Dogs also suffer knee problems like humans. One of these problems dogs and cats usually experience is a rupture of the cranial cruciate ligament. An injury or long-term deterioration, like weakening of the ligament due to old age, can cause this problem. But what is the cruciate ligament?
The cranial cruciate ligament or fibrous tissue attaching the thigh bone (femur) to the shin bone (tibia) helps maintain knee joint stability. Therefore, this ligament plays a critical part in your furry friend’s ability to walk, run, and move. However, as mentioned, your dog can suffer from a cruciate ligament injury due to an underlying or long-term injury or deterioration from old age.
What is Cruciate Ligament Injury?
When injury to the cranial cruciate ligament occurs, the femur and tibia misalign due to the loosening of the knee joint. The thigh bone slides down the shin bone, causing inflammation. As a result, your dog can experience discomfort and pain.
The most typical presentation is when the owner reports their pet suddenly running off to chase something and they let out a screech of pain and start limping. Your dog might become reluctant to put weight on its injured leg, and they tend to limp when walking and playing. When you observe these signs, bring your pet to a veterinarian. The veterinarian will diagnose the problem by examining abnormal movements and in some cases taking X-rays. Furthermore, the veterinarian will discuss options and suggest scheduling a ligament surgery upon confirmation of cruciate ligament rupture.
Although there has been a trend towards to a more conservative approach, for a young, active and or larger breed of dog, surgery is still often the best choice. But surgery is not always an option for people financially, and it is sometimes not appropriate due to other medical conditions or the age of the dog.
There are no long-term studies showing that non-surgical management of CCL ruptures can guarantee that your dog can always avoid surgery. But there are many studies that document the progression of arthritis in a cruciate-deficient (unstable) stifle joint. When Cruciate issues include Meniscal tears, surgery is generally considered the best option
Deciding on the right option is a personal choice; you should have a discussion with your Veterinary Team to decide what is the best option for you and your pet.
A cat or dog cruciate ligament surgery involves supporting the joint until the tissues and muscle around it can become strong enough to continue supporting the body.
It is worthwhile pointing out there is also a high chance of the other knee tearing during the recovery period of the first leg or at some stage in the future.
It is important to recognise that tailored rehab is really crucial in surgical or non-surgical cases, particularly in the early stages to maintain function and minimise muscle loss (which occurs very quickly after a cruciate tear).
A wheelchair should also be considered during the recovery period to assist taking weight off the joint while exercising and doing rehab – particularly with larger breeds which can be a challenge to nurse simply due to their size.
Below are the essential things you need to know about this surgical procedure:
When the veterinarian confirms the diagnosis, they may have the skills to operate in clinic or refer you to an orthopaedic specialist. Only licensed veterinary surgeons can perform cruciate ligament surgery. In addition, your surgeon has two surgical approaches to repairing a ruptured cranial cruciate ligament: traditional and modern. Here’s how the two approaches differ:
The traditional method of repairing the ruptured cruciate ligament involves mimicking or replacing the original ligament. However, the replacement materials might not be as good as the original ligament. This might mean more surgeries for your dog or cat when these replacement materials deteriorate in the long run.
The modern approach corrects the underlying problem of the ruptured cruciate ligament. The veterinarian cuts the shin bone using a surgical saw and repositions the tibia to disrupt the joint dynamics. Subsequently, the surgeon rotates and presses the femur or thigh bone on the tibial plateau (top portion) from a slope to stabilize the joint at a flat level. The femur won’t slide from the slope when your dog puts weight on its leg. Screws and plates hold the tibial plateau in place.
What does non-surgical treatment involve?
There are 2 main goals of non-surgical management of CCL tears:
- Protect the cartilage (minimize arthritis and inflammation)
- Strengthen the muscles supporting the stifle.
The ultimate aim of this management is to optimize your dog’s quality of life, functional abilities, and avoid surgery. However, non-surgical management can be challenging in terms of activity restrictions and avoiding situations that could lead to complete rupture of the CCL or exacerbation of ongoing arthritis.
Therapeutic laser (also known as “cold laser”) has been shown in studies in people and lab animals to decrease inflammation and pain associated with arthritis.
Rehabilitation professionals can use laser therapy in the management of CCL ruptures to decrease inflammation in the joint and to treat secondary muscle tightness or trigger points.
NOTE: Laser therapy is not expected to heal the CCL tear
A recommended series of exercises that are aimed at strengthening the hamstrings and other muscles of the back legs as well as “core” stabilizing muscles. A specific plan will be developed for you and your dog that incorporates leash walks, home exercises and in-clinic therapy including under-water treadmill. Approximately 30 minutes/ day should be devoted to therapeutic exercise—either at home or in a rehabilitation facility.
Your pet should not be allowed off leash for 3 months.
This means no running, jumping, playing or dog-park trips!
Leash walks of gradually increasing duration will be recommended, including uphill walking.
Swimming is not recommended unless it is done in a rehabilitation setting (no open water swimming). Some rehab facilities have Underwater Treadmills to assist with low impact hydrotherapy.
The return to activity following this initial period will depend on the severity of the CCL rupture (partial vs complete) and response to therapy.
Knee Braces for ACL Tears
Knee braces have come a long way, and when you get one designed specifically for your dog, it helps keep their knee in place as best as possible to allow their ACL to heal. Non-customized braces, splints, or neoprene braces are the best options after a custom-made knee brace.
Since these solutions aren’t made to precisely fit the unique structure of your dog’s leg, they aren’t able to provide the same level of support as a custom knee brace. But, they’re a much better option than leaving their leg without any orthopaedic support at all.
Interestingly, what many people don’t know is that pet insurance completely covers the cost of getting a custom-made, medical-grade knee brace if the injury wasn’t pre-existing. However, pet insurance does not cover any procedures necessary in the future to other body parts that become injured due to a previous ACL tear.
The severity of the tear will hold a lot of weight in what the recommended course of action is. For dogs with a completely severed ACL, Veterinarians will recommend getting surgery. For severe ACL tears like this, some Vets might choose to do a lateral stabilization suture as it’s the simplest surgery and more affordable than some of the newer surgeries.
If the tear is less severe an orthopaedic knee brace can be a great solution. Sometimes surgery isn’t necessary and it’s a much better option than leaving their leg to heal on its own.
With the right care, treatment and supportive care, your dog can live a happy, healthy life even after an ACL tear.
images above are Melbourne Animal Physio and Animal Rehab Klinik (Sydney) with patients in rehab for cruciate injuries
Walkin’ Pets Blog: https://www.handicappedpets.com/blog/
CARE: Canine Arthritis Resources and Education Blog: https://caninearthritis.org/
Kelly Ratcliff BSc Physio, PG Dip (Vet Physio)
Physiotherapist working with animals
Animal Rehab Klinik: https://animalrehabklinik.com.au/
Melbourne Animal Physio: https://melbourneanimalphysiotherapy.com.au/