Cruciate disease in dogs: What are the options?May 18, 2022
You may currently be in the unfortunate situation where your dog has ruptured their cruciate ligament and is experiencing cruciate disease. You are not alone! This is probably the most common hind limb injury seen in dogs. This article will explain what cruciate disease is, the clinical signs and the treatment options available today.
What is cruciate disease?
Cruciate disease does not only occur in dogs, but it also occurs in people too! Cruciate disease in dogs is associated with the ‘cranial (or anterior) cruciate ligament.’ Dogs have two cruciate ligaments, a cranial and a caudal portion, and they are situated within each stifle (the knee joint). Disease is more commonly related to the cranial portion, situated towards the front of the knee. The main function of the cruciate ligaments is to stabilise the knee by connecting the femur (thigh bone) to the tibia (shin bone).
The cranial cruciate ligament (CCL) can tear or rupture either partially or completely, leading to cruciate disease. Following CCL rupture, the knee loses its stability, leading to inflammation and joint pain. There are two most common causes of CCL rupture in dogs: Trauma and degeneration. CCL degeneration is more common, but CCL disease can be classed as a multifactorial disease, meaning there are multiple factors involved such as obesity, breed predisposition, ageing and conformation. This is different to the condition in humans, which is usually due to trauma – hence the different treatment options in dogs. CCL rupture is over-represented in larger breed dogs including Rottweilers and Labradors. Interestingly, it rarely occurs in felines!
What are the clinical signs?
The clinical signs often depend on whether the CCL has ruptured partially or completely, as this will vary the degree of hind limb lameness from mild to severe (where they may be non-weight bearing). In most cases, only one leg is affected, however, there are rarer cases where cruciate disease occurs in both hind limbs concurrently, which is very unlucky! When partial CCL rupture occurs, owners may not notice their dog’s lameness as easily as it can be more gradual alongside hind limb muscle loss. Dogs with CCL rupture may struggle to sit comfortably in normal position and may display difficulty rising. If you are worried that your dog may be displaying any of these signs, please contact us for advice.
Be very aware that if you dog has experienced CCL rupture on one hind leg, they are also likely to have CCL rupture in their other leg at some point!
How is it diagnosed?
Diagnosis of CCL rupture is based on clinical history, physical examination and may be supported by diagnostic imaging such as radiographs. When we examine your dog for suspected CCL, we will feel for a ‘cranial draw’ to check the laxity of the knee joint.
Due to surgical advancement over the years, there are now various surgical options to stabilise CCL rupture. Following a CCL rupture diagnosis, one of our vets will discuss with you the surgical options available. The following list will summarise to most widely used of these complex surgical options:
- Lateral suture – this is a more ‘old fashioned’ approach to CCL rupture, and it has largely been superseded by more modern approaches. In simplistic terms, this surgery involves placing a non-absorbable strong piece of suture material from the femur to the tibia to stabilise the knee. This surgery is rarely performed in larger size dogs, as in heavier breeds post-operative failure rates are higher.
- TTA – a ‘tibial tuberosity advancement’ surgery involves making a cut in the top of the tibia, moving it forward and stabilising it in place. By permanently changing the angle of the tibia and fixing it in place, it stops the tibia moving forward and stabilises the knee.
- TPLO – a ‘tibial plateau levelling osteotomy’ surgery involves altering the angle of the top of the tibia by cutting it, rotating it, and fixing it in place with a metal plate and screws. A TPLO does sound very similar to a TTA, however, the location of the cut in the tibia is different. This is one of the more favourable surgical options for CCL rupture, especially in larger breeds and heavier dogs. However, this is a very specialised procedure, and needs to be performed in a referral hospital; and there is a prolonged rest and recovery period while the bone heals.
- MMP – a ‘modified Maquet procedure’ is an even newer surgical option. The method is complicated: an incision is made in the top of the tibia and replaced with a wedge-shaped titanium foam implant, redirecting the impact of their quadriceps muscle and stabilising the knee. This surgery is less invasive than a TPLO and has a quicker restoration of function – many are able to dogs get up and walk (carefully!) right after surgery, although strictly controlled rest is needed for some months afterwards while the implant “beds in”. It’s also a procedure we are now able to perform in-house, as our head vet Chris Hall is trained in this specific technique.
So yes, there are multiple options for surgical management of CCL rupture in dogs and no surgery comes without risk. With CCL surgical options, there is no ‘one size fits all scenario’ and our vets will discuss whether your dog is an ideal surgical candidate, which option would be recommended, and the success/complication rates.
Statistically, smaller breed dogs may respond better to medical (also known as conservative) management than larger breed dogs. Medical or conservative management aims to ‘preserve function without the use of surgical intervention.’ Medical management does not only involve a strict exercise schedule and non-steroidal anti-inflammatory medication, but it also will include physiotherapy, hydrotherapy and very importantly weight control. Our vets will discuss with you whether medical management would be advised for your dog as a course of action. Furthermore, dogs that have cruciate disease are more likely to develop earlier onset osteoarthritis and therefore they may require long-term support.
To conclude, we hope that the above has summarised the ins and outs of cruciate disease in dogs. It is important to be aware of the various treatment options and to also know their limitations. If you suspect your dog has cruciate disease – or any other form of lameness – please contact us to arrange an appointment with one of our vets.