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Canine Cranial
Cruciate Ligament Disease
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There are two cruciate
ligaments in each stifle joint (the equivalent of the human
knee). The cranial and caudal cruciate ligaments connect the
tibia (equivalent to our shin bone) to the femur (equivalent to our
thigh bone). They are strong and prevent the
joint from over-extending. The ligaments are arranged in the form
of the letter X within the joint, hence the name cruciate (meaning
cross-shaped). Problems occur when degeneration causes
one or both ligaments to rupture. The cranial cruciate ligament,
which runs from the front of the top of the tibia to the back of the
bottom of the femur, is the most commonly damaged. This damage
can happen if a dog
undertakes very strenuous exercise and it can be fairly common in
working dogs. It is important to remember that both
conservatively managed and surgically managed rehabilitation
takes many months, possibly at least 12 -16 weeks of a gradual
rehabilitation programme designed specifically for your dog. A
successful outcome is dependant on optimising joint function and
integrity as well as improving muscle strength, co-ordination and limb
control. In addition, appropriate pain relief is essential in the
early stages to enable the dog to utilise its limb comfortably and thus
prevent expensive muscle wasting.
source
Helen Mathie ACPATA
What is Cruciate Disease?
Athletic injury in the back leg frequently affects the cruciate
ligaments. These lie within the knee joint, helping to stop the
thigh bone and shin sliding forward or backward when the dog brakes,
accelerates or turns.
The ligaments may be damaged by stumbling on uneven ground, falling in
a hole or getting the leg caght and pulling to release it. Old
age also weakens the ligaments. At first, dogs are very lame and
the stifle is swollen and painful to touch. Painkillers can help
reduce symptoms. After a few days the dog walks on its toes and
after a few weeks is fully weight bearing. Painkillers and rest,
with or without surgery, are required. Rehabilitation takes many
months.
Long term, whether or not surgery is carried out to repair the
ligament, arthritis will set in. Sadly this can be painful and
may reduce a dog's working life.
Harvey Caruthers
Canine Cranial Cruciate Ligament Disease
Ruptured Anterior (Cranial) Cruciate Ligament
Cranial Cruciate Ligament Rupture
Anterior Cruciate Ligament Tears
Major's Story
Canine
Cranial Cruciate Ligament Disease
Jeff Bowra DVM
Certified Canine Rehabilitation Practitioner
The dog’s stifle (which is
equivalent to our knee) is stabilized by many
ligaments. There are two bands of fibrous tissue called the cruciate
ligaments in each knee joint. They join the femur and tibia (bones
above
and below the knee) together so that the knee works as a hinged joint.
They are called cruciate ligaments because they “cross over” inside the
knee joint. One ligament connects from inside to outside the knee joint
and the other outside to inside, crossing each other in the middle.
They prevent abnormal forward and backward movement of the bones in the
knee.
This is
most often seen in dogs when running and suddenly changing direction so
that the majority of the weight is taken on this single joint. This
injury usually affects the cranial (front) ligament. The joint is
then unstable and causes extreme pain, often resulting in lameness. It
is now believed that most cruciate ligament disease in dogs is of a
more chronic nature which results from weakening of the ligaments over
time. The ligament may become stretched or partially torn and lameness
may be only slight and intermittent.
With continued use of the joint, the condition gradually gets worse
until rupture occurs. The typical scenario is that the dog is
chasing a ball, running around in a field or even jumping up on to
something. The dog is suddenly lame and often none weight
bearing on a hind leg. It may not be terribly painful to touch but very
painful to walk on.
Diagnosis is usually made by manipulation of the knee, although many
dogs need to be sedated to get proper relaxation and examination of the
knee. During the examination, the veterinarian will try to demonstrate
a particular movement, called a drawer sign. Other diagnostic tests
such as radiographs (x-rays) may also be necessary. Dogs less
than 20lb often do well without surgery. This may not apply to the 15lb
agility dog as the level of activity desired may
result in needing surgery. Geriatric dogs with other medical problems
where anesthetic is a major concern may function ok without surgery but
often times retired athletes are still very active and do much better
after
surgical repair.
Dogs weighing more than 20lbs (especially athletic dogs) need to have
surgery to prevent rapid degeneration of the joint
and arthritis. Each dog should be treated as an individual. A
50lb border collie that is active in high level agility may need
a more stable repair than a 90lb golden retriever couch potato. Weight
definitely plays a role and many of the dogs that I see with cruciate
injuries are overweight.
