CRUCIATE LIGAMENT RUPTURE / REPAIR
This is either an acute or degenerative injury of the cruciate ligament which results in
partial to complete instability of the joint.
Cruciate ligament rupture is the most common cause of hindleg lameness in dogs and is a
major cause of degenerative joint disease.
The function of the cruciate ligaments is to contain the stifle joint so as to limit internal
rotation and cranial (forward) displacement of the tibia (shin bone) relative to the femur
(thigh bone) and to prevent hyperextension.
Rupture can occur from:
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The stifle (knee) rotating rapidly, eg. The animal suddenly turns towards the side with
the foot firmly planted.
The joint forcefully hyperextending eg. Stepping into a hole or depression at a fast gait.
Jumping can also cause rupture if the force of the cranial tibial thrust exceeds the
breaking strength. (Four times the dogs weight) of the ligament.
Some dogs are prone to increased cranial cruciate strain due to their conformation.
Pain is noted early with sudden non-weight bearing. Left untreated most animals will start
using the limb within two to three weeks and continue use for several months until gradual
or sudden decline of use is noted. By then degenerative changes of osteoarthritis are
present and functional decline in use is continuous. Degenerative joint changes occur
within a few weeks of rupture and severe changes within a few months.
One of the most reliable means of diagnosing this injury is to move the femur and tibia in a
certain way to demonstrate the instability. This movement is called a “Drawer sign”. It can
usually be demonstrated with the dog conscious, however if there is severe pain, the dog
has very strong leg muscles, or is uncooperative it may be necessary to use sedation or
anaesthesia in order for the veterinarian to examine the joint thoroughly.
Any dog that is booked in for cruciate surgery has it’s stifles checked under anaesthetic on
the day, and pre-operative xrays taken of the affected leg, prior to proceeding to the
surgery table.
Surgery is recommended in all dogs with this condition as by stabilising the joint, it speeds
the rate of recovery, slows degenerative changes and enhances function. 85 – 90% of
dogs improve after surgery. While some dogs may not make a complete recovery, surgical
repair and rehabilitation significantly increase their quality of life.
Some complications can occur: secondary surgery can be required in 10 – 15% of cases
due to subsequent damage such as meniscal tears. Regardless of the method of
treatment, degenerative joint disease is common, return to complete athletic function is
uncommon and there is a possibility of the dog rupturing the cruciate ligament on the
opposite leg.
Other potential complications include seroma (fluid accumulation under the skin after
surgery), infection (as the surgery involves implanting a prosthesis), the dog
licking/traumatizing the surgical wound (it is extremely important that a joint surgery of this
nature is protected). Some complications are understandably related to the dog being
inadequately confined or the dog licking or chewing the surgical wound, so owners need to
be prepared to seek help quickly if they are not coping (eg Elizabethan collar, nasty tasting
liquid to apply to the wound, sedatives, extra pain relief).
A special note must be made concerning weight. Obesity or excessive weight can be a
strong contributing factor in cruciate rupture in dogs. The ligament may become weakened
due to carrying too much weight; this causes it to tear easily. Obesity will make recovery
time much longer, and will make the other knee very susceptible to cruciate rupture.
Prior to surgery the activity of dogs with torn cruciate ligaments should be limited to avoid
damage to the meniscal cartilage. Where possible physiotherapy can be applied.
Method of repair offered at Tony's Practice:
D’Angelis Cruciate Repair: this is a common procedure for all dogs.
In the D’Angelis method an extra-capsular reconstruction is done using a non-absorbable
suture / sutures. The suture passes through deep fascia surrounding the fabella (a small
bone at the back of the knee) through a pre-drilled hole in the tibial crest. Tying the suture
eliminates the cranial draw as the suture material creates a prosthetic ligament on the
outside of the joint.
Other methods for repairing damaged Cranial Cruciate ligaments include:
Tibial Plateau Levelling Osteotomy (TPLO)
Tibial Plateau Levelling Ostectomy (TPO)
Triple Tibial Osteotomy (TTO)
Tibial Tuberosity Advancement (TTA)
These are generally performed by a specialist surgeon. Referral to a suitable facility can be
arranged if necessary.
