If you've got a dog, or have ever looked into the health problems occurring in different breeds, you've probably heard of cruciate ligament injuries. Unfortunately, this is a common condition which affects a variety of breeds, and many dogs are diagnosed with it each year. It is usually treatable, and there are some things you can do to prevent injury or recurrence.
What and Where Is The Cruciate Ligament?
A dog's knee is a complex joint. It is made up of the patella, or kneecap, cartilage, and ligaments which connect the thigh and shin bones. When all of these parts work together, the knee is fully functional. In order to allow the joint to work properly, there are two additional ligaments which cross over one another, providing essential support. These are called the cranial (or anterior) and caudal (or posterior) cruciates.
Cruciate ligament damage is the most common knee injury in dogs, and can occur for a number of reasons. Once damage has been done, the injury is likely to cause great discomfort, and possibly lameness. Some dogs seem to cope with the injury better than others, usually depending on how severe the damage is and what can be done to fix it.
What Causes Cruciate Ligament Injury?
Most cases of cruciate ligament damage occur due to athletic injury. In most cases, a dog is simply running or jumping and lands awkwardly. This can occur in healthy dogs, but is also common in overweight dogs. The extra weight weakens joints and makes landing more difficult, which can lead to an increase in ligament damage. Some breeds are genetically predisposed to cruciate ligament damage, due to breeding making the knee structure weaker.
There is no real way to protect your dog from cruciate ligament damage. Keeping your dog fit and healthy is a good defence, as it will reduce the chances of injury occurring. In the case of obese dogs, effort should be made to reduce the weight down to a reasonable effort. If there is concern over the joints, a vet may recommend exercise methods which support the joints, such as swimming.
Diagnosing A Cruciate Ligament Injury
Dogs who are suffering from a cruciate ligament injury will often limp, or keep stopping. In severe cases, they may be unable to walk at all. As the injury is painful, your dog may yelp or whimper, but lack of noise should not be taken as an indicator of no injury.
Your vet will conduct an examination to try and isolate the pain as much as possible. In the case of cruciate ligament damage, a vet must first ensure the pain does not come from the hip, hock or foot. Once a knee injury is suspected, the joints will be gently manipulated. This allows the vet to feel for instability in the knee. Typically, the vet will attempt to move the tibia forward without moving the femur - a sign that the bones are no longer being supported by the cruciate ligaments.
In most cases, an examination is sufficient to diagnose the problem. If your vet is still unsure, or if you request more evidence, a stifle radiograph will be done - this can also check for signs of arthritis or fractures. In severe cases, an MRI or arthroscopy may be requested.
Treatment Options: Conservative Management
Some owners prefer to try a conservative management approach to treatment, rather than surgery. This typically involves the dog spending several weeks on complete cage rest, with very brief and calm bathroom visits. The dog will usually wear a supportive knee brace to prevent further damage and support the joint, and anti-inflammatory medication is usually prescribed to reduce pain.
This can be successful for very small dogs - usually those who weight under 25lbs. However, even in these dogs, the rate of re-injury is high. Conservative management is very rarely successful in bigger dogs, due to the stress on the joint. However, it may be attempted if surgery is deemed to be too risky due to age or health problems.
Treatment Options: Surgery
Surgery is the most common treatment for cruciate ligament damage. There are a number of different surgical methods to correct the problem, and in general they are very successful. Most dogs will recover quickly, and show no long-term complaints.
Extracapsular repair is the traditional ligament surgery. This involves removing the damaged ligament and replacing it with a very strong suture. The suture then acts as the ligament should, supporting the joint, and restoring normal function. Over several months, the knee tissues heal, and the suture eventually breaks completely. The healed skin then supports the joint. This is usually the cheapest surgery option, and is quick and easy to perform. It has a good success rate in small and medium sized dogs. The only downside is the long-term success - this type of surgery has more of a chance of re-injury than the others, but it is still significantly less likely than with conservative management.