Once the knee has been damaged, it will never be totally normal. With
rapid surgical intervention and proper rehabilitation we can greatly
slow down the onset of arthritis and regain almost totally normal
function of the knee. This is not an emergency surgery but if possible
it should be repaired with in several weeks of occurrence. The longer
the time is between injury and repair, the more likely the development
of arthritis. There are other concerns with waiting too long.
Instability of the joint will increase the risk of damage to the
cartilage (also called the meniscus). The prolonged lack of use of a
leg will lead to muscle atrophy from lack of use of the leg. For every
day of muscle loss (which starts from the day of injury) it takes 3
days to regain it. Studies have shown that dogs continue to lose muscle
mass in their thigh for 5 weeks after cruciate ligament repair. If you
do the math you can see that this will have serious implications in the
short
term for a high performance dog. The most serious secondary problem is
damage to the other knee due to the increased weight placed on it. It
is estimated that up to 40% of dogs will rupture the cranial cruciate
ligament in their second knee within 1-2 years of surgery on the first
one.
There are many different surgical techniques but they all should
involve exploring the joint and removing the pieces
of the torn ligament. The cartilage should also be examined as it
is often damaged as well. If damaged, the cartilage should be removed.
There are many techniques to repair cranial cruciate ligament tears
but they all centre on stabilizing the joint. Currently the most common
technique is called an extracapsular repair which involves placement
of high test nylon around the back and side of the knee (see picture).
This results in immediate stabilization of the knee and allows early
rehabilitation. Over time the suture will stretch and even break but by
that time enough fibrous tissue develops around the joint to support
itself. Possible complications (although rare)associated with this
repair are suture breakage or stretching, infection progression of
arthritis in the joint.
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A model showing extracapsular
repair
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There is a new repair
technique that has been developed in the last 10years. This is called
the tibial plateau leveling osteotomy (TPLO). It is based on the
premise that cruciate injury is a result of too steep of an angle on
the joint surface of the tibia (shin bone) ( see above line drawing)
This causes an increased forward movement of the tibia with respect to
the femur and stress on the cranial cruciate ligament. The surgery
involves cutting the tibia and rotating the joint surface so that the
tibial plateau angle is decreased resulting in decreased forward thrust
of the tibia. A bone plate is applied to stabilize the tibia.
The advantages of a TPLO are that the dog may have more rapid return to
athletic potential as compared to the traditional techniques. Many
canine
athletes can return to athletic function 3 months after cruciate repair
via TPLO although after 6-12 months there is really very little
difference between TPLO and extracapsular repair. It has been proposed
that a
TPLO repair will slow down the progression of arthritis in the knee.
On the other hand there are disadvantages to TPLO surgery.
Complications can be more severe then traditional techniques. It is
more invasive as the leg is actually fractured and then repaired with a
plate. Initially after surgery there is increased pressure on the front
of the knee and the knee cap (patella). This can result in tendonitis
and even breakage of the front of the tibia (tibial crest avulsion).
There may also be loosening of the screws or improper healing of the
fracture. These complications are rare and usually due to lack of
exercise restriction in the first 4-6 weeks after surgery. TPLO surgery
is also much more expensive than traditional repairs. I think that it
is a good idea to consider a TPLO in canine athletes where a high level
of athletic ability is desired. On the other hand I have seen canine
athletes return to high athletic ability.
When contemplating any cruciate repair you must also consider the
surgeon. I perform many extracapsular cruciate repairs but I do not
perform TPLOs. The TPLO repair is highly technical and requires special
equipment and expertise. I always recommend a board certified surgeon
for a TPLO repair and they need to do a lot of them to get good at it.
If you do not have a TPLO surgeon near you then this may be a factor in
your decision making.
Whatever your decision with respect to surgical intervention, I believe
that the post operative period is as important as the surgery. Studies
have shown that post operative physical rehabilitation will reduce
muscle atrophy and speed up weight bearing and return
to function. From my own experience, I also believe that physical
rehabilitation after cruciate ligament repair results in a reduced
incidence
of rupture of the opposite leg. One of the biggest factors with respect
to recovery is weight. The first thing that I do with a dog that has
ruptured
a cruciate ligament is put it on a diet. Although not usually a problem
in the canine athlete, obesity has an obvious negative effect on
cruciate
ligament recovery. But a normally active dog is going to gain weight if
its activity is reduced but its food intake is maintained at the
performance
level. I would recommend that any athlete that has an injury should
have
its caloric intake decreased by 20-25% until it is back to work. A
normally very active dog is going to gain weight when its activity is
reduced
for surgery and rehabilitation.
