Ingleby Barwick, Stockton on Tees. TS17 0WA

01642 760 999

reception@copelandvets.co.uk




Cranial cruciate tears Pet Advice

 

 

Cranial cruciate tears explained

 

Cranial cruciate tears are a common cause of lameness in the dog. These tears are seen in many breeds and types of dogs but are generally a greater problem in the larger breeds such as Rotweillers, Labradors, Golden Retrievers/Boxers, Shepherds Mastiffs and Bull Terriers. They may present as an acute painful lameness or as a more gradual chronic lameness/soreness.

 

What is the cruciate ligament?

There are in fact two cruciate ligaments in your dogs knee (stifle) joint. One goes from front to back the other from back to front. They form a cross in the knee and act as a point about which the knee hinges.

 

Also found in the canine knee are the menisci. These are two C shaped pieces of cartilage that sit between the femur and tibia and act as cushions within the knee joint.

 

 

Why did my dog’s cruciate tear?

The exact cause is unknown. We believe there are several factors involved including a weak or degenerative ligament and overloading of the ligament.

 

An important difference between your knee and that of your dog is the weight bearing part of the tibia in the dog slopes backwards. This means the femur is constantly trying to drop backwards and it is the job of the cranial cruciate to hold on or anchor the femur to the tibia. So even when your dog is standing the cruciate ligament is under strain.

 

Once the ligament tears the knee then becomes very unstable and painful. Sadly the ligament never repairs or heals probably because of a poor blood supply and the ongoing shearing action of the knees anatomy.

 

What happens once the ligament ruptures?

The general stability of the knee is lost and because the knee is then used abnormally degenerative changes begin which will lead to a progressive amount of arthritis and pain.

 

Often dogs are seen with cruciate tears with a seemingly gradual onset of lameness that suddenly get worse. This is because the ligament may have stretched or torn over a period of time leading to more and more instability and more degenerative joint disease/osteoarthritis.

 

What is a meniscal tear?

If your dog is really unlucky they will also damage their menisci. Approximately one third of cruciate tears will have some meniscal damage. This is caused by a scuffing action of the femur as the knee is bent and straightened . This would normally be stopped by the anchoring action of the intact ligament. These meniscal tears are acutely painful and significantly worsen the disease and prognosis for a full recovery. The longer the knee is left unstable the greater the risk of tearing the menisci and the more degenerative joint disease.

 

How will you diagnose a cruciate tear?

The clinical examination and symptoms are the most important factor in diagnosis.


Age:

 

Adolescents onwards often 4-5 years old

Breeds:

 

Retrievers,Shepherds,Boxers,Bull terriers, Mastiffs

Lameness:

 

Lameness this is often of gradual onset , stiff after resting then suddenly getting worse

Knee:

 

Knee the affected knee will often be swollen and painful On examination we may feel a “draw sign” showing the instability of the knee.



 

Radiographs will be taken while your dog is under general anaesthetic. This will allow us to see the degree of boney changes present within the knee. While under GA we can also check for the presence of a cranial draw sign, this is where the tibia can be shunted forward which will show how unstable the joint is. Also from the x-rays we can assess the slope of the tibial table

 

What is the best treatment for my dog?

“If there is more than one way to fix something there probably isn’t a perfect way” This is certainly true of cruciate tears where there are a dozen or so different techniques suggested for cruciate repair.

 

We use two main surgeries to treat cruciate tears

1. Lateral stabilising suture (LSS)

2. Tibial Tuberosity Advancement (TTA)

 

 

Lateral Stabilising Suture:

This involves replacing the ruptured ligament with a loop of hard nylon wire. The wire passes around a small bone at the back of the knee ( lateral fabella) then through two bone tunnels drilled in the tibia

Over 90%of dogs with this surgery show considerable improvement. Unfortunately 40-50%will still exhibit some form of lameness albeit intermittent.


This was until recently the main stay of our surgical treatment of cruciate ruptures and still remains a valuable option. However some patients particularly larger dogs may remain stiff and a full return to athletic potential is not achieved.

 

The inadequacy of this technique is, firstly we don’t have a ligament replacement that is stronger than the original ligament but retains the elasticity. Secondly it does not address one of the causes of the rupture i.e. the slope of the tibia.


