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Raven – modified maquet procedure (MMP)

Raven, a 3 year old Golden Retriever, is the 43rd case we have treated for a torn ACL (anterior cruciate ligament) using the MMP method, since beginning to offer this method of repair from December 2017. The accompanying photos provide a visual collage of the procedure. This procedure takes only around 30 minutes and leads to most dogs being 80 - 90% sound in as little as  four weeks post-surgery and the majority of dogs are free running again by just 12 weeks after surgery. There is no limitation to the size of the dog that this can be performed on. We have performed this procedure in dog’s as small as Pomeranians and Maltese Terriers, right through to very large dogs such as Great Danes and Mastiffs.

Skin incision over the inside (medial) surface of the stifle

The saw guide is positioned over the medial stifle and held in place with locating pins and a hole drilled over the proximal tibia at the end of the tibial crest.

The drill bit is left in place to hold the saw guide in position.

The tibial crest is then cut with a sagittal saw, via the saw guide.

The saw guide has been removed, and bone holding forceps are attached to the tibial crest to assist in distracting the tibial crest, to allow for location of the titanium wedge.

Placement of the titanium wedge with wedge inserter.

A stainless-steel bone pin is then placed through the tibial crest, continuing through a pre-drilled hole in the titanium wedge, into the tibia. This helps stabilise the wedge and keep it in place during healing.

A guide is then used to accurately drill holes for the titanium staple. The staple keeps the pressure required against the tibial crest during healing. This allows time for the unique feature of this method to occur, i.e. bone actually grows into the wedge, thus forming a very strong permanent union with the bone.

The staple is placed into the pre-drilled holes.

The staple is then tapped into place, forming a very secure, strong grip on the tibial crest to hold it in place.

This shows the completed procedure with the wedge, staple and pin in place.

This shows the closure of the tissues over the implants.

The skin is then closed.

Raven in surgery nearing the end of the procedure.

The surgery provides a very rapid return to normal function in the majority of dogs, yet takes only around 30 minutes to perform. We currently perform this for approximately $1,600 to $1,900 depending on the size of the dog and the medication requirements, though we have heard of quotes as high as $3,500 for this same procedure. The procedure has been shown to produce equivalent results to the TPLO method commonly performed by veterinary orthopaedic specialists for around $4,000 - $5,500. The video below shows Phoebe, a 12 year old Pomeranian, just four weeks after stabilisation of a right hind anterior cruciate ligament (ACL) tear, via the MMP method, at suture removal.

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