Beginning immediately after surgery we ice the leg as much as possible
to reduce pain and swelling. Starting the next day we want to encourage
weight bearing on the leg. The days of cage rest and bandaging are
gone!!! We send the dog home on anti-inflammatory medication for 5-10
days to reduce pain and encourage early usage.
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Icing
after knee surgery as the dog is recovering.
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We also start K-laser therapy immediately after surgery and continuing
over the next 2-3 weeks. Laser therapy helps to
reduce pain and swelling and promote healing.
Most of
the rehabilitation is done at home by the owner. We train the owner
to do range of motion exercises, stretching and massage (as well
as icing) to reduce pain, swelling and atrophy due to lack of use.
I also use weekly injections of a drug called cartrophen which
increases
joint fluid production which helps to reduce pain and heal the joint.
I recommend that all dogs with any kind of joint problem (whether it
be early arthritis or a cruciate rupture) take a glucosamine /msm
supplement forever. Starting in the second week after surgery we use
neuromuscular
electrical stimulation 2- 3 times per week. This passes an electrical
current through the muscles and causes a contraction. It simulates use
of the muscles to reduce pain, prevent atrophy and hasten recovery.
We continue this for 1-3 weeks until the dog is using the leg enough
to work the muscles on its own.
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Electrical stimulation of
the thigh muscles
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Starting about a week after surgery we start dogs
walking slowly on a land treadmill. The belt passing under the
feet increases extension of the knee and also promotes weight
bearing in the operated leg.
One of the best types of therapy for these injuries is hydrotherapy.
Underwater treadmill walking can start as soon as 7-10 days after
surgery but swimming should not start until at least 4 weeks after
extracapsular repair or 6-8 weeks after TPLO.
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Underwater treadmill walking after
extracapsular repair
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As each
week passes we increase exercise to strengthen the joint and muscles
and retrain balance and co-ordination. We use leash walks, hill walking
and progress to pulling weave poles, figure eights, cavellettis and
even tunnel work. Agility dogs do wonderfully with rehab as they
already know a lot of the exercises! It is very important to note any
stiffness or pain that occurs after exercise sessions. If this occurs
then we
have to step back on exercise and slow down the level of activity. It
is very important that the dog be as pain free and comfortable during
all
stages of rehabilitation. Usually with in 1-2 weeks they are bearing
more
weight than before surgery and by 3-4 months post-op they are bearing
full weight and can be back to full exercise. Cruciate ligament repair
is an intensive and expensive surgery and so I always make sure that
the owner is committed to the rehabilitation. Most owners of canine
athletes want
their dogs to return to a high level of function as soon as possible.
Physical rehabilitation will improve the outcome and decrease the
recovery time.
reprinted with kind permission from Jeff Bowra DVM
Certified Canine Rehabilitation Practitioner
26841 Fraser Highway Aldergrove, BC, Canada
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Ruptured Anterior
(Cranial) Cruciate Ligament
First, the Basics
The knee is a
fairly complicated joint. It consists of the femur above, the tibia
below, the kneecap (or patella) in front, and the bean-like fabellae
behind. Chunks of cartilage called the medial and lateral menisci fit
between the femur
and tibia like cushions and there is an assortment of ligaments holding
everything together, allowing the knee to bend the way it should and
keep it from bending the way it shouldn’t.
There are two
cruciate ligaments that cross inside the knee joint: the anterior
(or, more correctly in animals, cranial
cruciate) and the posterior (or, more correctly in animals, the caudal
cruciate). They are named for the side of the knee (front or back)
where their lower attachment is found. The anterior cruciate prevents
the tibia from slipping forward out from under the femur.
Finding the Rupture
The ruptured cruciate ligament is the most common knee injury of dogs.
Chances are that any dog that suddenly has rear leg lameness has a
ruptured anterior cruciate ligament. The history usually involves a
rear leg suddenly so sore that the dog can
hardly bear weight on it. If left alone, it will appear to improve over
the course of weeks but the knee will be notably swollen and arthritis
will set in quickly. Dogs can be presented
in either the acute stage (shortly after the injury) or in the
chronic stage (weeks or months later).
The key to the diagnosis of the ruptured cruciate ligament is the
demonstration of an abnormal knee motion called a drawer sign. It is
not possible for a normal knee to show this sign.
The Drawer
Sign
The veterinarian stabilizes the position of
the femur with one hand and manipulates the tibia with the other hand.
If the tibia moves forward (like a drawer being opened), the cruciate
ligament is ruptured.
Another test that can be used is the Tibial Compression test where the
veterinarian stabilizes the femur with one hand and flexes the ankle
with the other hand. If the ligament is
ruptured, again the tibia moves abnormally forward.
