on to your pet and will provide pain relief for three days following surgery. On the fourth day after surgery, you may remove the patch by clipping the sutures with a nail clipper and peeling it off like a band-aid. Please dispose of the patch by flushing down the toilet.

- The transdermal pain patch used for pain relief can cause constipation. Dr. Dew will ask that you feed your pet a certain amount of tuna in oil (Starkist®, Chicken of the Sea®, Etc.) for four days following surgery to prevent constipation. The tuna in oil is to be given in addition to your pet’s regular feedings.

- If your pet is not already on a joint supplement, Dr. Dew will send home a sample of Glycoflex®. Glycoflex® will supplement the cartilage and improve your pet’s joint health. Your pet may stay on Glycoflex® for the remainder of his/her life. The charge for a full bottle or bag of GlycoFlex® is NOT included in the surgery fee; this will be an additional charge to you.

- Your pet will also be sent home with a 14 day supply of Previcox®. Previcox is a non-steroidal anti-inflammatory that is used for the control of pain and inflammation associated with osteoarthritis in canines. Please follow the package instructions.

Food & Water:

- When you get your pet home, offer him/her a small amount of water. If your pet drinks it and does not vomit, then offer twice the original amount.

- Two hours later if no vomiting has occurred, offer ¼ of the amount of food in a normal meal.

- If your pet eats and no vomiting occurs in a 2-hour time period, then you may resume normal feeding(s).

- Please call Dr. Dew’s or your veterinarian’s office if your pet does not drink within the first 6 hours of being home or if vomiting occurs.

Rechecks:

- Your pet should be rechecked by Dr. Dew 10-14 days following surgery. Please call (866) 838-4282 to schedule this appointment.

Exercise Restriction: