Q1. I have trouble getting my graft passer to go through the joint. What am I doing wrong?
A. It is very likely that the tip of your graft passer is hittin g the tibial plateau. It is important to visualise where the tip of the graft passer is any any time. The tip has to pass between the condyles if it is to exit in the right place. Use the correct graft passer for the size of dog. Judge your graft passer against an xray if necessary.
Q2. Is it OK to push my graft passer through the joint from the front of the stifle exiting at the fabella?
A. If you have a lot of trouble passing the graft passer from back to front it is permissable to pass it the other way. Try to make the graft passer exit close to the fabella. You may pass the graft directly in this way or you may pass nylon or wire which is then used to pull the graft through.
Q3. What is the weakest point of the procedure?
A. The weakest point of the repair is where the graft is stitched onto the femur. It is very important to attach the graft to the fibrous femorofabellar ligament. By taking a longer graft it is possible to run the graft down to the straight patella ligament which creates a strong 'sling' for the femur. The graft weakens post operatively before gaining strength as the graft re-vascularises. It is important that the dog is on restricted exercise for at least 8 weeks.
Q4. Can I use the Over The Top Technique together with any other?
A. The over the top technique is rarely described as being used together with other techniques. Theoretically combining a graft with other techniques, paticularly tibial plateau altering techniques where the knee is left unstable would seem to make sense. We have to consider the implications of putting a graft into a diseased stifle. A number of surgeons, particularly in large dogs, use a combination of over the top plus a lateral suture. The theory is that the graft is weak post operatively and is protected by the lateral suture which ultimately breaks when the graft comes up to strength. It makes sense