Cruciate Disease & Injury

Cruciate Disease and injury is a common problem found in many dog breeds. The Cruciate Ligaments are located in the dog’s stifle (knee) and their role is to stablise the knee and prevent abnormal movement of the tibia and femur bones.  Cruciate means to cross over hence the name as they cross over each  other. The image opposite shows a normal  looking ligament vs a ruptured cruciate  ligament.  The cranial cruciate ligament is  the most commonly injured and can  rupture easily with little or no excessive  force.  When the ACL tears in your pet’s knee, the tibia is able to slide forward rubbing against the femur when your pet stands on the leg which is very painful.

Cranial cruciate rupture is the most common cause of rear leg lameness in dogs whether it be a partial or complete rupture or tear.  No genetic link is known at this stage and mostly it is due to repeated undue pressure on the ligament (chronic) which ultimately causes it to tear or a traumatic (acute) event like jumping incorrectly. Obesity can play a role as well with undue pressure and stress on the ligaments.  Spayed females appear to be more prone to crancial cruciate ligament disease as well as larger dogs under two years of age.

Clinical signs of cranial cruciate disease include:

• lameness – especially if acute and full tear holding the leg in the bent position while partial tears will have subtle to marked intermittent lameness
• muscle wastage (atrophy) in the rear leg, especially the quadriceps
• Pain
• Joint swelling

Your veterinarian will perform various tests to confirm a rupture including a cranial drawer test (specific manipulation to assess the ligament), getting fluid from the joint from a puncture or an arthroscopy.

If your dog has cruciate ligament disease  and depending on the severity you can look at the following treatment options:

Conservative Therapy – this can include hydrotherapy, massage, kinesiology, acupuncture, diet, herbal remedies, weight-loss and other non invasive treatments.

Most Common Surgical Procedures-

• Lateral Retinacular Suture: A non-absorbable suture is used to strengthen the joint but it can restrict range of movement and is not suitable for dogs over 40kgs.
• Tightrope Technique – similar to the lateral retinacular suture but does not restrict range of movement.
• TPLO – Tibial Plateau Levelling Osteotomoy – suitable for all breeds and changes the angle of the tibial plateau..  The tibia bone is cut and rotated reducing the the tibial plateau slope (where the femur and the tibia meet) meaning there is no more sliding between the tibia and femur so the knee is immediately stabilized. Plate and screws hold the tibial plateau in place.
• TTA- Tibial Tuberosity Advancement, Is the newest surgery and similar to a TPLO but less invasive.  The cut is made into the tibial tuberosity (not a weight bearing part of the knee joint) unlike the tibial plateau. This result in the tibial crest advancing forward so that the patellar tendon acts like the cruciate ligament. The primary advantage is very rapid recovery when compared with any other repair technique