If the rupture occurred some time ago, there will be swelling on side
of the knee joint that faces the other leg. This is called a medial
buttress and is a sign that arthritis is well along.
It is not unusual for animals to be tense or frightened at the vet’s
office. Tense muscles can temporarily stabilize the knee preventing
demonstration of the drawer sign during examination. Often sedation is
needed to get a good evaluation of
the knee. This is especially true with larger dogs.
Since arthritis can set in relatively quickly after a cruciate ligament
rupture, radiographs to assess arthritis are a good idea. Another
reason for radiographs is that occasionally when the cruciate ligament
tears, a piece of bone where the ligament attaches to the tibia breaks
off as well. This will require repair and the surgeon will need to know
about it before beginning surgery.
How This Happens
There are several clinical pictures seen with ruptured cruciates. One
is a young athletic dog playing roughly who takes a bad
step and injures the knee while playing. This is usually
a very sudden lameness in a young large breed dog.
A recent study identified the following breeds as being particularly at
risk for this phenomenon: Neapolitan mastiff, Newfoundland, Akita, St.
Bernard, Rottweiler, Chesapeake Bay retriever, and American
Staffordshire terrier.
On the other hand, an older large dog, especially if overweight, can
have weakened ligaments and slowly stretch or partially tear them. The
partial rupture may be detected or the problem may not become apparent
until the ligament breaks completely. In this type of patient, stepping
down off the bed or a
small jump can be all it takes to break the ligament. The lameness may
be acute but have features of more chronic joint disease or the
lameness may simply be a more gradual/chronic problem.
Larger overweight dogs that rupture one cruciate ligament frequently
rupture the other one within a year’s time. An owner should be prepared
for another surgery in this time frame.
What
Happens if the Cruciate Rupture is Not Surgically Repaired
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(almost) normal
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damaged
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Without an intact cruciate
ligament, the knee is unstable. Wear between the bones and meniscal
cartilage becomes abnormal and the joint begins to develop degenerative
changes. Bone spurs called osteophytes develop and chronic pain and
loss of joint motion result. This process can be arrested by surgery
but cannot be reversed.
Osteophytes are evident as soon as 1 to 3 weeks after the rupture in
some patients. This kind of joint disease is substantially more
difficult for a large breed dog to bear though all dogs will ultimately
show degenerative changes. Typically, after several weeks from the time
of the acute injury, the
dog may appear to get better but is not likely to become permanently
normal.
In one study a group of dogs was studied for 6 months after cruciate
rupture. At the end of 6 months, 85% of dogs under 30 lbs of body
weight had regained near normal or improved function while only 19% of
dogs over 30 lbs had regained near normal function. Both groups of dogs
required at least 4
months to show maximum improvement.
What Happens in Surgical Repair?
There are three different surgical repair techniques commonly used.
Extracapsular Repair
The dog may carry the leg up for a good 2 weeks after surgery but will
increase knee use over the next 2 months, eventually returning to
normal.
The dog will require 8 weeks of exercise restriction after surgery (no
running, outside on a leash only including the backyard).
The wire or suture placed will break 2 to 12 months after surgery and
the dog’s own healed tissue will hold the knee.
Intracapsular Repair
This procedure has fallen out of favor lately as it has been unable to
demonstrate superior results to the extracapsular technique described
above. Intracapsular repair intuitively seems like it should do better 
as it uses living tissue (rather than an
artificial material) to essentially make a new ligament. This takes
more time surgically. As with the extracapsular repair, the knee joint
is opened, fragments of the ligament are removed, as is damaged
meniscus. After this a strip of connective tissue is dissected locally
and passed through the middle of the joint exactly where the cruciate
ligament used to be. The new ligament is attached at the opposite end
to an implant or simply sewn into place.
Bandaging for
a couple of weeks after surgery is commonly recommended.
Again, the dog may not bear weight for a good two weeks after surgery
and will likely require 2 months to return to normal function.
Again, 8 weeks of exercise restriction will be necessary for healing.
Tibial Plateau Leveling Osteotomy (TPLO)
This procedure uses a fresh approach to the biomechanics of the knee
joint and is meant to address the lack of success seen with the above
two techniques long term in larger dogs. With this surgery the tibia is
cut and rotated in such a way that the natural weight-bearing of the
dog actually stabilizes the knee joint. As before the knee joint still
must be opened and damaged meniscus removed. The cruciate remnants may
or may not be removed depending on the degree of damage.