With these problems in mind the TPLO was designed and the TTA was a further development of this. This has been a massive advance in our treatment of cruciate tears allowing a full return to athletic activity and minimising subsequent arthritis.

 

Tibial Tuberosity Advancement:

This is technically more demanding and requires specialised instruments and implants. The tibial tuberosity (the top part of the shin) is cut and moved forward then reattached to the tibia with custom made titanium implants.

 

Effectively this changes the position of the patellar ligament relative to the tibial table thus removing the effect of the backward slope of the tibia, so now there is no need for the anchoring of the cruciate ligament.

 

 

We have been performing TTAs for several years and the results are very exciting. Many dogs both working and pets make a full recovery to athletic ability often with little or no long term painkillers.


The other huge benefit from a TTA is there is significantly less degenerative joint disease and arthritis as these dogs get older compared to other treatments. This is the most important feature of TTAs

 

Summary

Cranial cruciate tears are a common , debilitating condition of the dogs knee. It will produce arthritis, pain and lameness all of which will progressively worsen with time. However with correct treatment and care we can now expect all our patients to exercise happily and enjoy a good quality of life.

 

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Post op notes following Lateral stabilising suture to repair cruciate tear

 

Your pet has sustained an injury to one of the major ligaments stabilizing the knee joint. The result of this type of injury is an unstable knee joint. This instability is the reason for the lameness which you have observed and will result in degenerative arthritis. Many dogs (and cats) that sustain this injury are overweight. If this is the case, weight loss is imperative. Additionally, 30-40% of patients that injure their cruciate ligament, will suffer the same injury in the opposite limb. Maintaining an optimal body weight speeds the recovery process and may reduce the potential for injury to the opposite limb

The surgery we have performed today used an extra-articular nylon sutures (outside the joint) placed to stabilize the joint in a normal alignment (see picture above ,arrow shows new ligament). Fibrous scar tissue will develop over time to enhance the stabilization. The sutures prevent abnormal motion in the joint and minimize but do not prevent the development of arthritis. Limb function is improved, but the affected joint may never be totally normal. However with good aftercare most pets will return to a happy pain free athletic life

 

Analgesia( pain medication)

During surgery and in the immediate post op period we will have given your pet several pain killers to make sure they are happy and pain free. We know that a pain free recovery is not only a kind thing but produces better end results.

 

You will have been given one of Metacam ,Rimadyl or Previcox to give every day. These ideally should be given with food.

 

You may also have been given additional pain killers eg Tramadol theses are normally to use at your discretion if you think your pet is uncomfortable .In general if you are not sure give them! It’s better to give pain relief and they don’t need it than not give it when they do.

 

Side effects – these are often not seen if there is any vomiting loose stools or behavioural changes stop the analgesics and ring us for advice.

 

Ice packs

You will have been given an ice pack ,use this 4-6 times a day as long as your dog does not resent this.

 

Wrap the pack in a tea towel and apply to the inside of the leg at knee level. Leave on for 4-6 minutes if your dog is happy with this. The first few times wrap in couple layers of the towel and leave on for 1-2 minute just till your dog is happy with the idea. Then leave for longer and just one layer of towel

 

Wound care

The incision site is on the lateral outside of the knee. Normally we will have used subcuticular sutures so there will be no stitches for you to see or more importantly for your dog to chew!

 

If the wound discharges or your dog continually licks at the wound let us know immediately

 

There will often be some post op swelling ,this may start under the wound site then drop down to the hock. This is not normally a problem and ice packing will help

 

Exercise

We like your dog to be moving about fairly quickly after cruciate surgery but in a controlled fashion. Below are guidelines at any point if your dog seems sore or doesn’t put the operated leg to the ground then stop and reduce the amount of exercise. If excessive activity is allowed too soon following surgery, stabilization of the knee can be lost requiring additional surgery. After the initial 48 hours you should begin gentle flexion and extension (bending and straightening) of your pets knee for 5-10 minute sessions three times daily. Continue this therapy until the dog starts to use the affected limb well.

 

It is not uncommon for your pet to carry the limb for two weeks following surgery. By 2-4 weeks they will usually start to touch the foot on the ground and by 6-8 weeks they usually start to bear considerable weight on the limb.

