Beside a patellar dislocation, a cruciate knee ligament partial or complete tear is the most common skeletal injury among dogs and cats.
Cause
Cruciate knee ligaments prevent unsteadiness and translacijski zdrsbetween tibia and femur. The injury appears as acute palliation of the rear leg or a gradual limp, swelling of the knee joint, pain, thigh muscle atrophy, etc.
As opposed to the typical injury in human, the cranial cruciate ligament rupture in dogs has a multifactorial cause: joint capsule inflammation, meniscus injury, osteoarthritis, chronic infections, breed predisposition, hormonal disruptions and last but not least, trauma.
Breeds that are predisposed to knee joint problems: Rottweiler, Bullmastiff, German boxer, retrievers.
How to recognise the rupture?
After the acute injury, dogs or cats limp heavily, they do not step on the injured leg. After a week, they start touching the floor with their toes, and in the following weeks, the limping partly improves but quickly recurs when the pet is more weighed down.
The chronic injury causes an occasional limp, gradual disuse of the leg and a thigh muscle atrophy (partial or complete wasting away of the muscle). A pet does not bend its knees completely when sitting.
The knee loses its normal range of motion, and irreversible injuries of joint structures (mainly cartilage and meniscus) start developing.
Diagnostics
We clinically examine the animal and emphasise the orthopaedic and neurological part of the examination.
We check up the injured knee with special techniques (‘sit test’, way of walking, predalni test, femur slide test) and take a diagnostic X-ray, through which we can see specific changes of soft articular tissues and bones.
Therapy
After we have confirmed the diagnosis, we talk about potential treatment with the owner.
Conservative treatment of a cruciate ligament tear offers a minimal improvement and can only be done under a particular circumstance. We only recommend it for tiny and light dogs and cats that do not walk with a pronounced limp. With bigger breeds, a cruciate ligament tear can be treated conservatively with anti-inflammatory medicines, physiotherapy and strict inactivity that could last months. Chances of the knee recovery decrease if a meniscus is injured during an inconsistent recuperation, or a joint has already been chronically impaired.
We strongly advise surgical therapy.
There are over 300 techniques of surgical therapy of cruciate ligament tear, through which biomechanics of an impaired joint is changed (see Large dog breeds). They are divided into three groups: intracapsular technique, extracapsular technique, and osteotomy. Each of them has its pros and cons.
Recommended therapy
Dogs <15 kg
- Strict inactivity from 4 to 6 weeks:
- Leash, activity only to defecate
- Anti-inflammatory/painkiller therapy and physiotherapy
- Surgical intervention, in case of unsatisfactory progress after six weeks:
- Extracapsular technique or biomechanical stabilisation (see Large dog breeds)
Dogs 15-30 kg
- Extracapsular technique or biomechanical stabilisation (see Large dog breeds)
- (Conservative treatment)
Dogs >30 kg
- Intracapsular/Extracapsular technique or biomechanical knee stabilisation (see Large dog breeds)
Large Dog Breeds
- Extracapsular lateral suture stabilisation (nylon/polyester/Tight Rope lateral suture)
- Biomechanical stabilisation (TPLO/TTA [Tibial Tuberosity Advancement]): techniques, by which the tibial angle is decreased. It amounts to knee joint stabilisation when moving, during weight-bearing and a quick recovery after the surgery.
Intracapsular stabilisation | Extracapsular stabilisation | Biomechanical stabilisation– joint angle optimisation (preferred method) | |
+ | • Autologous tissue – body’s own tissue
• No implants
|
• Use of permanent materials with extra-articular stabilisation
• Minimally invasive surgery • price
|
• Quick recovery after surgery
• Good surgical outcome • Immediate results of stabilisation • Early extremity use • TTA least invasive surgery of all osteotomy techniques • Use of most robust and least irritating titan implants that are not used with other types of osteotomy |
– | • Relative unsteadiness
• Long-lasting recovery
|
• Relative unsteadiness
• Long-lasting recovery
|
• More invasive surgery
• Price |
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