Pet's ligament rupture can be repaired, rehabilitated
By Bruno Massat, DVM, DACVS, DECVS, CCRP
Friday, April 10, 2009
Published in the "Your Pet" column of The Nashua Telegraph.
The column runs on the second and fourth Fridays of each month.
A ruptured ACL, or anterior cruciate ligament, is not just reserved for Tom Brady. In fact, a torn cruciate is the most common orthopedic condition of the canine knee, also called the "stifle."
And with adequate surgical repair and rehabilitation, your dog companion – just as Brady, as we can only hope for the future of the New England Patriots – can return to an athletic lifestyle.
But what does the ACL do? You would not believe that this shiny white little band of collagen tissue is such an important structure. When ruptured, the resulting joint instability creates pain, inflammation, a possible meniscal tear and, ultimately, arthritis.
In general, a canine cranial cruciate ligament rupture results from a progressive weakening of the ligament. The rupture can be either a progressive partial or a sudden complete one. And the lameness will vary from a progressive lameness, worse after rest or exercise, to a sudden non-weight bearing limp.
Any dog can have it, but if you own a female-spayed large breed and overweight dog with rear leg lameness, you can bet your veterinarian that you know the diagnosis. It's still a good idea to let the vet confirm it, though! This will be done with a comprehensive orthopedic examination and radiographs. You will hear names such as drawer sign, tibial compression test and McMurray sign, which is medical jargon for stifle instability and meniscal tear. For atypical cases, a MRI may be requested.
The conservative treatment with rest and pain medication is rarely adequate. Often, surgery is the definitive treatment. And this is where the confusion starts. So, let me try to summarize it for you. All available procedures can be divided in a few broad categories:
• The intracapsular techniques: A piece of tendon or fascia is used to reconstruct a new ligament within the joint.
• The extracapsular techniques: A strong suture is placed immediately outside the joint capsule as a substitute for the broken ligament.
• The fibular head transposition: Another knee ligament, the lateral collateral ligament, is moved around to take over the function of the ruptured cruciate.
• The corrective tibial osteotomies: They offer a more solid repair and a quicker return to function. The two most common osteotomies are the tibial plateau leveling osteotomy and the tibial tuberosity advancement. The tibia, the bone forming the lower part of the stifle joint, is cut and reset with special implants in such a way that the cruciate ligament becomes unnecessary. Initially designed for large-breed dogs, TPLO and TTA are also appropriate for smaller patients.
Choosing the best procedure is confusing, and a frank discussion between you and the surgeon is required. And beware of what you read on the Internet! There is a lot of false information out there in cyberspace.
For all dogs, but particularly for athletic or working dogs, postoperative rehabilitation is indicated. The best rehabilitation is under the guidance of a professional veterinary therapist. The therapist performs therapeutic ground or aquatic exercises and uses different modalities, such as therapeutic ultrasound, laser and muscle electrical stimulation. Specific home exercise and nutritional plans also are provided.
For most dogs, a return to normal function is expected about three months after the surgery. However, a functional leg does not mean a completely normal stifle. Any pre-existing arthritis is not reversible. And if the injury is neglected, the arthritis can become so severe that the dog will be better served by a total knee replacement with a prosthetic joint.
Delaying treatment is not in your dog's best interest. As a general rule, any lameness not markedly improved after three days of rest warrants a visit to the vet. This is one area of a dog life where the saying "Better safe than sorry" definitely holds true.
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