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CRUCIATE LIGAMENT INJURY & SURGICAL REPAIR (see TPLO Below) This injury is exceedingly common in our domestic dogs. Valley Veterinary Services has provided surgical repair for ruptured cruciate ligaments both for our own patients as well as on a referral basis from other practices for 13 years with great success. In the past, we have only offered the more traditional Extracapsular Repair Procedure. Dr. Steinebach has taken post-graduate training in providing the lasted surgical repair for this injury called Tibial Plateau Leveling Ostectomy (TPLO). While we continue to offer Extracapsular repair, we now strongly recommend TPLO. Read on for more information on Cruciate Ligament Injury.
There are two bands of fibrous tissue called the cruciate ligaments in each knee joint. They join the femur and tibia (the bones above and below the knee joint) 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. Humans have the same anatomical structure of the knee. Cruciate ligament rupture is a common knee injury of athletes. The term anterior cruciate is used to describe the identical anatomical structure in humans. How does a cranial cruciate injury occur? The knee joint is a hinged joint and only moves in one plane, backwards and forwards. Traumatic cruciate damage is caused by a twisting injury to the knee joint. This is most often seen in dogs and athletes when running and suddenly changing direction so that the majority of the weight is taken on this single joint. This injury usually affects the anterior or cranial (front) ligament. The joint is then unstable and causes extreme pain, often resulting in lameness.
A more chronic form of cruciate damage can occur due to weakening of the ligaments as a result of disease. 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. How is it diagnosed? With traumatic cruciate rupture, the usual history is that the dog was running and suddenly stopped or cried out and was then unable to bear weight on the affected leg. · Many pets will “toe touch” and place only a small amount of weight on the injured leg. · During the examination, the veterinarian will try to demonstrate a particular movement, called a drawer sign. This indicates laxity in the knee joint. Many dogs will require mild sedation before this test can be performed. Radiographs (x-rays) must also be performed. Is other joint damage common? Inside the knee joint are pieces of cartilage called menisci. The menisci act as shock absorbers between the femur and tibia. Many times these cartilages are also damaged when the cruciate ligaments rupture. They are usually repaired at the same time as the ligament surgery. Is an operation always necessary? Dogs under 10 kgs (22 lbs.) may heal without surgery. These patients are often restricted to cage rest for two to six weeks. Dogs over 10 kgs (22 lbs.) require surgery to heal. Unfortunately, most dogs will eventually require surgery to correct this painful injury. What does surgery involve? There are various techniques available to replace the action of the cruciate ligaments. These surgeries most often involve the placement of artificial ligaments (implants) along the outside of the knee joint. There is a newer surgical technique available called tibial plateau leveling osteotomy (TPLO) that may be more beneficial for giant-breed, markedly overweight or more athletic dogs. Your veterinarian will discuss with you the best treatment option for your pet. Regardless of which technique is performed, if menisci are damaged, they too require removal during the surgery. Is post-operative care difficult? It is important that your dog have limited activity for six to eight weeks after surgery. Provided you are able to carry out your veterinarian’s instructions, good function should return to the limb within three months. Unfortunately, regardless of the technique used to stabilize the joint, arthritis is likely to develop in the joint as your dog ages. Weight control and nutritional supplements such as glucosamine / chondroitin may help delay the onset of arthritis in your pet. Many dogs will receive physical therapy after the surgery to speed recovery and reduce complications. Your veterinarian will discuss your pet’s recommended post-operative care with you prior to surgery. Is obesity such a problem? Obesity can result in cruciate ligament rupture. If your dog is overweight, the recovery time will be much longer. Obesity also increases the risk of injury to the other knee. Weight loss is as important as surgery in ensuring rapid return to normal function. Some dogs that have suffered a cruciate ligament injury will also have concurrent hypothyroidism or a poorly functioning thyroid gland. This will lead to weakening of the cruciate ligament and weight gain which will increase the load on this weakened ligament. Performance of blood tests prior to surgery to determine if hypothyroidism is contributing to this condition is necessary. Can dogs suffer partial ruptures? Some dogs will present with all the symptoms of a cruciate rupture but will still have a stable joint. These dogs have likely suffered a partial tear of the ligament or have stretched the ligament. While this can be nearly as painful as a complete rupture it has an opportunity to heal without surgery. These dogs will need to have all activity completely limited for 6-8 weeks, be treated continuously during this time with a potent anti-inflammatory medication and be administered a specific anti-arthritic medication call cartrophen. Most of these dogs will have the ligament heal completely and will go back to relatively normal function. Some of these dogs will suffer a complete rupture of the ligament at some time necessitating surgery. A sub-group of dogs with strained ligaments will have sustained injury to the cartilage in the joint. These dogs will not improve remarkably during treatment or will continue to be troubled with knee pain after treatment is complete. These dogs are good candidates for surgery of the joint. Tibial Plateau Leveling Ostectomy
TPLO surgery corrects the steep angulation of the tibial plateau thus minimizing abnormal motion within the joint. This is achieved through rotating the head of the tibia to correct for the mis-angulation and fixing this in its new orientation with a specialized bone plate designed specifically for this purpose. Dogs that undergo TPLO procedures are often noted to want to use the affected leg very quickly following the surgery. While we are delighted by how well our patients do, owners have the daunting task of trying to keep their pets activity level low while healing is taking place (6 -12 weeks). Compared to the traditional Extracapsular procedure, TPLO dogs are more comfortable more quickly and can often resume full activity within 3 months of the procedure with very little problem subsequent to the procedure. Extracapsular procedures while often very strong, can limit mobility and can sometimes result in some problems with occasional discomfort particular when activity levels are high. There is also a risk of rupture of the permanent implants which might result in needing an additional surgery.
TPLO = rapid recovery and excellent future function
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The injury also occurs commonly in obese dogs, just by stumbling over a pebble while walking.
Cruciate ligaments are typically injured due to faulty conformation of the knee joint.