Introduction
Cruciate ruptures are one of the most common orthopedic injury in dogs. There are a number of reasons that the rupture may occur which can be debated, but there are also contributing factors that include obesity, activity and age. Large and giant breed dogs, such as Labradors, Rottweilers, Goldens retrievers, German Shepherds and Pitbull’s, in reality suffer higher rates of cranial cruciate ligament (CCL) rupture than small breed dogs.
Cruciate rupture can happen in two ways: chronic injury and acute injury.
How does a cruciate rupture occur?
This type of injury will occur during vigorous activity – like playing soccer or rugby with your dog on the weekends, or in working dogs that chase and/or fetch birds. It could also occur when dogs get only occasional strenuous activity like chasing a frisbee in the park. some specific breeds of dogs are very straight legged and put tremendous stress on their knees.
Dogs can also suffer from chronic cruciate damage from normal day-to-day wear and tear on their knee joints – simply as a result of the angle of your dog’s knee.
There is research that show that an imbalance of hormones can cause ligament issues stemming from early sterilization.
In reality most cruciate ruptures are not acute, but rather chronic. In other words, most ruptures result from repetitive hyperextension micro-injury to the cranial cruciate ligament resulting in long-term degeneration that weakens the ligament over time until it tears.
Symptoms of CCL Injury
Depending on the severity of the CCL injury, a dog’s symptoms may vary from a slight hint of lameness to being completely unable to bear weight on the injured leg.
If your pet has a full tear you will most likely know immediately. Your dog will hold their leg in a slightly bent position and not use it and he/she will have a lot of discomfort and pain. In addition to this, there may be some swelling on the knee. The fluid build-up is a significant concern and must be seen to immediately.
An indicator of a torn CCL in dogs is the presence of the "drawer sign." Here, the veterinarian will hold the dog’s femur in place, the tibia can be pulled forward in a manner similar to a drawer sliding open. If there is little sign of the drawer movement, it does not mean there is not damage to the CCL.
Treatment
An initial complete physical examination will be done by your vet, followed by radiographs of your dog's knee to investigate the degree of deterioration and rule out if there could be any other possible causes of/for lameness. In addition to the damage the radiographs will allow your doctor to determine the presence of fluid or possible arthritis in the joint, and also whether any small pieces of bone may have broken off when the ligament ruptured.
When deciding a treatment option going forward the vet should consider:
· The age of your pet
· The general activity of your pet
· Your willingness and availability to your pet for post-surgical recovery and home care
· Your financial ability
After consideration, a treatment option can be decided. It must be noted that should the tear/torn/ruptured ligament be left untreated can cause the bones to rub against one another leading to possible bone spurs, further arthritic change and a decrease in range of motion. However, it is said that in small breeds, the lameness can improve within 3-6 weeks.
1. Non-Surgical Treatment: in these cases, it is only recommended for small breed dogs that weigh less than 12-15kg. typically this would include cage rest (house rest) combined with anti-inflammatory medication for 6 weeks to 2 months.
2. Surgical Treatment: surgery for dogs includes a number of different techniques that aim to provide stability to the joint.
The Procedure we use at Craig View Veterinary:
Tibial Tuberosity Advancement (TTA).
This orthopaedic procedure was developed by Dr Slobodan Tepi and Professor Pierre Montavon at the School of Veterinary Medicine, University of Zurich in Switzerland in the late 1990’s.
It is a technically challenging bone-cutting procedure that changes the angle of the stifle joint, with a similar mechanical end-point as the TPLO. Moving, or “Advancing” the tibial tuberosity changes the patellar tendon angle and negates the pressure on the joint.
For large dogs, it is a feasible procedure for a speedy return to weight-bearing and good consistency of result. It appears to be a less invasive procedure to some other stabilizing techniques as it leaves the tibial bone shaft intact for weight bearing after surgery. Dogs with TTA are generally healed in 8 weeks, still less time than the TPLO for return to normal activity.
Post-Operative Care
1. Activity:
· There should be no running or jumping, no unsupervised use of stairs (avoid slippery floors), or no rough play with other pets or children in the home.
· Any walk outside for toileting should be done on-leash.
· Activity must be restrained to 3 short walks a day on lead for ablutions and will be so for 8 weeks post-surgery.
· It is recommended to maintain a crated recovery for the 6-8week period before follow-up radiographs are taken. The small enclosure allows for limited movement which will be optimal rehabilitation.
2. Wound care:
· Before discharge, your veterinarian will discuss the likelihood of your pet licking their wound. If your pet is prone to licking please advise as a collar would be necessary.
· The wound must be monitored daily for infection. Any signs of redness, inflammation, discharge or sudden pain to touch is of concern and must be reported to your surgeon.
· The incision must be kept dry and clean for a minimum of 14 days. Thus, no bathing or swimming.
3. Medication:
· Medication is critical for the recovery process; however, should your pet experience loss of appetite, vomiting, diarrhea or dark stool, it should be reported promptly.
· As the owner, ensure you have a schedule and reminders to dispense the medication.
4. Estimated Recovery Time
· The recovery from the surgery is slow but steady, with gradual improvement on the leg concerned. They are expected to walk and bear weight within the first few days of the surgery.
· Generally, the full recovery time is 8 weeks.
