CRANIAL CRUCIATE LIGAMENT RUPTURE

Dog and cat knees are similar to humans. For example, knees have five ligaments, two menisci, a knee cap, and joint cartilage. The ligament most commonly affected in dog and cat knees – the cranial cruciate ligament – is the same ligament most commonly damaged in professional athletes. Dogs and cats usually tear this ligament when out running around, or sometimes when landing wrong after a jump.

The cranial cruciate ligament is a large, strong ligament located within the knee joint. It is not actually a single structure, but is, in fact, made up of a bundle of individual fibers tightly bound together to form the ligament. Most of the time when the ligament is injured, it is completely torn in half. Sometimes, only a portion of the ligament will tear. Though only a portion of the ligament may be torn, the whole ligament is damaged.

When a cranial cruciate ligament is torn, it causes sudden pain and often results in the pet holding its leg up. It also causes an instability in the knee joint. The pet may put the leg down and start using it within a day or so, but will continue to limp for several weeks. Normally, at the end of several weeks, the initial pain subsides and the pet is willing to use its leg more; however, the joint remains unstable. Every time the animal puts weight on the leg, the tibia (shin bone) slides forward in relationship to the femur (thigh bone). The abnormal motion causes wear and tear on the joint cartilage, causing pain and arthritis. This motion can also put excessive stress on the menisci ("C" shaped pieces of cartilage within the knee joint), causing damage or tearing. An isolated meniscal tear can cause pain, lameness and arthritis as well.

Surgery is the only corrective measure for cranial cruciate ligament injuries. Many surgical procedures have been tried on people and animals during the last 60 years; however, most orthopedic surgeons agree that the procedures are not as successful as they would like. Knees that suffer this injury are never completely normal even after surgery is performed. Surgery does, though, stabilize the knee, allowing it to regain normal motion and thereby reducing the formation of arthritis. Surgery has been and remains the treatment of choice for this injury. If surgery is not performed, progressive arthritis will occur and the lameness will worsen with time.

There are many different ways to stabilize the knee with cruciate ligament injury. The procedure that we typically use here is a modification of the DeAngelis procedure, which involves placing heavy gauge suture material from the back of the femur, across the joint and to the front of the tibia. This will tighten up the joint and stabilize it. The majority of animals will regain normal or near normal use of their leg after the surgery and after a period of rehabilitation. Strict limitation of strenuous activity combined with controlled physical therapy is necessary after the surgery for a period of six to eight weeks so that the animal rehabilitates the knee and leg muscles and does not over stress the repair before the leg is ready for full activity. Most dogs begin touching the leg to the ground in 10-14 days and are usually ready for normal activity in six to eight weeks. Complete recovery usually takes 3-4 months. We recommend Tibial Plateau Leveling Osteotomy (TPLO) for large, heavy or very athletic dogs.

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