What you can do for your dog following cruciate surgery.
Passive range of motion (PROM)
Passive range of motion is a means of regaining joint mobility and re-training muscles. It is
similar to manipulation in that it is moving a joint through and beyond its normal ranges of
motion. This technique involves moving the limbs, joints and muscles through their fullest
range of extension and contraction possible until the extremity is fatigued.
In order to perform PROM the dog’s muscles need to be relaxed and movement must be
performed slowly. Using PROM in your pets after care can result in less muscle loss post
surgery. Moving through the normal range of motion prevents contractions from forming,
and it has been demonstrated that regeneration of cartilage can occur. Passive Range Of
Motion ideally should be initiated on the day of the surgery and continued for 2 to 3 weeks.
During surgery your dog will be given an injection of a strong pain killer, an antibiotic and
an anti-inflammatory. He / she will be also given some tablets to go home with and the leg
will be bandaged to reduce swelling around the surgery site. The discharge notes will
direct you when to revisit for bandage removal as this can vary depending on the surgeons
wishes for the individual case. The sutures will require removal in 10 to 14 days.
When you pick your pet up from our hospital he/she will be drowsy. This is quite normal
following an anaesthetic and surgery. The drowsiness should reduce over the next 24
hours. Please keep your pet in a quiet place, make sure they are kept warm, and give only
a small amount to eat tonight. He/she can have water when you get home. He/she will
require a supportive bed to recover on, one that is flat at ground level to enable them to get
onto the bed easily and of high density foam (at least 10cm thickness) to avoid bed sores is
ideal.
The procedure for stifle after care should be used as a guideline dependant on the dogs
recovery rate. Your pet will required regular veterinary visits up until they are using their
leg sufficiently so the veterinarian can discuss your dogs recovery rate and after care
during these regular visits.
The evening you take your pet home ice can be applied to your dogs leg for ten minutes at
a time if they allow. This will help ease the pain and reduce swelling (eg 10 mins on/30
mins off). Your pet will require support when getting up and down and must stay on a
leash when taken outside to go to the toilet.
Week 1
Short, controlled leash walks on level surfaces to go to the toilet only. Passive range of
motion 20 – 30 repetitions 2 – 3 times per day followed by ice for 20 minutes. At all other
times your dog should be confined to a small pen.
Week 2
Apply heat for 15 minutes prior to exercise twice a day. Slow leash walks for 5-10
minutes, continue PROM and apply ice after exercise. In between walks your dog may
walk around quietly in a small yard or room.
Week 3
Increase leash walks to 15 – 20 minutes and include grass walks (slightly uneven
surfaces).
Week 4 – 6
Continue PROM; increase leash walks to 30 – 40 minutes with gradual incline and decline
in terrain. Ice if required.
Week 7 – 11
Continue to increase leash walks, adding walk – trot – walk transitions. Continue to
increase incline / decline if being tolerated, eg include stair climbs. Swimming.
Week 11 onwards
Allow to return to normal back yard behaviour. No ball throwing, the dog can do small
retrievals but no repetitions.
At no time until week 11 post surgery should your dog be allowed to play with other
animals or jump onto and off of furniture.
Additional information:
Physiotherapy can be started following bandage removal. Physiotherapy is commonly
used in conjunction with the veterinarian for after care with cruciate ligament rupture,
having excellent results. Physiotherapy is a controlled practice used to speed your pets
recovery.
The use of joint formula made here at Tony's Practice, and a course of Pentosan
injections (an anti arthritis injection) during the weeks after surgery and ongoing can be
very helpful and is recommended. It may help limit cartilage damage and degeneration.
There is usually no additional fee for bandage or suture removal or checking the wound
after surgery up to the time of suture removal. However, there are other fees for further
medications or if other matters need attending to. Also, there will be further costs if your
dog does further injury to the limb and subsequent surgery is required.
We hope you have found this information useful. For any other enquires please contact
the clinic: we are available 24 hours a day on 03 5427 9200.