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Graham Oliver and his team welcome you to East Midlands Referrals.We specialise in orthopaedic, neorology and MRI services for Dogs and Cats.
We have pioneered many diagnosis techniques and surgical procedures, thus improving the level of care available.
To refer a new patient please click on 'Visit My Web Site' link for our referral form
Cruciate ligament failure
· The clinic treats approximately 250 cases annually, almost all surgically. There are a bewildering array of options ( even from a veterinary perspective!) with nearly 70 different techniques having been devised since the 1950s. These fall into 3 groups
· Replacing the ligament with a biological tissue (grafting )
· Replacing or mimicking the function of the ligament with synthetic materials (imbrications and direct replacements)
· Re-engineering the joint so that it will function well without a cranial cruciate ligament (osteotomies)
Over the last 10 years the options have generally crystallised into either the second or the third group with biological grafts becoming infrequently performed ( still used in the human field)
The second group can be split into 2 categories,
· Lateral suture systems/lateral retinacular imbrication
· Tightrope suture system
The latter is more recent and has advantages in larger patients since in almost all cases with these techniques the synthetic material will fail over time and success may be chiefly reliant on the biological reaction to generate supporting scar tissue.
The third group the osteotomies (bone cutting operations) stemmed from work by Barclay Slocum ( now deceased) in the States in the late eighties. This represented a radical lateral re-thinking of this problem and its treatment and has given rise to many other osteotomies ( TTA , tibial wedge osteotomy and TTO). These procedures do not rely on repair or replacement of the ligament but on altering the internal angles of the joint to re-orientate the forces acting on it and effectively render the failed ligament redundant. These are the most frequently performed surgery in referral (specialist or second opinion) practices.
This clinic uses either TTO ( devised by Warwick Bruce – Sydney university) or tibial wedge osteotomy ( TWO)- the latter in very small patients. Examples shown below.
These operations are more complex and costly than alternatives but it has become clear that they provide much more rapid recovery helping to maintain joint mobility and limb strength as a result. After a period of scepticism ( some years ago) I am in no doubt that for many of our patients this approach gives far superior results.
Fractures and dislocations
These occur with high impact injuries- usually road traffic accidents or falls. Fractures can most often be repaired and dislocations put back (reduced) , this may be doen by manipulation under anaesthetic or by an operation called “hip toggling”