 

Week one- Keep confined ideally to one or two rooms in house non slip flooring. Take out to garden ON LEAD and potter round for 5 minutes at least 5-6 times a day

 

Week 2-3 Still house confined but you can take your dog outside for short walks as long as they are steady walkers on a lead. Start with 5minutes 2-3 times a day and gently increase to 15-20 minutes

 

If they pull do not yank them back, pull them back gradually. Try and get them to walk on your right if they have had their right leg operated on or left if left operated on. This way if you do pull them back their weight will transfer onto the good leg.

 

General points

The incision site is on the lateral outside of the knee. Normally we will have used subcuticular sutures so there will be no stitches for you to see or more importantly for your dog to chew!

 

If the wound discharges or your dog continually licks at the wound let us know immediately

 

There will often be some post op swelling ,this may start under the wound site then drop down to the hock. This is not normally a problem and ice packing will help.

 

Keep off slippy floors laminate , wood and tiled floors must be avoided

Cages; it is not necessary to have your dog caged in fact steady pottering about in the house aides recovery

Do not allow your dog to go up stairs or steps

Stay on a lead; you do need to keep your dog on a lead at exercise for at least the first 6 weeks after surgery. This will avoid sudden explosive actions when your dog suddenly decides the surgery was so good he will chase that squirrel!

 

Unfortunately, arthritis involving the knee joint may result in some intermittent lameness or stiffness on the affected limb long term. Some patients will also have subsequent damage to the meniscus (cartilage) of the knee joint following the repair that requires a second surgery to remove the damaged cartilage. With a gradual return to normal activity good function can be expected on the limb.

 

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Post op TTA

 

Your dog has had a TTA (Tibial Tuberosity Advancement) this is the most recent advance in treatment of canine cruciate disease. The post operative period is every bit as important as the surgery. If there is anything you are unsure of just ask.

 

Analgesia( pain medication)

During surgery and in the immediate post op period we will have given your pet several pain killers to make sure they are happy and pain free. We know that a pain free recovery is not only a kind thing but produces better end results.

 

You will have been given one of Metacam ,Rimadyl or Previcox to give every day. These ideally should be given with food.

 

You may also have been given additional pain killers eg Tramadol theses are normally to use at your discretion if you think your pet is uncomfortable .In general if you are not sure give them! Its better to give pain relief and they don’t need it than not give it when they do

 

Side effects – these are often not seen if there is any vomiting loose stools or behavioural changes stop the analgesics and ring us for advice.

 

Ice packs

You will have been given an ice pack ,use this 4-6 times a day as long as your dog does not resent this.

 

Wrap the pack in a tea towel and apply to the inside of the leg at knee level. Leave on for 4-6 minutes if your dog is happy with this. The first few times wrap in couple layers of the towel and leave on for 1-2 minute just till your dog is happy with the idea.Then leave for longer and just one layer of towel

 

Wound care

The incision site is on the inside(medial aspect )of the knee. Normally we will have used subcuticular sutures so there will be no stitches for you to see or more importantly for your dog to chew !

 

If the wound discharges or your dog continually licks at the wound let us know immediately.

There will often be some post op swelling ,this may start under the wound site then drop down to the hock. This is not normally a problem and ice packing will help

 

Exercise

We like your dog to be moving about fairly quickly after TTAs but in a controlled fashion. Below are guidelines at any point if your dog seems sore or doesn’t put the operated leg to the ground then stop and reduce the amount of exercise

 

Week one

 

Keep confined ideally to one or two rooms in house non slip flooring.

 

Take out to garden ON LEAD and potter round for 5 minutes at least 5-6 times a day

Week 2-3

 

Still house confined but you can take your dog outside for short walks as long as they are steady walkers on a lead.Start with 5minutes 2-3 times a day and gently increase to 15-20 minutes

 

If they pull do not yank them back, pull them back gradually.Try and get them to walk on your right if they have had their right leg operated on or left if left operated on.This way if you do pull them back their weight will transfer onto the good leg.

 

 

General points

Keep off slippy floors laminate , wood and tiled floors must be avoided

 

Cages; it is not necessary to have your dog caged infact steady pottering about in the house aids recovery

 

Do not allow your dog to go up stairs or steps

 

Lead exercise; you do need to keep your dog on a lead at exercise for at least the first 6 weeks after surgery.This will avoid sudden explosive actions when your dog suddenly decides the surgery was so good he will chase that squirrel!

 

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