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An Urban Experience
at the talus. The caudoproximal part of the tibiotalar ligament is taut in  exion, all remaining ligaments are taut in extension of the tarsal joint. The lateral collateral ligaments originate at the distal part of the  bular malleolus and the  bularis brevis tendon attaches to the lateral aspect of this bony prominence. The  bulotalar ligament inserts proximolateral on the talus, immediately deep to the  bular malleolus. The  bulocalcaneal ligament inserts proximal and lateral on the calcaneus. The  bularis brevis tendon attaches distal and lateral on the calcaneus. The only structure on the lateral side of the tarsus taut in extension is the  bularis brevis tendon. Both ligaments,  bulocalcaneal as well as  bulotalar, are taut in  exion.
One of the advantages of these noel techniques is
that they may not require immobilization of the joint
with coaptation, transarticular external  xator or transarticular pin to spare the repair. Immobilizing the joint with a transarticular  xator has the potential to lead to degenerative joint disease, but the described repair techniques have not suf cient strength to withstand
the repetitive loading in the postoperative period. An important consideration is that cats presenting with tarsal instability typically have open access to the outdoor and may not be con ned by the owners. A novel technique that we developed combining Fiberwire and knotless anchors offer signi cant advantages such as decreased risk of implant failure, earlier return to joint mobility and better long-term function. Our initial clinical experience using small Bone PushLock anchors in a cat with
tarsal instability has been excellent. Further testing is necessary to determine which technique offers the best biomechanical performance.
The Swivel Lock or Push Lock anchor can be used to reconstruct the MCL of the sti e or collateral ligaments of other joints including the shoulder, elbow, carpus and tarsus. The Push Lock anchor is introduced into the bone tunnel by impaction rather than screwing into place. One end of the FiberWire or FiberTape
is attached to bone using a suture anchor or suture button. The suture is tightened to the desired tension and securely fastened into a bone tunnel using a Peek Swivel Lock or Push Lock anchor, reconstructing the collateral ligament. Stabilization of the shoulder for medial instability has been recommended by ligament reconstruction, imbrication of the subscapularis tendon or imbrication of the medial glenohumeral ligaments (MGHL) and medial joint capsule. Reconstruction of the MGHL is typically performed through a craniomedial approach to the shoulder, followed by ligament reconstruction using suture anchors and Fiberwire or FiberTape. It is important to reconstruct both arms of the ligament if they are both damagesd Stabilization
of the lateral glenohumeral ligament by joint capsule imbrication using a suture anchor technique was recently reported with good results in 2 dogs having tears of
the LGHL. Thermal shrinkage of the joint capsule was previously recommended as a means of stabilizing the shoulder, but this technique has fallen out of favor due to inconsistent results. Following any type of surgical repair of surgical instability, it is recommended that the shoulder be protected with restricted, controlled activity and a thoracic jacket or bandage. Immobilization of the shoulder has been recommended for 6 weeks, followed by rehabilitation exercise for an additional 6 weeks.

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