Canine Cruciate Ligament Injury
Canine Cruciate Ligament Injury
Canine Cruciate Ligament Injury
When it comes to dog cruciate ligament tear, one aspect to consider is that the dog's knee has similarities to a human's knee. Dogs have the same ligaments and other structures within their knee as humans and like humans, they are predisposed to rupturing their cruciate ligament.
Hands down, dog cruciate ligament rupture is the most common orthopedic disease that veterinary surgeons treat. In a study published in 2005 in the Journal of the American Veterinary Medical Association, the estimated economic impact of cruciate ligament injury in dogs for the year of 2003 was more than $1.32 billion and the occurrence of the injury has not changed since that time but the costs of repair have increased.
When we look at the structure of the knee, there exist two ligaments within the knee that form a cross or x-shape termed the cruciate ligaments. The cranial cruciate ligament (anterior cruciate ligament in a human) is the one that is commonly injured in dogs. The ligaments are labeled from where they start or originate on the tibia. The cranial or anterior cruciate ligament originates in the front of the tibia while the caudal or posterior cruciate ligament starts at the back of the tibia. The problem with these ligaments becomes that once they are injured, they will not heal. This is primarily do to a very poor blood supply to the middle segment of the ligament where it usually ruptures.
In people, usually there is some type of trauma that occurs for the anterior cruciate ligament to rupture, just like football players getting hit or skiers crashing abnormally, twisting the knee, and damaging the ligament. In dogs, we can see some that rupture the ligament while playing and falling abnormally but a majority of the time, dogs just begin to develop a lameness without any obvious trauma to the leg. These dogs appear to partially damage the ligament over time. We guess that dogs have a degeneration of the cruciate ligament that deteriorates the ligament letting it to tear with time. Commonly these dogs will show a mild limp with exercise that over time progressively worsens to the point of lameness continuously. Almost all partial injuries) of the cranial cruciate ligament will continue to full tears provided enough time.
Why we see the variation in rupturing of the ligament between people and dogs is believed to be due to the dog's structure is different in a few ways. When a dog stands, there exists a natural angle to the knee joint. As a result of this, their tibia has a downward slant to it. This slant is parallel to the ground when a dog stands but scientific tests have demostrated that when a dog is weight bearing on the limb and the musculature surrounding the knee are tightened, because of this slant, the tibia attempts to slide forward in relation to the femur. This is called cranial tibial translation and it is the force that the cranial cruciate ligament is required to not allowing. Because this pressure is there at all times the dog is weight bearing on the limb, the cranial cruciate ligament is always being stressed. We guess that this is the explanation why with time the ligament deteriorates and starts to break down slowly and rupture.
The main clinical sign viewed with cranial cruciate ligament injuries in dogs is limping. The lameness can be acutely and intense with a sudden, comprehensive rupture of the ligament or the limping can be minor and progress over time with a incomplete rupture. Another signal we see with a cruciate tear is that the dog will usually sits with the affected limb off to the side. They do this because the knee is cannot bend fully due to swelling to sit normally.
Making the diagnosis of cranial cruciate ligament injuries is usually done by palpating the joint. Your veterinarian will feel the joint for swelling and then attempt to show unnatural laxity in the joint. What they are attempting to feel is a sliding of the tibia and femur which can only happen when the ligament is ruptured. There are two tests that are performed, the cranial drawer test and the tibial compression test. When there is a full tear of the ligament, there is usually considerable abnormal shifting of the bones. With partial ruptures, demonstrating the sliding can sometimes be more subtle and very difficult to elicit. Radiographs sometimes help when you are unsure if the ligament is injured. Although we cannot see the cruciate ligament on radiographs, we can visualize swelling and arthritis formation which lets you know that there is something abnormal with the ligament. The diagnosis of a cranial cruciate ligament damage is usually done at surgery during which the ligament will be visualized either through an incision into the joint, or with arthroscopy utilizing a camera to visualize within the joint.
There are sometime situations were dogs will do alright missing their cruciate ligament, the vast majority of dogs will need surgery to stabilize the knee if they are very likely to return to using the leg well. Because the ligament will not heal on its own, the only chance a dog has to improve is that the formations around the joint thicken enough to give some stableness for the joint. In some smaller dogs (less than 10 lbs.) this may occur but in the bigger dogs, it usually does not happen at least enough for the dog to have a functional leg. Physical therapy and rehabilitation can sometimes improve the chances that a dog may not have to have surgery but usually even that is inadequate to get dogs to return to normal.
There are a variety of possibilities for repairing cranial cruciate ligament tears in dogs. Often times the choice of surgery is determined by the dogs size, owners capability to meet the expense of the surgery costs, and the surgeons personal preference on repairing the ligament. Because there are several procedures for repairing the knee, there is undoubtedly no one surgery in particular that is best. The procedures that are at present widely used are the lateral suture extracapsular repair, intracapsular reconstruction of the ligament, fibular head advancement, tibial plateau leveling osteotomy, tibial wedge osteotomy, tibial tuberosity advancement, and tightrope stabilization technique. Determining what is the best repair for your dog is best figured out by consultation with your doctor.
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