Canine Cruciate Center of New England
Disadvantages of TPLO
So, your dog’s just been diagnosed with some form of a tear to their ACL or CCL and the TPLO or TTA technique has been suggested to repair it. To start, let’s quickly go over the main issues and disadvantages with the metal hardware implant methods of canine ACL/CCL repair.
Some surgeons will advocate the TPLO procedure (tibial-plateau-leveling osteotomy) in larger breeds of dogs over the traditional lateral suture procedure (not recommended for dogs over 30 lbs) because in theory changing the angle of a steeply sloped tibial plateau through surgery is thought to alter the mechanical forces on the stifle joint and allow for improved function, particularly in larger breeds of dogs. The tibial-plateau-leveling osteotomy (TPLO) surgery involves cutting of bone (tibial-plateau) and re-leveling that bone at a precise angle and then reattaching the bone with metal hardware.
In essence the procedure attempts to redesign the anatomy of the canine stifle (knee) and re-engineer the biomechanics of the joint. These metal implant surgeries are very traumatic and painful procedures with prolonged and difficult recoveries. It is widely known that fifty to sixty percent of patients who have these metal implant procedures will tear their opposite limb cruciate ligament (CCL) within the first year following surgery. There are published reports that seventy to eighty percent of TPLO patients will tear their opposite limb cruciate ligament (CCL) overall (over a lifetime). It is our opinion that this is in large part because they are putting most of their weight on the opposite leg for such an extended period
These metal implant procedures have significantly greater complication rates. Infection and/or immune rejection of implanted hardware, implant failures such as screws that loosen or “back out” from mechanical forces of use over time and defects or recalls of the hardware (as in 2002) are prime examples. There are also multiple new reports and studies documenting the development of osteosarcoma (bone cancer) at the site of TPLO surgeries some years later. Published reports of TPLO complication rates vary, depending on how the study defines a complication (minor and major), but in our review of the literature we found that in sum total the most reliable information indicates a complication rate for TPLO surgery ranging between nineteen and thirty-eight percent. If one takes the midpoint of that range—roughly one-third of TPLO surgeries will have significant complications of one form or another. It is no wonder that people across the U.S. and even outside of the country have sought us out to find a viable alternative to these highly invasive and traumatic methods.
What is the QLF?
Now let’s discuss how the QLF surgical procedure differs from the TPLO and other metal hardware implant procedures.
Tearing of the cranial cruciate ligament (CCL or ACL) is the most common orthopedic injury in dogs. The CCL (ACL) is one of the main stabilizing structures in the stifle (knee) joint. The CCL (ACL) surgical repair procedure performed at the Massachusetts Veterinary Surgery Referral Center (MVSRC) at NAHAH is a proprietary procedure which provides exceptional stabilization of the canine stifle joint and consistently outstanding results that enable our patients to be highly functional and resume an active lifestyle.
Rather than attempting to redesign the anatomy of the canine stifle and reengineer the biomechanics of the joint, the QLF procedure simply re-stabilizes and reinforces what mother nature created in the first place. The anatomy of the canine stifle is virtually identical to the human knee, and in fact, the anatomy of this joint is (with the exception of some more exotic species) pretty much identical and pervasive throughout all mammals. This anatomy and its biomechanics have withstood the test of time, surviving and perpetuating over millions of years of evolution. Why is that? Because it works. Who among us would choose a human redesign of this anatomy over mother nature’s tested and proven design that has survived and thrived for millions of years? Try outrunning a sabre tooth tiger!
The science behind QLF surgery is derived from the same principles of physics utilized in the design of cable bridges. Specifically, the principles of load sharing and providing for multiple points of structural failure before complete failure is ever a possibility. QLF surgery utilizes load sharing among multiple heavy gauge synthetic nylon filaments or “artificial ligaments” placed at strategic angles that provide stability throughout the entire range of motion of the canine stifle joint. Together the tensile strength of the implanted synthetic nylon filaments is many times the weight or load they will carry starting from day 1.
