1. STIF INTRA ARTICULAR CCL RECONSTRUCTION
STIF CCL ligaments are different for Right or Left joint to respect physiological torsion .
Recommended Ligaments and Screws
kgs : 30 fibres with free intra articular fibres of mm - drill bit diam 3.6 mm X20 screws
30-35 kgs : 44 fibres - free fibers 22mm
Drill bit diam. 4.2 mm X20 screws
Above 35kgs 60 fibres - free fibres 28mm
Drill bit 5mm X25 mm screws
The size of the ligament depends also of the size of the notch and the bones . The strongest that can be used is recommended .

2. CCL 30-17 R THE FREE INTRA ARTICULAR FIBERS 30 fibers
17mm intra articular
Right
CCL R

3. For soft tissue protection Male screwdriver
Female screwdriver
Telescopic tubes
For soft tissue protection
Male screwdriver
2 blunt K wires
Drill bits
5mm -4.2mm- 3.6mm
6x wire loops
2 K wires
2mmX20cm
Double ended shqrp
Passing tube 20 cm
2 hexagonal K wires

4. CCL FEMORAL INSERTION
ENTRANCE POINT
EXIT POINT
60%
40%

5. STEP 1 : femoral guide K wire
A medial parapatellar arthrotomy approach offers a better view

6. STEP 2:the guide K wire is drilled down into the tibia
STEP 2 : the K wire is inserted downwards into the tibia from the femoral side.
The flexion is ajusted to allow the penetration of the Kwire at the posterior part of the tibial CCL foot print

7. STEP 2b is :another option for the tibial K wire
If the orientation of the Kwire in the femur does not allow a proper direct placement in the tibia or leads to a friction of the ligament against the notch , the Kwire can be drilled separately with the joint in hyper flexion
The Kwire is placed into the foot print and drilled down towards the medial tibial cortex

8. STEP 3 : drilling of the tunnels
Hold the Kwire during the tibial drilling
Protection tube
The telescopic tubes are inserted on the K wire to protect the soft tissues; The cannulated drill bit adapted to the size of the ligament is guided by the K wire . The drillings are performed from outside-in to avoid damages to remnants and cartilage

9. STEP 4 :passage of the ligament
The Wire passing tube is placed through the tunnels followed by the wire loop . The passing tube is removed
The threads of the ligament are inserted through the loop and the ligament is pulled until the free fibres are adjusted intra articularly

10. STEP 5 : femoral fixation
Cannulated screw
Hexagonal K wire
1or 2 cm of the hexagonal K wire are inserted into the tunnel parallel to the ligament. Then the appropriate screw is driven down and inserted with the female screw-driver until 1 mm remains outside the cortex . The telescopic tubes can be used if needed .

11. STEP 6 : adjustment of tension
and tibial fixation
The ligament is tensioned once and then the joint is put in full flexion and extension. If the placement is isometric there should not be any movement in the tibial tunnel . A small sliding of 1or 2 mm is admissible and the tibial fixation must be completed to allow a full range of motion . The ligament must never be over tight
The insertion of the screw is made like on the femoral side with the help of the hexagonal K wire ; The male screw driver is used to adjust the insertion when the K wire has been removed

12. Note about fixation
The screws have to be tight in the bony tunnels. If there is a doubt about the strength of the fixation ( bone density –heavy and active dog ) it is recommended to drill a second transverse tunnel .
Insert the extremity of the ligament in it and put a second screw

13. POST OPERATIVE CARE No immobilisation or brace are necessary
Full weight bearing
Control the activity of the dog for one month