The TPLO rotates (as indicated by the arrow) the sloped tibial plateau
until it is perpendicular to the line between the stifle and the hock
joint centers
This surgery is complex and involves special training in this specific
technique. Many radiographs are necessary to calculate the angle of the
osteotomy (the cut in the tibia). At this time the TPLO is felt to be
the best way to repair a cruciate rupture regardless of the size of the
dog and is probably the only procedure to be considered for dogs over
50lbs. This
surgery typically costs twice as much as the extracapsular method.
Most dogs are
touching their toes to the ground by 10 days after surgery though it
can take up to 3 weeks.
As with other
techniques 8 weeks of exercise restriction are needed.
Full function
is generally achieved 3 to 4 months after surgery and the dog may
return to normal activity.
General Rehabilitation after Surgery
Rehabilitation following the extracapsular repair method can begin as
soon as the pet goes home. The area can be chilled with a padded ice
pack for 10 minutes a couple times daily. (Do not
try to make up for a skipped treatment by icing the area longer;
prolonged cold exposure can cause injury.) Passive range of motion
exercise where the knee is gently flexed and extended can also help. It
is important not to induce pain when moving the limb. Let the patient
guide you. Avoid twisting the leg. After the stitches or staples are
out (or after the skin has healed in about 10-14 days), water treadmill
exercise can be used if a facility is available. This requires strict
observation and, if possible, the patient should wear a life jacket.
Walking uphill or on stairs
is helpful for strengthening the back legs but no running, jumping or
other "explosive" type exercise should be performed for a full three
months after surgery. Rehabilitation for patients with intracapsular
repair is similar but slower in progression.
Rehabilitation after TPLO is gentler. Icing as above and rest are the
main modes of therapy. After 3 to 4 weeks, an increase in light
activity can be introduced. A water treadmill is helpful. No jumping,
running or stair-climbing is allowed at first. Expect the osteotomy
site to require a good 6 weeks to heal.
What if the Rupture Isn’t Discovered for Years and Joint Disease is
Already Advanced?
A dog with arthritis pain from an old cruciate rupture may still
benefit from a TPLO surgery. It may be worth having a surgery
specialist take a look at the knee. Most cases must make do with
medical management. Visit our section on arthritis
treatment.
Meniscal Injury
We mentioned briefly the “meniscus” as part of the knee joint. The
bones of all joints are capped with cartilage so as provide a slippery
surface where the bones contact each other (if the bones contact each
other without cartilage, they grind each other down). In addition to
these cartilage caps, the stifle joint has two special “blocks” of
cartilage in-between the bones. These blocks are called the menisci and
serve to distribute approximately 65% of the compressive load delivered
to the knee. The only other joint with a meniscus is the jaw
(tempero-mandibular joint).
When the crucial ligament ruptures, the medial (on the inner side of
the knee) meniscus frequently tears and must either be removed, partly
removed, or ideally repaired. This is generally done at the time of
cruciate ligament surgery and we would be remiss not to mention it.
Pets with meniscal damage may have an audible clicking sound when they
walk or when the knee is examined, but for a definitive diagnosis the
menisci must actually be inspected during surgery. It is difficult to
access the menisci and thus repairing a
tear in the meniscus is problematic; furthermore, poor blood supply to
the menisci also makes good healing less likely. For these reasons,
removal of the damaged portion of the meniscus is the most common
surgical choice. This leaves some meniscus behind to distribute the
compression load on the knee but removes the painful, ineffective
portion.
Areas of current research include techniques to improve blood supply to
the healing meniscus so that repair can be more feasible. If meniscal
damage has occurred in a cruciate rupture, arthritis is inevitable and
surgery should be considered a palliative procedure.
Date
Published: 4/11/2005 10:42:00 AM
Date Reviewed/Revised:
04/09/2007
Copyright
2007 - 2007 by the Veterinary Information Network, Inc. All rights
reserved.
This work was
originally published by Veterinary Information
Network, Inc.
(VIN) and is republished with VIN's permission.
***********************
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Cranial
Cruciate Ligament Rupture
By Roger Ross DVM
One of the more common
lameness injuries we see in dogs is caused by the tearing or damage of
the cruciate ligament in the knee.
By the way, the ligament is similar to twine in that it's made up of
many twisted fibers. When just some of the fibers are torn we
usually describe the injury as a ligamental tear. When the entire
ligament is torn, we say it is ruptured. Actually, such
nomenclature is sort of meaningless in the sense that it's
hard to tell on physical exam how badly damaged the ligament is,
because either way it hurts and on exam there's excessive play in the
joint.
It does matter, though, in terms of healing. Without surgery, a
completely torn ligament has no chance of healing. But with a
little luck, time, and support, a partially torn ligament might heal
without surgery. Especially if the patient is small and not too
active.