Tibial plateau levelling osteotomy, or TPLO, is a more complex procedure. It does require a surgeon who is trained in this method, which does tend to increase costs. Rather than replacing the ligament, TPLO changes how the knee functions, removing the need for a cruciate ligament. Put simply, the surgery involves cutting the top of the tibia, and rotating the tibial plateau to change its angle. A metal plate is attached to keep the bone in place, and the joint is let heal. Dogs who have undergone this treatment usually show some improvement within days, and significant improvement over the months. Usually, the plate causes no problems, so it is left in even after the joint has healed into position.
Tibial tuberosity advancement, or TTA, is a very new surgery. It works on the same principal as TPLO, in that it allows the knee to function in the absence of a cruciate ligament. The basic surgery plan is the same, with the tibial plateau moved and metal inserted, but some vets claim TTA is less invasive and that dogs will heal faster. In studies, results from both surgeries have been the same, including recovery time. However, some dog's anatomies are more suited to this surgery type. The cost of TTA is around the same at TPLO.
The Operation
On the day of the operation, your dog will usually be admitted early in the morning. Most dogs are not permitted to eat prior to this operation. A vet will re-examine and weigh your dog to confirm the injury, and a blood sample will be taken to ensure anaesthetic is safe, if your dog has not been operated on before.
Most vets will use a drip to during these operations. It is routine that dogs are given analgesics (painkillers) and a sedative prior to surgery, so inserting the drip is usually not stressful. During the operation, your dog will be intubated to protect the airway, and monitored by a theatre nurse.
Your dog's leg will be shaved and washed before the procedure. After the surgery, the wound will be sterilised using saline, and a spray bandage applied. A sterile bandage is wrapped on top of this. If your dog has undergone TTA, a post op X-ray may be required to confirm the metal is in the correct place.
Post-op, your dog will receive painkillers as necessary to keep them calm and comfortable.
What To Expect When Collecting Your Pet
When you arrive to pick up your pet, a vet will talk you through the procedure. If there were any complications, you'll be told about them. Usually, you'll be given a sheet to remind you of how to look after your dog post-op, but the vet will also talk through this with you.
Before you collect your pet you may be asked to make a follow-up appointment. There is typically one three days later, to check on progress, and one ten days post-surgery. This allows any problems to be spotted and dealt with quickly.
The instructions you receive will depend on the surgery type you chose. Traditional surgery usually requires almost complete rest, apart from toilet breaks, for four weeks. Jumping, stairs and boisterous play are also forbidden during this time. TTA is more flexible, with walks of a few minutes allowed from the day after surgery.
At three or four weeks post-op, a rehabilitation plan should begin. This might be controlled by the vet, or your vet may just offer guidance on things you could do with your dog. Hydrotherapy is a common choice, as it allows exercise without putting pressure on the joints. Using a water treadmill twice a week has shown great improvement to many dogs, especially medium and large breeds.
Your vet may also give once weekly injections for four weeks, to prevent swelling and inflammation around the joint which can affect healing.
Should I Worry About Arthritis?
Unfortunately, due to the nature of cruciate ligament damage, it does often lead to arthritis. However, arthritis is a progressive disorder and there are plenty of things you can do to slow down progression and minimise the effect the condition will have on your pet.
Weight is very important here. Having an overweight or obese dog will not cause arthritis, but it will antagonise the condition and lead to faster progression, as the extra weight will put stress on the joints involved. Being overweight a with a weak leg means an increased pressure on the other legs, and cruciate damage in another leg is a big possibility.
Exercise should be carefully managed. Your dog will need daily exercise to keep him in good condition, but strenuous activity can be just as damaging as none at all. It is important that your dog has gentle exercise daily - having no exercise all week before a big workout at the weekend is not beneficial. If you are concerned about your dogs exercise, your vet will be able to advise you. You might also find hydrotherapy a good option to relieve joint pressure.
Supplements and medications. Supplements have an important role to play in protecting the joints. If your dog is on other medication, speak to your vet before you purchase any, to prevent any interference. Some supplements are poured over food, others come in tablet form. These are usually given daily. Medication is the prescribed drugs which can manage stiffness and inflammation. These are typically given after surgery and during arthritis flare-ups, but can also be prescribed long-term if necessary. This usually occurs much later in the condition, when it cannot be managed anymore.
For well-managed cases, arthritis may only cause a slow decrease in activity, an adverse reaction to cold weather and some stiffness, usually after periods of inactivity.
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