by Helga Schmitt
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.
The prosthetic material used will eventually fatigue and break. During the healing process, the fibrosis that develops within 8 to 10 weeks will secure the knee for life, leaving no need for the material to remain intact. If a rehabilitation program is adhered to, the knee will be even more stable after the surgery.
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.
Passive range of motion (PROM) exercises, cryotherapy and NSAIDs (non-steroidal anti-inflammatory drugs), are the beginning of a rehabilitation program for your dog. To regain active use of the limb, slow 10 minute leash walks and light stretching is suggested. If the incision has healed and there are no open wounds, aquatic therapy as soon as one week post surgery, is of enormous benefit. The pre-operative stifle motion should be regained through PROM exercises. The approximate time to achieve this is 10 days post surgery.
One of the procedures, the intra capsular stabilization method, utilizes a part of the patellar ligament and fascial strips, or a prosthetic material. To allow more normal joint movements, this is positioned in an intra articular fashion by way of arthrotomy or arthroscope, to imitate the path of the original CCL. The same rehabilitative program and pain control measures are used as for the extra capsular method.
A procedure that is being used on larger and heavier breeds, is the TPLO (tibial plateau leveling osteotomy). This is a relatively new concept which offers stability to the joint. The theory behind this procedure is that prevention of cranial drawer movement during weight bearing, and altered bio mechanical forces along with active muscle contraction needs to be done. This works on the stifle to secure the joint while weight bearing.
In the TPLO, an osteotomy of the proximal tibia is performed, which permits the tibial plateau to be rotated to nearly a level position. To secure this in place, a specially designed bone plate and screws are used.
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.
Meniscal injuries are almost always related to partial or complete ruptures of the CCL in dogs. Almost 50% of the dogs presented with CCL injuries have concurrent medial menisci damage. It is almost a given that if the meniscus is normal at the time of CCL surgery, the medial meniscus will become damaged at some point in the future. The same stifle rehabilitation and physiotherapy protocol is followed as in the ACL post surgery regime.
Individual patient characteristics must be considered when laying out a protocol for them. Included in this is an established baseline data of the dog prior to surgery to establish a suitable rehabilitation regime for them post surgery. It is very imperative that the dog be as comfortable and pain free as possible during the rehabilitation process. Their success counts on it.
About the Author:
Helga Schmitt has been keenly researching dog health, physiotherapy and rehabilitation hands on for the past 20 years. She is a Chartered Herbalist, Holistic Nutritionist and holds a Certificate in Homeopathy. She strives to enlighten dog owners about healthy choices. For your Free Dog Health Report and to read more on ACL injuries visit www.treatment-for-dogs.com.
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