Cruciate Surgery for Pets - Lake Geneva WI
Cruciate Ligament Rupture
What and where are the cruciate ligaments?
There are two bands of fibrous tissue called the cruciate ligaments in each knee joint. They join the femur and tibia (the bones above and below the knee joint) together so that the knee works as a hinged joint.
They are called cruciate (meaning cross) ligaments because they “cross over” inside the knee joint. One ligament connects from inside to outside the knee joint and the other outside to inside, crossing each other in the middle.
Humans have the same anatomical structure of the knee. Cruciate ligament rupture is a common knee injury of athletes. The term anterior cruciate is used to describe the identical anatomical structure in humans.
How does a cranial cruciate injury occur?
The knee joint is a hinged joint and only moves in one plane, backwards and forwards. Traumatic cruciate damage is caused by a twisting injury to the knee joint. This is most often seen in dogs and athletes when running and suddenly changing direction so that the majority of the weight is taken on this single joint. This injury usually affects the anterior or cranial (front) ligament. The joint is then unstable and causes pain, and lameness.
A more chronic form of cruciate damage can occur due to weakening of the ligaments as a result of disease. The ligament may become stretched or partially torn and lameness may be only slight and intermittent. With continued use of the joint, the condition gradually gets worse until rupture occurs.
How is it diagnosed?
With traumatic cruciate rupture, the usual history is that the dog was running and suddenly stopped or cried out and was then unable to bear weight on the affected leg.
- Many pets will “toe touch” and place only a small amount of weight on the injured leg.
- During the examination, the veterinarian will try to demonstrate a particular movement, called a drawer sign. This indicates laxity in the knee joint. Many dogs will require mild sedation before this test can be performed. Other diagnostic tests such as radiographs (x-rays) may also be necessary.
- Tests such as arthroscopy may be needed to rule out other damage to the joint.
Is other joint damage common?
Inside the knee joint are pieces of cartilage called menisci. The menisci act as shock absorbers between the femur and tibia. Many times these cartilages are also damaged when the cruciate ligaments rupture. They are usually repaired at the same time as the ligament surgery.
Is an operation always necessary?
Dogs under 5 kgs (11 lbs.) may heal without surgery though will develop arthritis. These patients are often restricted to cage rest for two to six weeks. Dogs over 5 kgs (11 lbs.) usually require surgery to heal. Unfortunately, most dogs will eventually require surgery to correct this painful injury.
What does surgery involve?
There are various techniques available to replace the action of the cruciate ligaments. Historically, the surgeries focused on replacing the ligament that was torn using a very strong suture called an Extracapsular Technique ($1200 to $1700). Though tihis surgery is still done, especially on dogs under 30 pounds, it has been largely replaced by two newer methods. These two techniques involve changing the conformation of the joint so the ACL is no longer necessary. The first technique was the Tibial Plateau Leveling Osteotomy (TPLO) ($3000-3600). The second is the Tibial Tuberosity Advancement (TTA) ($2200-2600) done "in-house" by Dr. Scot Hodkiewicz. These are especially beneficial for larger, more athletic dogs that tended to break the suture in the Extracapsular Technique.. Studies have shown a clear benefit of the TTA and TPLO methods over the older Extacapsular Techniques. The TTA and TPLO have very similar outcomes in most dogs. Dr. Scot Hodkiewicz can help determine which surgery would be best for your dog.
Is post-operative care difficult?
It is important that your dog have limited activity for six to eight weeks after surgery. Provided you are able to carry out your veterinarian’s instructions, good function should return to the limb within three months. Weight control and nutritional supplements such as glucosamine / chondroitin may help maintain good function. Many dogs will receive physical therapy after the surgery to speed recovery and reduce complications. Your veterinarian will discuss your pet’s recommended post-operative care with you before your dog is sent home.
Is obesity such a problem?
Obesity can result in cruciate ligament rupture. If your dog is overweight, the recovery time will be much longer. Obesity also increases the risk of injury to the other knee. Weight loss is as important as surgery in ensuring rapid return to normal function. For overweight dogs, it is not practical to attempt weight loss prior to surgery since arthritis forms quickly in damaged knees and will result in chronic pain.
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