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Canine Cranial
Cruciate Ligament Disease
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There are two cruciate ligaments
in each stifle joint. They are strong and prevent the joint from over-extending.
The ligaments are arranged in the form of the letter X. Problems
occur when degeneration causes one or both ligaments to rupture. This
can happen if a dog undertakes very strenuous exercise and it can be fairly
common in working dogs.
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
****************
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.
***********************
back to top
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
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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.