If you have a limping pet, your vet has a good chance of detecting the
cause during the initial exam because she or he will be able to detect
the excessive play in the joint.
However: sometimes the veterinarian who first examines your pet
misses the problem because the initial swelling and inflammation from
the injury hides the excessive joint play, so understand that the
cruciate damage may not be detected at first. If you didn't know
this, you might think the first vet was stupid. But if you think
about it, there's a lot of situations in life where it's necessary to
check your work a second time before you discover what you're
looking for.
The cruciate ligament keeps the femur (upper leg bone) from sliding too
much on the tibia (lower leg or shin bone) when you put weight
down. Without a healthy, intact cruciate ligament, this extra
sliding causes wear and tear on the joint cartilage (and miniscus).
This really hurts at first, but given time and rest the initial pain
resides and a lot of pets will start using their injured limb again
after a month or so. But because the knee is
less stable, re-injury is much more likely. And if the
knee isn't repaired surgically, it's very likely that the
knee will become arthritic with time.
What
To
Expect When You Go To The Vet
(Of
course, other vets may do things differently)
A Good Exam and
History.
If your pet is limping, we will check out the entire pet to assess
general health and other problems. We will want to know how long
your pet has been limping and if there have been other rear end
problems in this patient. We will check out the toes and paws,
check for abscesses, feel the lymph nodes behind the knees and in the
inguinal or crotch region. We will stretch out the leg, and do a
series of range of motion tests...all of which will narrow the problem
down to the knee if your pet's problem is a torn cruciate
ligament. There are a couple of
simple motion tests we will do looking for excessive play in the
knee called "drawer movement" which is tell tale for curciate
tears. This is often simply and quickly determined by an
experienced vet, but sometimes it will take a little extra effort (see
below) to pin the problem down. And as I mentioned in the
introduction, sometimes we miss the problem entirely during the first
visit,
but pick it up in the recheck visit.
Also, lack of drawer movement doesn't rule out cruciate tears: partial
tears that don't result in drawer movement are common and
can be quite difficult to diagnois.
Another sign your vet will be checking for is scar tissue to
thickening called a buttress on the medial or inside side of the
knee. This scar or bony reactive tissue isn't present early on in
the disease but is noticed after several months of stress to the joint.
Diagnostic Procedures
Once your vet detects excessive drawer movement suggesting a torn
cruciate ligament, he or she may want to:
1. Run blood
work to see if there is a high white blood count indicating infection
of the joint, electrolyte or mineral imbalances, and as a routine check
of other organs prior to anticipated anesthesia and surgery
2. Sedate or
pet to allow better range of motion tests and palpation of the joints
and limb. Sometimes pets are too antsy, tense, or resistant to do
a good lameness exam without muscle relaxers or sedation.
3. Your vet may trot your pet and then recheck the limb.
Sometimes the lameness is more evident after a little workout.
4. Radiograph the knee to rule out damaged bone and cartilage
structures. And while ligaments don't show up on xrays, they are still
quite useful: radiographic evidence of increased joint fluid is usually
associated with cruciate tears.
5. Fancier Stuff: Other vets may have more sophisticated
equipment and experience and may suggest an MRI or scoping the joint.
Treatment Options
Conservative, Non-Surgical Treatments:
1. Short term steroids, other anti-inflammatories, and pain
medication for the intial swelling and pain are likely to be used at
first whether or not you elect to surgically repair the knee in the
future.
2. Forced Rest and/or support bandages are often helpful in
getting the swelling and inflammation under control quickly. This
also prevents further damage to the joint.
3. Heat wraps, Heat Rubs, BenGay etc.
NOT Recommended I mention this possible
treatment because a lot
of people are used to using this type of treatment on themselves and on
horses with lamenesses.
But we rarely use heat rubs on dogs mainly because they get sick when
they lick them off. I suppose heat wraps might have some
benefit, but I haven't heard of any vet using them. It's
difficult to wrap dog knees.
4. Glucosamine, MSM, Anti-Oxidants, and Omega 3 Fatty Acids might
very well be recommended for their properties of reducing damage and
speeding healing of cartilage etc.
5. Weight loss. Being fat puts a lot of extra stress on
joints.
6. Time, rest, and patience. Most patients with cruciate
damage would benefit from surgery. But, if for reasons of
money or other circumstances you elect to avoid surgical repair, your
pet will probably heal without surgery to the
point where it will use the leg ginergly or adequately. It all
depends, but the more active and robust and big the dog, the more
likely your pet will have life time problems and pain using the leg
unless the problem is corrected surgically. Surgery will also
minimize future arthritis.
