Ruptured cruciate ligament?! What is this?
Compared to a human knee, our dog’s knees are an anatomically imperfect joint. Due to the angle the bones meet, they naturally want to slide forwards and backwards during weight bearing and movement. The cruciate ligaments sit inside the knee joint stabilising it, preventing any movement and rotation, but the ligaments are under constant demand and stress, which can lead to rupture. Whereas cruciate rupture in humans is often due to trauma, think sporting injuries, in dogs it tends to be due to degeneration meaning that over time the ligament becomes weaker.
A cruciate rupture typically refers to the tearing of the cranial cruciate ligaments within the knee joint. This injury results in the joint surfaces grinding against one another cause pain, discomfort, lameness and difficulty walking for our furry friends as well as a rapid deterioration of the joint surfaces themselves.
How is it diagnosed?
The diagnosis of a cruciate ligament rupture involves a combination of physical examination, history taking and diagnostic imaging.
Your vet will look for signs of lameness, pain and instability of the affected leg. They may also, if your dog allows, manipulate the knee joint to assess its stability and check for something termed ‘cranial drawer’. This is where abnormal movement is felt between the shin and thighbone.
If we suspect there may be an issue, the next step is to take x-rays in house to assist with diagnosis, also allowing us to rule out any other issue related to the knee and hip joint. Occasionally further imaging such as a CT scan or arthroscopy (a procedure where a small camera is inserted into the joint), may be required if a diagnosis is unclear.
My dog’s cruciate ligament is ruptured!! What now?!
Once a diagnosis is confirmed, your vet will discuss the appropriate treatment options with you based on the severity of the injury, your dog’s size, age, health and financial constraints. In many patients the preferred surgical option is a technique called a ‘Tibial Plateau Levelling Osteotomy’ (TPLO), and this will be the focus of this article. This involves changing the angle at the top of the shin bone by cutting, rotating, and stabilising it in a new position using a plate and screws. Altering this angle provides a “level” joint surface that helps prevent the sliding motion that results in the rupture.
Here’s where we introduce Freddie, a 10 year old, West Highland White Terrier, who underwent surgery on his right knee to repair his cruciate ligament this summer and we wanted to share his journey with you all!
On the day of surgery:
- Freddie had a pre-operative health check completed, an i/v cannula placed, pre-medication administered and placed under anaesthesia for this procedure.
- His right leg was shaved, from his hip down to his ankle, and was scrubbed and prepped ready for surgery by the nursing team resulting in a sterile surgical field.
- We use a local orthopaedic surgeon for a lot of our orthopaedic surgeries. This allows for our patients to be cared for by the Mayne Vets team, and removes the stress of travelling further afield.
- Once Freddie recovered from his surgery, the nursing team monitored him throughout the afternoon, offering him food, monitoring his comfort levels, giving him further medication as was necessary and applying a cold compress to his surgery site. We advise for owners to cold compress, if the dog allows, for the first few days after surgery to help reduce any swelling.
- Freddie went home the same day of his surgery, here he is below relaxing and recovering in the evening. This is often the case for most surgeries, unless we are concerned with your pet’s anaesthetic recovery or pain management.
- Freddie was prescribed a combination of different pain relief medications for his parents to administer for around 2 – 4 weeks. A course of antibiotics was also prescribed.
- Much to Freddie’s delight, a buster collar is recommended to prevent dogs from causing trauma to their incision and is advised to be kept on for at least 2 weeks.
- Freddie had to undergo strict rest initially, he was confined to a crate and was only allowed outside to toilet for quite a few weeks.
Here is the lovely Freddie showing us what life is like on his first day in the crate after getting home, and his last day in the crat before he was allowed some freedom to stretch those legs!
Around 4 weeks post-surgery, exercise can be increased, although it needs to still be restricted and gentle. Why so much rest you may ask? There is potential even one month after the surgery for the implant and surgery to fail if your dog slips or knocks their knee. The bone needs time to heal and strengthen.
Here is Freddie enjoying some time outside his crate enjoying the sun in the garden, as you can see Freddie’s owners are amazing, making sure he was still restrained by his lead. This prevents an injury in case your dog is a keen chaser of birds or squirrels! The recovery process is a long one, and it’s all down to owner’s time and dedication.
There are a few considerations when your dog is recovering from surgery:
- Seeing as they are not going to be exerting much energy, switching to a lower calorie food or reducing the amount you feed can help maintain your dog’s body weight and prevent any weight gain.
- We’ve mentioned the risks of slips and falls to the success of the surgery and there are a few ways you can combat this at home. Consider using non-slip matting on wooden or laminate flooring, avoiding walking up steps and stairs. If there are some steps coming into the house then a ramp would be beneficial, or using a sling to support their back leg, especially early on in their recovery.
- Take into account their mental wellbeing during rehabilitation, how about providing food puzzles, chew toys or supervised time out of the crate.
- The addition of joint supplements to your dog’s routine would be advised in order to support their joints long term. Unfortunately after a cruciate rupture dogs are more prone to arthritic changes.
Follow up x-rays are taken 8 weeks post-surgery to check the healing of the bone and position of the implant.