Cruciate Ligament Injuries
Cruciate Ligament Injuries
The cruciate ligaments are in the knee and act to stop the femur (top leg bone) and tibia (lower leg bone) from sliding excessively forwards and backwards. The cranial cruciate ligament and the caudal cruciate ligament cross over each other at ninety degrees creating a cross, hence the name. The cranial cruciate ligament is often damaged by sudden jarring of the back leg by jumping or by wear and tear.
When this ligament tears, it is very painful and when it ruptures completely it can no longer prevent excessive movement in the joint. Dogs typically present with “toe touching” as if their foot were sore, as bearing weight causes them to feel the pain in the knee. Some animals also damage their meniscus, a cartilage pad that provides cushioning between the femur and tibia which is also very painful.
Whilst a damaged meniscus generally needs surgery, the body is capable of repair of the ligament but it is difficult for this to happen in the face of movement (especially with bigger dogs) so an important part of dealing with these injuries is stabilizing the joint and preventing movement. This can be done with various surgical techniques and also strict rest.
The simplest surgical option is the placement of a Nylon suture which is aligned to prevent instability in the stifle and stop excessive movement while healing takes place. Providing that the strict post-operative rest is taken with no exercise for the first few weeks to ensure minimal risk of the nylon breaking, the rate of success is high.
Other surgical options involve more invasive surgery with the placement of special plates to realign the knee joint and they allow for a quicker return to function of the leg without the risk of breaking the artificial nylon ligament used in the simple procedure just described. These are specialized techniques such as TPLO (Tibial Plateau Leveling Osteotomy) or TTA (Tibial Tuberosity Advancement) performed by surgeons who use them routinely and are ideal for larger dogs and especially those that are difficult to keep rested and will have greater risk of the nylon ligament surgery failing.
During surgery, the menisci (joint cushions) are assessed and the loose parts are removed if they are damaged which eases pain greatly. Stabilizing the knee joint with surgery is a good way to help prevent further joint damage and helps to minimize the progression of arthritis. Arthritis is inflammation in the joint leading to protrusions of cartilage into the joint which can be painful and is common in dogs with cruciate disease. Some dogs, because of the way that they are built (their conformation), are prone to cruciate disease and their ‘good leg’ may also develop cruciate ligament damage at a later stage, especially if it takes the damaged knee a while to repair and they rely on their ‘good leg’ to weight-bear for an extended period.
After surgery, rest for 4 – 12 weeks is important to ensure a successful outcome. Dogs need to be restricted to a crate, or a small room for most larger dogs so that they don’t put excess strain on the affected knee by running or jumping. They need to be taken outside to toilet three times a day on a lead to prevent them running off and stairs must be avoided. Other forms of entertainment such as chew toys and company are essential for mental stimulation during this time.
During rehabilitation, a gradual return to exercise is imperative and physiotherapy and hydrotherapy are useful tools to assist recovery as can therapies like acupuncture, NIS osteopathy, kinesiology, chiropractics. Hyperbaric Oxygen Therapy is another invaluable healing aid helping to reduce inflammation and speed up healing.
Providing optimal nutrition with wholesome food and avoiding excessive carbohydrates as well as chemicals and preservatives helps to support the body’s healing process. Optimal amounts of nutrients such as omega 3 fatty acids, anti-oxidants, proanthocyanidins, vitamin C and glucosamine as well as herbs such as turmeric are helpful too. Weight management is also very important and feeding lower amounts is helpful for dogs that are inactive so that they don’t gain weight.
With the right strategy, most animals heal beautifully and even though it can be a long haul to recovery, investing the time and effort to support optimal healing is well worth it in the long run.