Surgical Repair
There are quite a few different types of surgical repair techniques
done on damaged cruciates in both humans and pets. That's because
no one has come up with a perfect repair procedure
yet. Whenever we in medicine discover a great
treatment procedure for a problem, it doesn't take long for word to get
out and soon that's the way everybody does it, because it's the
best. But there are lots of problems for which we have helpful
treatments
or surgeries but not perfect solutions...fixing damaged knees are
in this latter category.
But nothing is more likely to make your pet weight bearing and
functional again than surgery. Nothing is as likely to minimize
and prevent future arthritis, pain, and further injury than surgery.
The most common types of knee surgery involves connecting the back of
the femur to the front of the tibia using heavy suture material or
surgical wire. This tightens up the joint and reduces slipping
and sliding. Over time, scar tissue will cover the suture and act
somewhat like the original ligament.
Most pets recover full or near normal use of the knee over a period of
1-3 months.
Post Op Monitoring
It's important to rest the knee after surgery and to daily check the
support bandaging for slippage, abrasions, ulcers, and odor. Your
pet will probably be on post op medications for pain and
inflammation. I often prescibe short term sedatives if needed for
"over active" pets.
reprinted with kind permission from Roger Ross DVM
********************
There are two different tears. One is a partial tear and the
other is a complete tear. These tears fall into two categories,
acute (immediate) and chronic
(ongoing).
First, let's talk about partial tears
A partial tear (PT) is one that a dog can
recover from without undergoing surgery. The thing about
PTs is that they either heal or further down the line they tear
completely, at which time your dog will require surgery to stabilize
the knee. Another deleterious aspect to the partial tear is that
the dog will compensate for the injury by using its other
leg, bearing more weight on it, which will cause degeneration in that
knee and hip if there is no serious and committed intervention by the
owner.
What can the owner do in the case of a tear? Two things are
vital. First, the dog needs to be crate rested and this must be
adhered to STRICTLY.
The dog MUST be CRATE RESTED. If you aren't going
to be committed to this aspect, please
stop reading and go stock up on arthritis medicine for your dog--he'll
be needing it.
Ligaments are notoriously slow healers. They do not have good
blood flow to carry the necessary nutrients for fast healing. In
short, letting a dog play and rough
house while injured is plain irresponsible ownership. Just
because you are too weak to not give in to sad eyes, your dog will
pay the price. Secondly, the dog needs to be supplemented with
Glucosamine and Chondroitin. The absolute best source of this is
Cosequin DS. I'm not a mean person but far too many
people can't grasp that not giving into your dog's sad face now will
save him from years of pain as he ages. I looked away almost
constantly when my dog was injured, and he recovered from a complete
tear, fully; eight years later, he is not even remotely arthritic at
twelve. Except for the four months of crate rest he has had full
use of his legs, without pain.
Some vets will suggest an anti-inflammatory or a cox 2 inhibitor.
Unless it is medically necessary (i.e. the inflamed tissue is damaging
the joint further) neither drug should be given and the dog should be
allowed to be in pain. It sounds awful, but there are excellent
reasons for this.
To ascertain the reason, look into the dog's future. I think a
dog would rather spend a few weeks in pain rather than a life of
pain. Pain is Nature's way of saying REST THYSELF.
Because of pain, a dog
healing will be less active, more stationary, and will heal more
completely and permanently. And the trade-off of removing the
dog's pain is really poor: not only do you risk a greater chance of
your dog getting reinjured, but the anti-inflammatory you just gave him
can easily damage his renal or hepatic system, or, kill him. Dogs
do not handle NSAIDs very well at all; NSAIDs can even kill cats in one
dose. I highly urge you to never use Rimadyl on your dog.
My dog has damage to his renal system that causes him to have PD/PU
(polydypsia/polyuria--i.e he drinks alot and pees alot) and I have
spent over a thousand dollars to find out he is healthy except for this
odd PD/PU...which started at the time he was first given Rimadyl over 8
years ago. On an email list, I just found out a dog died from
Rimadyl and her starting symptoms were precisely what my dog went
through (same breed) even though the drug manufacturer states its
mostly hepatic, not renal, issues. Regardless, there are many
holistic remedies that can be used that are far safer and have less
toxic aftereffects. I wish I knew this then.
Back to the topic: A complete
tear requires surgical intervention by a specialist.
