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Cruciate Ligament Repair (CBLO)

Cruciate Ligament Repair (CBLO)

At Poulsbo Animal Clinic, we offer an advanced and effective solution for cruciate ligament repair in pets, known as the CORA-Based Leveling Osteotomy (CBLO). This technique, an evolution of the Tibial Plateau Leveling Osteotomy (TPLO), has been mastered by our own Dr. Craig Adams. He acquired his skills under the guidance of renowned surgeons, including Dr. Don Hulse from Texas A&M University, who played a pivotal role in developing this procedure.

The CBLO method holds several advantages over the TPLO and other cranial cruciate ligament procedures. One of the most significant benefits is the location of the bone cut, which is outside the joint. This results in less damage to the articular cartilage over time. Moreover, CBLO is known for its rapid healing process, typically spanning 6 to 7 weeks, much faster compared to the several months required by other CCL procedures. The technique also ensures excellent passive stability and shows remarkable short and long-term functional results.

A key feature of CBLO is its suitability for younger patients. Unlike other methods, it doesn’t involve the growth plate, making it an ideal choice for juvenile pets. This aspect of CBLO is crucial as it allows for early intervention in young animals, preventing the progression of joint damage and ensuring a healthier life.

Understanding the Cranial Cruciate Ligament (CCL) and its role is essential in appreciating the significance of CBLO. The CCL is a major stabilizing structure in the canine or feline stifle (knee) joint, maintaining a normal relationship between the femur (thigh bone) and tibia (shin bone) in all angles of motion. When this ligament ruptures, it leads to stifling instability, altered leg mechanics, inflammation, arthritis, and pain. If left untreated, this instability not only persists but also exacerbates, leading to additional complications like meniscal damage.

Our clinic has witnessed remarkable success stories with CBLO. For instance, Sparky, an 8-year-old dog, demonstrated significant improvement, utilizing all four legs efficiently at his 8-week post-operation examination. In another case, Magenta, a 5-year-old Australian shepherd, showed excellent healing and bone remodeling 16 weeks post-surgery. These examples underscore the efficacy of CBLO in restoring normalcy to our furry friends’ lives.

In comparison to TPLO, CBLO offers a more refined approach to addressing cruciate ligament injuries. While TPLO has been a reliable method for about 30 years, long-term follow-up studies have indicated a breakdown in joint cartilage. CBLO, on the other hand, addresses some of the issues that TPLO might present, including the alignment of the weight-bearing axis with the anatomical axis of the tibia, thus minimizing long-term complications.

Post-surgery rehabilitation is a critical part of recovery. It begins immediately as the pet returns home, with treatments including chilled padded ice packs and gentle limb movement exercises. As the pet progresses, walking uphill, stair climbing, and water treadmill exercises, if available, are recommended. High-impact activities, however, should be avoided for a full two months after surgery.

In cases where the rupture hasn’t discovered for years and joint disease has already advanced, surgical repair might still offer relief from arthritis pain. Additionally, meniscal injuries, often accompanying CCL ruptures, are addressed during the surgery to remove or repair the damaged cartilage.

The CBLO technique at Poulsbo Animal Clinic stands as a testament to our commitment to providing advanced, effective treatments for our pet patients. Through this procedure, our team strives to ensure the health and mobility of pets, helping them return to their active and joyful lives.

ADDITIONAL PUBLICATIONS


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Sparky’s Recovery

  • Background: Sparky, an 8-year-old dog, faced significant mobility challenges, being three-leg lame prior to undergoing CBLO surgery.
  • Outcome: At his 8-week post-operative examination, Sparky showed a remarkable recovery, effectively using all four legs. This significant improvement highlights the efficacy of the CBLO technique in restoring mobility and quality of life in pets.
Sparky’s CBLO Recovery

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Magenta’s Healing Progress

  • Background: Magenta, a 5-year-old Australian shepherd, underwent CBLO surgery performed by Dr. Adams.
  • X-ray Observations: The x-ray series taken over 16 weeks post-surgery showed excellent healing and bone remodeling. Notably, Magenta was sound just 8 weeks after the procedure.
  • Outcome: The arrows in the X-ray images indicate areas where substantial healing and bone remodeling were observed by the 16-week mark. This case exemplifies the CBLO technique’s ability to facilitate rapid and effective recovery from serious ligament injuries.
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Excessive Angle Tibial Plateau Repair Using CBLO

Some dogs have an excessive tibial plateau slope and the bearing surface of the tibia is angled dramatically rearward.  In these cases, the traditional repair methods, such as TPLO, cannot be used.  By using a double-cut CBLO technique, a wedge is removed prior to rotation and the result maintains the weight-bearing axis though the center of the bone.

Click here to see an example of a case where CBLO surgery worked for a dog with excessive tibial plateau slope.


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The red lines in the photos below show the rearward slant of the tibial plateau before and after CBLO surgery. The goal is to reduce the angle to about 10 degrees, not completely eliminate it. The curved cut in the bone (osteotomy) is clearly seen in the second photo, as are the screws and plate used to stabilize the osteotomy.

digital xray

In the x-ray images below, the femur can be seen to have slipped rearward off the tibial plateau because the cranial cruciate ligament is ruptured. This is the positive cranial drawer sign. The post-CBLO x-ray on the right image shows the femur back in the appropriate weight-bearing position on the tibial plateau. This is a small dog that also had a luxating patella repaired at the same time. The round ball is 2.5cm in diameter, for comparison.

Cruciate Ligament Repair (CBLO)

Video Demonstration of Successful CBLO Surgery

Roca’s Post-Surgery Mobility

  • Background: Roca underwent CBLO surgery on her left leg, performed by Dr. Adams. She had previously had the same procedure on her right knee two years earlier.
  • Observation: A video demonstration shows Roca walking comfortably on the sidewalk next to the clinic just two weeks post-surgery.
  • Outcome: The footage of Roca, only a fortnight after the surgery, underscores the minimal recovery time and the remarkable effectiveness of the CBLO procedure in restoring normal gait and mobility in pets.

These patient stories serve as compelling testimonials to the success of the CBLO technique used at Poulsbo Animal Clinic. If your pet could benefit from the ability to significantly improve their quality of life or is suffering from cruciate ligament injuries, contact us.