MMP for Cranial Cruciate Ligament Surgery
Warren Animal Clinic we are now pleased to be able to offer this new modification of the TTA (tibial tuberosity advancement)
procedure. For almost 10 years the Tightrope procedure has addressed most of our ACL repairs with outstanding results. Since all breeds
differ in size and function there are occasions where a TTA procedure is indicated. The MMP produces the same great results as
tightrope, just a another way to accomplish it according to individual patient needs. We are excited that the MMP is minimally
Like the TTA and the TTO the overall aim of the procedure is to get the tibial plateau at 90 degrees to the patellar
tendon. In simple terms this makes the patellar tendon act in a similar way to the ACL/CCL.
The MMP procedure is based on a technique
developed almost 50 years ago for use in human knees by Dr Maquet, a Belgian orthopedic surgeon. The surgery works by redirecting
the force generated by the large quadriceps muscles to compensate for the failed cruciate ligament. This is achieved by freeing,and
moving forward, the part of the tibia (the tibial tuberosity) attached to the quadriceps muscle. The void is stabilized using a modern
orthopedic implant material called OrthoFoam. Thus the name Modified Maguet Procedure (MMP).
The porous titanium OrthoFoam promotes
rapid bone in growth and healing. Capillaries penetrate the OrthoFoam quickly. This is key to the reduced convalescence and minimal
pain seen with MMP surgery. Successful recovery after knee surgery, no matter which procedure has been used, requires a period of
controlled activity. Compared to other procedures, MMP causes less discomfort and while a comfortable, pain-free patient is obviously
a good thing, many dogs are tempted to use the operated leg too much, too soon. No matter how comfortable and confident your pet is
feeling in the days after their MMP operation, it is absolutely essential that running, jumping, and general “rough and tumble” with
other pets is avoided for the first 6 weeks or so.
The bone must be given time to heal adequately and too much strain placed on the
osteotomy too early can result in stress fracture or implant failure and while this is rarely catastrophic, the ensuing complication
may be painful and will certainly delay the recovery. The recovery period is outlined below.
First 2 weeks
Bandages are not used following
MMP because it is important that your pet is able to flex and extend the operated knee freely right from day one. The skin sutures
are removed 10 to 14 days after surgery.
During the first 14 days
Your dog should be encouraged to take frequent short
leash walks 5-10 minutes, six or eight times daily is a good starting point. It is important that the operated knee joint is returned
to use as quickly as possible . Concentrate on walking slowly as this will encourage the patient to use the leg. Ideally, your
dog should go outside ON A LEASH to urinate and deficate during the first two weeks after surgery. Do not swim the dog.
No other exercise is recommended for the first 14 days – it is important to not let your pet loose to run freely in the house, particularly
up and down stairs.
Third and fourth weeks
The amount of activity can now be gradually increased but it is essential that the patient
is still not allowed off the leash. Leash walks can be longer and faster though you need to take care to ensure that the patient continues
to use the operated limb confidently at every step.
Fifth and sixth weeks
Check X rays are scheduled for the end of week four
and these should confirm that the osteotomy is healing well. Bear in mind that although bone healing and remodelling will be progressing
nicely, full strength will not be established for several more weeks. At this stage, the patient will be capable of frequent lengthy
(30 minutes or more) leash walks and we will soon be introducing some free running activity. The key to success is a program of gradually
increasing activity. At first,the patient can be allowed off the leash towards the end of the last walk of the day – choose a quiet
area with a good surface – a short cut grassy park is ideal – without dogs or other distractions that might encourage your pet to
do too much too soon. Five minutes is enough for the first day off the leash. Subsequently, the amount of free running play and exercise
can be increased gradually back towards normal pre-injury levels. Most dogs will be capable of full, unrestricted athletic activity
within 12 weeks of their MMP operation. Some residual low grade stiffness and lameness may still be seen at twelve weeks but this
will resolve completely over the subsequent month or two as the patient regains full fitness and muscle tone.
31980 Van Dyke, Warren, MI 48093 586.264-4621 firstname.lastname@example.org
Richard L. Lanier, DVM