It is estimated that there are over 15.5 million dogs suffering from arthritis right now – many of whom are silently suffering.

Arthritis is defined as inflammation in the joint, and it may be accompanied by pain, discomfort and/or stiffness. There are 5 general areas which are most succeptible to arthritic change: hips, knees, elbows, shoulders and spine.

In the case of arthritis related to cranial cruciate ligament (CCL) injury, the onset of arthritis is linked to the traumatic injury of the knee joint.

Dogs do not exhibit signs of pain in the same way we do by crying, whimpering or complaining. You will need to pay close attention to the habits of your pet to try and determine whether arthritis is an issue.

Arthritis in Dogs – What to Look For:

• Slowing Down
• Sleeping More & Sleeping Longer
• Standing with Back Legs Closer Together
• Wide Front Leg Stance
• Running with Hind Legs Together aka “Bunny Hopping”
• Joint Licking
• Slow to Rise
• Walking Less than Normal with Frequency and Distance
• Avoiding Jumping or Stairs
• Stiffness
• Limping
• Muscle Atrophy

How to Diagnose Canine Arthritis:

Dr. James suggests if at all possible, you need to have x-rays taken to accurately diagnose arthritis, particularly, the exact point of origination for the arthritic change.

The video above was created by veterinarian, Dr. James St. Clair of TopDog Health and Rehabilitation. Dr. James created his GlycanAid-HA joint support formula as a result of working with many patients and owners coming into his rehab center with a plethora of different supplements. In 2007 he began working with one of the leading experts in the world of veterinary supplements and developed joint health supplement formulas packed with ingredients that he knew worked, and were something he wanted to offer his patients.

Basics of Ligament Injury and Arthritis – Video is a post from: Dog Knee Surgery and Ligament Injuries

Dr. James St. Clair of TopDog Health and Rehabilitation shows a simple, informative technique of measuring hind leg muscle to help track your dog’s progress during recovery from CCL surgery or throughout Conservative Management.

How to Measure Your Dog’s Muscle – Video is a post from: Dog Knee Surgery and Ligament Injuries

Help!  My dog is limping – Could it be a torn ligament?

This guide is a good starting place for anyone looking for more information on dog knee problems, specifically cruciate ligament injury in dogs.  This article will give an overview of dog knee injuries covering everything from symptoms to recovery.

What is a Cruciate Ligament Injury?

An injury to the CCL (also known as the cranial cruciate ligament and sometimes called the ACL) can cause lameness in dogs, and is one of the most common causes of rear leg lameness. The function of the cruciate ligament in dogs is to stop the femur (large bone at the top of the leg, above knee) and tibia (smaller bone at bottom of leg, below knee) from rubbing against one another. When the cranial cruciate ligament is torn or ruptured the leg loses stability because these bones are now free to move back and forth on top of one another, causing friction, inflammation, possible meniscal injury and eventually arthritis.

During activities with a healthy dog ACL ligament there will be tension on the ligament, preventing the femur from pressing into the tibia, creating a sliding motion for fluid movement. If your dog is walking or running with a cruciate ligament tear there will be no tension on the CCL, allowing the bones to unnaturally move together, causing pain, lameness and an aversion to using the leg. The best way to think of this would be to envision the ligament like a rubber band, but instead of holding the bones together, the rubber band is in place to prevent the bones from coming into contact. When the rubber band is snapped, there is no longer a gliding joint in the knee and there is contact between the bones.

Acute vs. Chronic Causes of Cruciate Ligament Injury

Acute injury is generally associated with trauma. If the CCL (also referred to as ACL because of it’s similar function to the human ACL) is injured acutely it will most often be due to improper rotation of the knee and hyper extension. This can occur in many different ways such as a dog taking a misstep off a curb, stepping into a divot, jumping or becoming stuck, using a jerking motion to free him/herself.

Chronic injury of the canine ACL is generally associated with disease, age related degenerative changes of the ligament, excess weight (obesity) and conformation of the knee joint (certain large breed dogs are more prone to these types of injuries due to the way their back legs are formed). In the case of chronic injury of the cruciate ligament, there is very little that can be done to prevent the injury from taking place.

Size Matters

Small and large dogs fair differently with the same type of ACL injury. Studies have shown that dogs weighing less than about 25 pounds can experience a full recovery from ligament damage without surgery. This is not true in dogs above the 25 pound threshold. While dogs over 25 pounds may appear to be improving with conservative methods, these larger dogs rarely return to their full function without any issue. This is not to say that there has never been a case of a medium to large sized dog recovering from a torn CCL with only conservative management, but does demonstrate that smaller dogs have an easier time fully recovering using the conservative approaches.

