ACL Surgery Program
at the Massachusetts Veterinary Surgery Referral Center
Quadri-Lateral Fabellar (QLF)
Tearing of the ACL (anterior or cranial cruciate ligament) is the most common orthopedic injury in the dog. The ACl (CCL) is one of the main stabilizing structures in the stifle (knee) joint. The ACL surgical repair procedure which is performed at NAHAH (the QLF) is proprietary (to be published) and incorporates the general principals of the “lateral suture” or “external imbrication” procedure (which typically utilizes only a single “suture”) to provide support and stabilization for the stifle (knee) joint of the canine patient. However, NAHAH’s hybrid surgical procedure, called the Quadri-Lateral Fabellar (QLF) procedure is at least four times as strong as the traditional lateral suture technique and far more stable because it utilizes a series of four heavy gauge nylon filaments anchored in a triangulating fashion (strategically placed at crossing angles) in both the patellar tendon as well as a hole drilled in the tibial crest. This additional strength and stability are essential and necessary and is a crucial advantage to the QLF procedure over the traditional lateral suture technique which generally cannot overcome the mechanical forces on the stifle joint (caused by a steeply sloped tibial plateau), particularly in larger breeds of dogs. These mechanical forces are why some surgeons will advocate the TPLO procedure (tibial-plateau-leveling osteotomy) in larger breeds of dogs over the traditional lateral suture procedure. Thomas J. Murtha, III, DVM, Chief of Surgery at NAHAH, has been a surgeon for more than 30 years and was originally mentored in ACL surgical repair procedures by surgeon Dr. Joseph Nichols as well as by his own father (Dr. Thomas J. Murtha, Jr.). Dr. Murtha has been performing and refining the this hybrid procedure (the Quadri-Lateral Fabellar surgical procedure) for more than 30 years with consistently outstanding results replicated in more than a thousand surgical cases. NAHAH’s client’s satisfaction with the outcomes achieved with this procedure is virtually 100%. NAHAH can provide stellar references from clients whose dogs have had the QLF procedure done here at NAHAH and were of every size imaginable. Dr. Murtha no longer performs the TPLO procedure for a number of reasons. First, the TPLO and TTA surgical procedures, which utilize metal implants and are far more invasive and traumatic to the patient, have much longer and more difficult recoveries that typically require formal physical therapy rehabilitation programs for optimal results. Second, these procedures have significantly greater complication rates. Infection and/or rejection of implanted hardware, implant failures such as screws that loosen or “back out” over time and defects/recalls of the hardware (as in 2002) are prime examples. Third is the cost to the client. These surgical procedures themselves are significantly more expensive but also more traumatic and so require formal postoperative physical therapy programs at an additional significant cost for proper rehabilitation. Last and most important is the end result – which procedure provides the greatest benefit to the patient. The end result in performing either the TPLO or TTA procedures, as opposed to the QLF procedure, simply is not appreciably any better. As such, Dr. Murtha simply cannot justify the added trauma (and postoperative disability) to the patient, the prolonged recovery time and the substantially greater expense of doing the TPLO or TTA procedures. It has been Dr. Murtha’s experience through his own clinical observations over 30 years as a surgeon that no better result is achieved for his patients with these more invasive and costly procedures as compared to the QLF procedure, particularly in the hands of an experienced surgeon. Dr. Murtha does not do or recommend the TPLO and TTA procedures simply because he has consistently achieved the same and typically better results for his patients with the QLF procedure performed here in the ACL Surgery Program at NAHAH. Nationwide, a statistic that is frequently referenced is that approximately half (50%) of dogs who tear one ACL will tear the other ACL (opposite limb) within 12 months. Because patient recovery time in The ACL Surgery Program here at NAHAH is significantly shorter, we resultantly see substantially fewer patients (less than 15%) rupturing their other (opposite) ACL. Dr. Murtha firmly believes this is because the recovering patient is not forced to carry the bulk of their body weight on their opposite (“good”) hind limb for an extended period of time through the lengthy and difficult postoperative recovery period that follows the traumatic TPLO and TTA procedures. It has been Dr. Murtha’s clinical observation that for the majority of his patients the faster and easier postoperative recovery has a “sparing effect” on the opposite (“good”) hind limb in terms of avoiding a second ACL surgical repair on that leg – as well as a “sparing effect” on the client’s bank account, saving the additional and significant cost that goes along with a second ACL surgical repair procedure.
Case Study: TPLO Surgery Failure
Marlee Donohue had corrective surgery (QLF surgical procedure) at MVSRC to stabilize her stifle (knee) and successfully restore function to her limb (Marlee has done very well in the 2-plus years since her corrective QLF surgery) after her prior TPLO surgical procedure performed at another facility had seriously failed.