CCL Lateral Suture
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CCL Update Overview of Technique The joint capsule is closed using Safil (PGA) suture. ■ The lateral fabella is exposed using a Hohman retractor (J235B) ■ A small eyed graft passer (J236SE) is passed between the lateral fabella and femur. The nylon suture and crimp tube pack is opened. ■ The nylon is passed through the eye of the graft passer and pulled through. ■ The nylon passes deep to the femuro fabella ligament. ■ A hole is drilled through the proximal tibial tubercle using a bone tunnel borer (2.8 mm), (J712). ■ The nylon is passed latero-medially through the hole. ■ The nylon is passed back medio-laterally under the distal patellar ligament using the same graft passer. ■ The free ends of the nylon are passed through the crimp tube from opposite ends. ■ The initial crimp with the crimping forceps (J710) is made in the middle of the tube. The walls of the tube grip the nylon while still allowing it to be tensioned. ■ The free ends are pulled through the crimp tube to place appropriate tension on the nylon loop. If the initial crimp is correct, the tension will be maintained by the crimp tube. ■ The tensa fascia lata, sub cutaneous tissues and skin are closed in layers. Size of nylon c.f. size of dog Very little data has been published. It would seem wise to error on the side of caution. 11kg 18kg 45kg 25lb 40lb 100lb 50lb line 80lb line 2x80lb line These guidelines are only for a lateral suture. Boisterous heavy dogs may benefit from a medial suture also. Some surgeons are protecting their “over the top” repairs with a lateral suture. The immediate post operative strength gives the graft time to consolidate. Simple loop or figure of 8 Most surgeons use a simple loop which does not cross over. There may be advantages in a figure of 8. Some surgeons use 2 loops one of each. Results are comparable with other techniques Post operative strength of the repair is immediate and good Risks to intra-articular structures are minimal Technique Summary Heavy monofilament nylon is placed on the lateral side of the stifle. The large knot normally required for this suture is replaced by a metal crimp tube. The appropriate tension is placed on the suture, then a crimp tube, applied over the suture ends, is held in place by a special crimping instrument. The lateral nylon is placed behind the lateral fabella bone and then through the tibial tubercle. Additional features include: A special graft passer for proper anatomical placement of the nylon suture. A bone tunnel borer for drilling hole through proximal tibial tubercle. A stifle retractor (J240W) for proper examination of the meniscus and intra–articular structures. For more information please contact: The free ends are removed. ■ Tension of loop There is little published data on appropriate tension. The current advice is that the tension should be sufficient to eliminate anterior drawer motion but not enough to cause outward rotation of the tibia. Over tensioning will create difficulties particularly if the hole in the proximal tibia is incorrectly positioned. It is a relatively quick procedure The initial crimp is completed by firm crimps on either side of the first. ■ Position of Tibial anchor point The position of the end of the loop is critical. If the anchor point is too far distal, extension of the stifle may be restricted. It is recommended that the hole in the proximal tibia passes through the tibial tuberacle at the level of the insertion of the straight patellar ligament. If two holes are used both must be through the tibial tuberacle. Some surgeons countersink the hole to minimize abrasion of the nylon at the kink point. Treatment of Cranial Cruciate Ligament rupture by placement of a lateral nylon suture is rapidly gaining popularity amongst veterinary surgeons. ▼ ■ CCL Lateral Suture System Soft tissues Any soft tissue included in the loop (usually around the fabella) will become necrotic and give way under the tensioned nylon resulting in loss of tension. ▼ The meniscae are examined using both a stifle retractor (J240W) and Gelpi retractor (J240). ▼ ■ JORGENSEN LABORATORIES, INC. ▼ The tensor fascia lata is dissected free from the joint capsule and the tibial tubercle. The joint capsule is incised and the patella dislocated medially. ▼ ■ Position of crimp It is currently the view of most users that the crimp tube should be placed on the more distal strand of the loop over the Tibialis Cranialis muscle. (See drawing). At the final closure the crimp and nylon are covered by the fascia of the Biceps Femoris. Thus, once again the line has been passed behind the fabella, the top strand passes under the distal straight patellar ligament back through the hole in the tibial tuberacle and joined to the lower strand. ▼ A lateral para patellar incision is made. ▼ ■ JORGENSEN LABORATORIES, INC. 1450 N. Van Buren Avenue Loveland, Colorado 80538 970-669-2500 • 1-800-525-5614 FAX 970-663-5042 • email: info@JorVet.com

J ORGENSEN L ABORATORIES CCL Lateral Suture System A lateral para patellar incision is made. The tensor fascia lata is dissected free from the joint capsule and the tibial tubercle. The joint capsule is incised and the patella dislocated medially. The meniscae are examined using a combination of Gelpi’s and a stifle distractor. The joint capsule is closed using Safil. The nylon is passed back medio-laterally under the distal patellar ligament using the same graft passer. The free ends of the nylon are passed through the crimp tube from opposite ends The initial crimp with the crimping...