What is Extracapsular Repair (Ex-Cap)?
An Ex-Cap is a surgical procedure performed to address a ruptured cranial cruciate ligament (CCL) in dogs. Cranial cruciate ligament ruptures are one of the most common injuries in the dog and the major cause of degenerative joint disease (DJD) in the stifle joint. The CCL is one of the most important stabilizers inside the canine knee, it connects the femur and tibia together so that the knee works as a stable, hinged joint.
The two most common causes of CCL ruptures are trauma and degeneration of the ligaments within the joint. Acute or traumatic cruciate rupture is caused by a twisting injury to the knee joint; this twisting occurs most often when the dog is running and suddenly changes direction. A cruciate ligament rupture is usually extremely painful and the knee joint becomes unstable, resulting in lameness.
A more chronic form of cruciate damage occurs due to progressive weakening of the ligaments due to repeated trauma or arthritic disease. Initially, the ligament becomes stretched or partially torn and lameness may be only slight and intermittent. With continued use of the joint, the condition gradually gets worse until a complete rupture occurs.
Diagnosis
- Radiographs
- Clinical symptoms; toe touching, lameness, limping, etc.
- Demonstration of cranial drawer motion using direct and indirect palpation techniques
Surgical Technique
The Ex-Cap procedure involves using a special type of heavy-gauge suture to stabilize the knee, preventing the tibia from slipping back and forth.
The heavy-gauge suture is passed around the lateral fabella, the suture is then brought forward across the lateral aspect of the stifle joint and one end is passed under the patellar ligament to the inner side of the stifle. It is then passed back to the lateral side through a bone tunnel drilled in the top of the front portion of the tibia and the two ends of the suture are brought together and adjusted to the appropriate tension, then a tiny metal clamp (crimp) is used to secure the two strands together
This suture now runs in the same direction as the torn cranial cruciate ligament and is stabilizing the joint
The photo to the right shows a radiograph taken after an Ex-Cap procedure
Recovery
- Activity levels are restricted to short, slow leash walks only for several weeks
- Recheck appointments are in place to check before slowly increasing activity levels