Pioneered in the dog by Stephen Arnoczky and simplified by Hamish Denny the Over the Top Technique remains popular amongst surgeons worldwide. The technique attempts to replace anatomically, as far as is possible, the Cranial Cruciate Ligament (CrCL) with an auto graft of patella ligament. Several variations of the technique are available but all have the similar difficulties.
Secure attachment of the graft to the femur is difficult. Screws and spiky washers or ligament staples are more secure than sutures.
The graft weakens during the first 4 or 5 weeks as revascularisation takes place. Typically the recovering dog is eager to stress the graft at a time of minimal strength.
Intra-articular manipulations, to pass the graft, carry potentially more serious sequelae than extra-capsular techniques.
It would seem resonable to augment the autograft with a lateral suture to protect the graft during the revascularisation phase. Theoretically the graft should be up to strength when the lateral suture fails. I am not aware of a published series of this technique. I am aware of a number of surgeries who apply this technique to large dogs.
The technique illustrated is that described by Hamish Denny.
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