Because we are implanting multiple synthetic nylon filaments that each carry a share of the load this inherently requires that multiple “points of failure” must occur before the QLF repair can be disrupted. In essence QLF surgery re-stabilizes and re-enforces mother nature’s anatomy and mother nature returns the favor by re-enforcing our synthetic implants over time. Cadaver studies (microscopic evaluation of nylon implants in patients deceased years later of unrelated causes) show that the body encases nylon implants with scar tissue. Scar tissue is comprised of collagen. Ligaments and tendons as it turns out are also made of collagen (slightly different forms, but collagen). So not by design or intent, but with QLF surgery we basically implant the infrastructure on which the body essentially builds a new “ligament” by encasing the synthetic nylon filaments in collagen and so the bio-synthetic union just gets stronger and stronger over time.
Another fantastic benefit? Since patient recovery time from QLF surgery is significantly less (the majority of our patients are beginning to use the repaired limb with some authority by the time we are removing the skin staples at 2 weeks after surgery), we see substantially fewer patients tearing their opposite limb CCL (ACL). Our opposite limb tear rate is 11% overall. Dr. Murtha firmly believes this is because the recovering patient is not forced to carry most of their body weight on their opposite (“good”) hind limb for an extended period of time as is the case with many TPLO surgery patients. Dr. Murtha believes the faster and easier postoperative recovery definitely has a “sparing effect” on the opposite hind limb and significantly reduces the chances of having to do a second CCL (ACL) surgery – and so has a “sparing effect” on the client’s bank account as well.
Meet Dr. Murtha, "The ACL Vet"
In a manner of speaking, Dr. Murtha has a lifetime of experience in the veterinary profession. He grew up working in his father’s veterinary practice in Lancaster, Massachusetts. Prior to becoming a veterinarian, Dr. Murtha was pursuing a career in research at Harvard Medical School. After graduating from the Cummings School of Veterinary Medicine at Tufts University in 1985, Dr. Murtha realized his passion was in healing his patients and began his career in clinical practice pursuing his interests in surgery.
In addition to his private clinical practices, in 1986 Dr. Murtha became involved in the medical care of racing greyhounds as the result of ethical concerns he had regarding their welfare. For twenty-four years Dr. Murtha was a state-licensed official tasked with the responsibility of overseeing the welfare of hundreds of racing greyhounds as well as their medical and surgical care. This extensive experience afforded Dr. Murtha a wealth of knowledge in canine sports medicine, orthopedics, and surgery that has served him well throughout the years in caring for his patients in his clinical practices.
After the racetrack closed in 2009, Dr. Murtha dedicated his time and energy for the last 10+ years to his surgical practice and refining his proprietary QuadriLateral Fabella (“QLF”) surgical procedure, a revolutionary alternative to the commonly used TPLO method. Having now performed thousands of QLF’s with a nearly 100% satisfaction rating, Dr. Murtha feels confident that his QLF procedure has been perfected.
Dr. Murtha has performed thousands of QLF procedures over the last 35 years. Dr. Murtha started doing post-operative surveys in 2018 to document the success rate and benefits of the QLF procedure. The survey results reflect the most recent 350+ procedures Dr. Murtha has performed. Located in North Andover, Massachusetts, we perform QLF surgery for clients who come from all corners of New England each and every week and we regularly see QLF clients from all over the country and beyond… from as far west as Michigan, Colorado and Nevada to as far south as Alabama, Florida and even St. Johns in the Caribbean (after 2 failed CCL surgeries on the island). We have 5-star ratings anywhere and everywhere one can look (Yelp, Google, etc). No distance is too great to come to us for QLF surgery. And no patient is too big for QLF surgery. We have successfully performed QLF surgery on many giant breed dogs, from Newfoundlands to 200 lb. Mastiffs.
QLF Cost Chart
Our QLF procedure is on par with (and usually a bit less than) the cost of a standard TPLO procedure.
|Weight Group of Pet||Cost Estimate for QLF Surgery|
|0 – 20 lbs||$4,271.39|
|21 – 40 lbs||$4,644.14|
|41 – 60 lbs||$5,022.14|
|61 – 80 lbs||$5,384.39|
|81 – 100 lbs||$5,757.14|
|101 – 120 lbs||$6,570.29|
|121 – 140 lbs||$6,784.79|
|141 – 160 lbs||$7,153.29|
|161 – 180 lbs||$7,527.29|
|181 – 200 lbs||$7,884.79|
Payment Options & Plans
For payment options, our hospital accepts cash, credit card, and certified bank checks (no personal checks). To book the procedure, we require a 10% non-refundable deposit, which will go towards the cost of the surgery. At the time of drop-off, we require an additional 40% of the cost. Upon pickup, the remaining 50% is due.
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