(If you have a practitioner perform the surgery, understand that you
chance greater risk of a less than desirable result, so
get referrals. There is a reason why some vets are cheaper than
others. It's my opinion that "shopping around" is not
a good idea; going with the vet with the strongest referrals is a
good idea.) Once the surgery is performed, the dog MUST be
crate
rested, with NO stairs, no jumping, nothing.
This is the first two weeks of his return
to the home:
Exercise schedule for the dog undergoing surgery:
Week 1:
1.)
PROM every day 3x
2.)
Bag of frozen peas applied to
surgery site 3x (ice packs should never be applied for more than 15
minutes)
3.)
Walking a lap around
your house 1x
(PROM is Passive Range of Motion--if you have a PT or OT in the circle
of friends/family, have them
demonstrate the technique for you).
What ...a bag of peas?? Frozen peas are the BEST cold packs you
can buy and they are cheap too. Apply
these after ANY exercise your dog completes.
Week 2:
1.) PROM every day, 3 x
2.) Walking lap around house 2 x
per day (if your dog's limping becomes worse stick with 1 lap)
3.) Bag of peas 5x (15 min max per
application)
Week 3:
1.) PROM 3x
2.) Building laps up slowly,
remember, BABY STEPS! 3-5x
3.) Peas (15 min max per
application)
And so on. In between these therapy
sessions your dog ought to be in his crate resting and healing.
You MUST protect the good leg at all costs so that he does not
blow that knee out due to the compensation he will place on it.
The absolute worst case scenario is when a dog has two blown knees.
Also, all tears that need surgery should have surgery performed within
no more than 5 days of the tear. The reason is simple: the
meniscus remains undamaged and has less build up of scar tissue, which
in turn helps the cruciate heal faster. Chronic cruciate tears
are a train wreck.
I suggest strongly that you do not hesitate to contact your vet
immediately and see what options are available to you and your
dog. Your vet is your best source of up to date information on
this. I also have never had a vet take an xray of the knee since
ligaments don't show up well on xray film. But many others tell
me their vets do do this. (WHY??)
What my vet has done is sedate the dog and attempt a drawer of the
joint. A drawer is the one immutable sign a dog has injured its
knee. A drawer negates the need for an xray.
We adopted Major
from an animal rescue center in Watford when he was approximately six
months old so
his 'family ancestry' is unknown to us. What
we do know is that when he was taken in there he was a girl and they
went to spade her
- that was when they discovered she had 'boy bits' tucked inside.(pseudohermaphrodite) A
hormone test was carried out and it came back
that there were more male hormones than girl ones so that
is how she became he. They had named him Hampton and his
chip etc., was registered in that name so we just added the Major in
front - hence, my email address name.
He is a well travelled dog. He lived with us in Florida having the time
of his life chasing alligators etc., but, Oh! those tics.
We then went to Spain before returning to England. He had no
problems with all the flying and was none the worse for his journeys
but he was really happy to get back to England and our local park where
he resumed his friendship with 2 big Huskie dogs.
He is now 8.5 yrs old and over the past few weeks developed a limp. I
initially thought that it could be hip dysplasia but on seeking
advise took him to the vet and discovered that the problem was a
ruptured cranial cruciate in his right knee which required
surgery. He also has hip dysplasia and spondylosis in his lower back.
His surgery was carried out
just under a week ago and he is still feeling very sorry for
himself. It is going to take anything from 6-8 weeks before he will be
able to take gentle exercise. I have tried to attach a photo so that
you can see the wound with stitches which are on the inside of his leg.
2 days after the surgery his poor leg looked like a piece of raw meat
but I used Arnica soothing gel
and a cloth that I kept putting in the freezer [much easier than ice
packs] so by the time we took him back to the vets it looked
a lot calmer. He is on pain killers and antibiotics which finish today
but he also has Cosequin for his joints. He is off his food
a bit which isn't a bad thing as he isn't moving about. His stiches are
to removed in another week and then he has to have physio -
thank heaven I trained in that field as I don't think the insurance
would cover that. The initial vet bill was for just over £1000
and the estimate for the surgery was £2500 [I haven't received
the bill for that yet]. I will never moan about the cost of the
insurance policy again.
I will keep you updated on his progress.
Yours,
Dorothy and Major
Thank you Dorothy for sharing your story
back to top
***********************
Video
Cruciate Ligament Damage in Dogs, Diagnosis and Treatment
|
This group is for those, who for various reasons,
are looking for alternatives to orthopedic surgery.
The above information is simply
informational. It's intent is not to replace the advice of a
veterinarian nor to assist you in making a diagnosis of your pet.
Please consult with your own
veterinarian for confirmation of any diagnosis. Your pets life may
depend
on it.
