The diagnosis is partial tear or complete rupture of your dog's anterior cruciate ligament in the knee. Nobody likes to hear this because it can entail a long recovery period and worst of all surgery. All breeds are susceptible to this injury and it is becoming very commonplace. Many of us are questioning why this is occurring? What is the reason that dogs of all breeds are rupturing their cruciate ligaments more often? Questions abound and we search for answers. We need to prod deeper into this injury and have some insight.
There are cases where a dog has a sudden acute rupture from trauma, but most cases are from a slow degenerative process of the fibers within the ligament. Larger breed dogs have a tendency to damage them more frequently than smaller dogs, due to the force that is placed on the knee. Another incidence that has been reported is for spayed females between the ages of 4 to 8 years getting CCL (cranial cruciate ligament) changes.
The support structure within the knee is the ACL (anterior cruciate ligament) or commonly also referred to as the CCL (cranial cruciate ligament). Degenerative changes will take place and it is inevitable that osteoarthritis will set in. Conservative management works for smaller breed dogs, permitting them to avoid surgery, but nevertheless, atrophy and arthritic changes will occur.
50 different techniques have been devised to treat ACL injuries. The preferred methods are the extra capsular, intra capsular and the TPLO (tibial plateau leveling osteotomy). Included in these stabilization techniques is the debridement of any loose or torn menisci parts and any fragments of ligament. The caudal horn of the medial meniscus has to be tidied up and clean.
The extra capsular stabilization method uses nylon or stainless steel suture material to mimic the support of the intact CCL. This is passed around the lateral fabella and into a tunnel drilled into the proximal tibial crest. This allows early rehabilitation, minimal cranial drawer and immediate stabilization of the stifle.
During some point of the healing process, the prosthetic material used will fatigue and break, but the fibrosis that develops over 8 to 10 weeks is what will stabilize the knee for their life. A more stable joint will result after surgery if a rehabilitation regime is employed and adhered to.
Another method of extra capsular stabilization is by the fibular head transposition, taking into account that the lateral collateral ligament inserts on the fibular head. A pin and a tension band hold the fibular head cranially from its normal position. This new position offers the same function as the CCL, limiting internal rotation of the limb.
The day after surgery, physical rehabilitation should start with cryotherapy, NSAIDs, and very gentle passive range of motion exercises. Gentle stretching and slow, deliberate 10 minute leash walks are recommended for active use of the limb. Aquatic therapy is strongly recommended one week after surgery if the incision has healed and there are no open wounds. Passive range of motion exercises is recommended until preoperative levels of stifle motion have been regained at approximately 10 days post surgery.
The method known as the intra capsular stabilization technique, uses either a prosthetic material or fascial strips and part of the patellar ligament. To imitate the path of the original CCL, this is placed in an intra articular fashion. This is done by way of an arthroscope or arthrotomy and allows for more normal joint movements. A physical rehabilitation regime is applied postoperatively. This protocol is the same as what is done for the extra capsular procedure.
The TPLO (tibial plateau leveling osteotomy) is a fairly new procedure that offers a different concept to providing stability to the joint. This procedure is based on the principle that to prevent cranial motion drawer movement during weight bearing, altered bio mechanical forces and active muscle contraction needs to be done. This acts on the stifle during weight bearing to steady the joint. This is a preferred choice for larger breed dogs, but not mandatory.
In this procedure an osteotomy of the proximal tibia is done, which ultimately allows the tibial plateau to be rotated to nearly a level position. Screws and a special bone plate designed for this are then used to secure the osteotomy.
Postoperative difficulties can arise out of any surgery. The modified bio mechanics of the stifle is what usually will cause some difficulty. The patellar ligament may develop inflammation during the first month from this operation. A higher amount of weakness is expected initially with this surgery. Pain will be noticed at the insertion point of the ligament upon examination. This is due to the patellar ligament being wider.
Pain management from TPLO surgery generally involves a program of mandatory rest, NSAIDs and cryotherapy. Most concerns are self-limiting as the joint heals from the new tissue remodeling. From altering the stresses on the cartilage and the bone of the joint, there has to be adequate healing time or bone implant failure is a possibility. One of the most remarkable therapies for all of this is aquatic therapy, which reduces weight-bearing stress on the limb.
As a result of the TPLO procedure which creates an over rotation of the tibial plateau, and in addition to the extra stress placed on the CdCL, a caudal cruciate injury can occur. It is very important that physical rehabilitation starts within 24 hours and the use of the limb is promoted. Aqua therapy should start one week post surgery provided the incision has healed.
Partial or complete ruptures of the cranial cruciate ligament almost inevitably involve a meniscal injury. Simultaneously to an CCL injury, 50% of dogs have menisci damage. The medial meniscus can be normal at the time of a CCL surgery, however, it is almost guaranteed that at some time in the future it will be injured. The same protocol is followed for rehabilitation and physiotherapy as is for ACL injuries.
With ACL injuries, each dog needs to be assessed and a specific program developed for their situation. The post surgery regime is individualized as to each dog's specific circumstances. The rehabilitation and physiotherapy program is tailored to their needs and situation on an individual basis. The dog needs to experience the least amount of pain as is possible for them to succeed. This is of critical importance.
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