Dog ACL Injuries
Dog ACL Injuries and What You Need to Know
Cranial cruciate ligament rupture or injury is one of the last things anyone wants to hear about their dog. Just the very thought of it entails visions of pain, surgery, and a long road to recovery. It is however, becoming so increasingly common among all breeds of dogs today. What is the reason for this? Why are these injuries happening so much more frequently? There is no doubt many questions surrounding this issue. Here’s some insight into the matter.
Acute ruptures occur usually from trauma, but nearly all cases happen as a result of a slow degenerative process of the fibers within the ligament. This is much more frequent in medium to large breed dogs, due to the force that is applied onto the knee. Spayed females between the ages of 4 to 8 years also report a higher incidence of CCL (cranial cruciate ligament) changes.
ACL (term synonymous with CCL), injuries cause a loss of support within the structure of the knee. This loss of support invariably leads to OA (osteoarthritis) degenerative changes. Smaller breed dogs can potentially side step surgery through conservative management, however, the atrophic and degenerative changes will occur.
There has been up to 50 different techniques designed to treat ACL injuries. The most frequently performed procedures are the extracapsular stabilization, intracapsular stabilization method, and TPLO (tibial plateau leveling osteotomy). Further to these stabilization procedures, loose or torn ligament remnants and damaged portions of the menisci have to be debrided, especially the caudal horn of the medial meniscus.
The extra capsular stabilization method uses nylon or stainless steel suture material to mimic the support of the intact CCL. This is passed around the lateral fabella and into a tunnel drilled into the proximal tibial crest. This allows early rehabilitation, minimal cranial drawer and immediate stabilization of the stifle.
During some point of the healing process, the prosthetic material used will fatigue and break, but the fibrosis that develops over 8 to 10 weeks is what will stabilize the knee for their life. A more stable joint will result after surgery if a rehabilitation regime is employed and adhered to.
Another method of extra capsular stabilization is by the fibular head transposition, taking into account that the lateral collateral ligament inserts on the fibular head. A pin and a tension band hold the fibular head cranially from its normal position. This new position offers the same function as the CCL, limiting internal rotation of the limb.
The day after surgery physical rehabilitation should start with cryotherapy, NSAIDs, and very gentle passive range of motion exercises. Gentle stretching and slow, deliberate 10 minute leash walks are recommended for active used of the limb. Aquatic therapy is strongly recommended one week after surgery if the incision has healed and there are no open wounds. Passive Range of Motion exercises is recommended until preoperative levels of stifle motion have been regained approximately 10 days post surgery.
The intracapsular stabilization method uses fascial strips, a part of the patellar ligament, or a prosthetic material. This is positioned in an intraarticular fashion by way of arthrotomy or arthroscopy to imitate the path of the original CCL and allow more normal joint movements. A postoperative protocol for physical rehabilitation and pain reduction is in par with the extra capsular procedure.
The TPLO (tibial plateau leveling osteotomy) is a fairly new procedure that offers a different concept to providing stability to the joint. This procedure is based on the principle that to prevent cranial motion drawer movement during weight bearing, altered biomechanical forces and active muscle contraction needs to be done. This acts on the stifle during weight bearing to steady the joint.
In this procedure an osteotomy of the proximal tibia is done, which ultimately allows the tibial plateau to be rotated to nearly a level position. Screws and a special bone plate designed for this are then used to secure the osteotomy.
As with all procedures there are postoperative complications associated with the procedure. In this case they are primarily related to the altered biomechanics of the stifle. In this surgery complications are usually patellar ligament desmitis during the first month. In TPLO surgeries, dogs may experience more lameness than expected. This is due to the patellar ligament being wider and there is pain on palpation of the ligament at the insertion point.
Most dogs with TPLO surgery have their pain managed with enforced rest, NSAIDs and cryotherapy. The issues generally are self-limiting as the healing progresses with the new tissue remodeling. In addition to healing the joint capsule and the altering of stresses on the cartilage and bone of the joint, there has to be adequate time for healing the bone or bone implant failure is a possibility. Aquatic therapy is very useful to reduce weight-bearing stress on the structures.
Caudal Cruciate Ligament injuries generally occur alone or as a result of the TPLO procedure from over rotation of the tibial plateau, which places additional stress on the CdCL. Physical rehabilitation begins in 24 hours and active use of the limb is encouraged. Aqua therapy can be started one week post surgery provided the incision is sealed.
Meniscal injuries are almost always related to partial or complete ruptures of the CCL in dogs. Almost 50% of the dogs presented with ACL injuries have concurrent medial menisci damage. It is almost a given that if the meniscus is normal at the time of CCL surgery, the medial meniscus will become damaged at some point in the future. The same stifle rehabilitation and physiotherapy protocol is followed as in the CCL post surgery regime.
Individual patient characteristics must be considered when laying out a protocol for them. Included in this is an established baseline data of the dog prior to surgery to establish a suitable rehabilitation regime for them post surgery. It is very imperative that the dog be as comfortable and pain free as possible during the rehabilitation process.
About the Author
Helga Schmitt has been passionately studying and researching dog health, physiotherapy and rehabilitation hands on for the past 20 years. Her keen interest in health and healing motivated her to become a Chartered Herbalist and also obtain a degree in Nutrition and Advanced Holistic Nutrition. She furthered with a Certificate in Homeopathy and continues to study various healing modalities to this day. She is a Certified and Registered Canine Hydrotherapist. Her research, past and current studies and experience, have her striving to educate dog owners that there are numerous ways to achieving and maintaining optimum health for your pet. Read more on ACL injuries and TPLO surgery with dogs. Her best-selling book, “The Ultimate Rehabilitation & Physiotherapy Guide for Dogs” is available here.