Symtoms of a torn, ruptured or injured CCL will vary from dog to dog, and depending on whether the injury was acute or chronic in nature. Some dogs with a fully torn cruciate may only exhibit mild lameness, while others with a tear may not bear any weight on the leg at all. This again varies based on the type of dog, their size and whether other structures within the knee (particularly the meniscus) were also damaged. Below are some of the most common symptoms associated with a dog knee ligament injury.

Symptoms of a Dog ACL Tear:

1. Decreased range of motion.
2. Hind leg extended straight when sitting down (this is known as the sit sign).
3. Crackling noise of bones rubbing against each other – the medical term for this is Crepitus.
4. Dog exhibits signs of pain when knee (stifle) joint is touched.
5. Exercise intolerance.
6. Limited range of motion or mobility.
7. Stiffness, limping or unwillingness to use the leg after exercise.
8. Knee joint is swollen and/or hot to the touch.
9. Thick, tight, hard and/or firm feel to knee.
10. When standing will only place weight on the toe instead of using entire foot (called toe-touching). An early sign of toe-touching is to only have weight on one side of the body when standing.

There are other conditions with symptoms similar to a dog ACL injury such as: arthritis, knee sprain, meniscal injury, hip dysplasia, patellar fracture, patellar luxation, myelopathies, lyme disease and others. Please schedule an appointment with your vet if your dog shows any of the CCL tear symptoms listed above.

What if my dog’s CCL is never repaired?

This, again, depends on their size, breed and a number of other factors. Some dogs without a CCL may do just fine, while others may use the ability to use their leg. One truth for any dog without a supporting knee ligament is the fact that they will be more succeptible to injuring other structures within the knee, particularly the meniscus. The role of the mensicus in the knee is to act as a cushion, and absorb shocks. Damage to the meniscus is serious and typically leads to arthritic change and lameness.

What to Expect During Your First Veterinary Visit for a Suspected CCL Injury

Consultation and Review of Symptoms

Your veterinarian will review your dog’s symptoms and time of onset.  Going through a detailed history will allow your vet to determine if conditions with similar symptoms may be ruled out at this time.

Physical Exam

Walking Gait

Your veterinarian will want to watch your dog walk and run to see how they are balancing their weight and using the affected leg.

Palpation of the Joint

Your veterinarian will touch your dog’s knee to assess the joint looking for signs of:

• Swelling or Inflammation
• Loss of Muscle Tone
• Pain or Soreness
• Range of Motion
• Popping of the Joint
• Fluid Accumulation

Drawer Sign Test

During the drawer test the veterinarian with stabilize your dog’s femur with one hand while manipulating the tibia with the other. If the tibia moves forward, known as a positive drawer because of the way the bone moves similar to a drawer being opened, the ligament is ruptured.   A negative drawer sign does not necessarily mean your canine does not have a cranial cruciate injury, and false negatives can happen if your pet is tense, if the injury is old and if there is arthritis.

Tibial Compression Exam

Another test, similar to the eliciting the drawer sign, is the tibial compression test. During this exam your veterinary physician will stabilize the dog’s femur with one hand, while flexing the ankle with the other. In dogs with a ruptured cranial cruciate ligament, the tibia will display forward motion upon flexion of the ankle joint.  Again, a negative tibial compression exam does not rule out a cruciate ligament injury, and many factors can contribute to a false negative result.

How to Test a Dog for a Knee Ligament Injury

X-Rays for CCL Injuries

Radiographs are usually taken, not to diagnose a cruciate ligament injury (soft tissue damage is not clearly visible on x-ray), but to rule out other diseases such as cancer and hip dysplasia. An xray will confirm the presence of fluid in the joint as well as arthritis, which will help to confirm the diagnosis of a cruciate ligament injury.

Ultrasound for CCL Injuries

Ultrasound may be used to positively diagnose a CCL injury. Unfortunately a minority of medical clinics are equipped to do ultrasound, and many veterinarians rely on the results of the consultation with you, physical exam and ruling out any other conditions by x-ray to make the diagnosis of a CCL injury.

My Dog Has Received a Positive Diagnosis of a CCL Injury – What Are My Treatment Options?

There are two major avenues for treating a dog knee ligament injury – conservative management or dog knee surgery.

What Is Conservative Management?

Conservative management is a non-surgical option for treating cranial cruciate ligament (CCL) injuries in dogs. Depending on the size of your dog, the severity of the injury, presence of other damage (particularly to the meniscus – remember, this is the part of the knee that acts as a shock absorber) and the duration of time since the onset CM may be a good option for your dog. As mentioned above, dogs weighing less than 25 pounds tend to have better outcomes using conservative techniques than larger dogs.

A variety of techniques can be used if you choose Conservative Management (CM) for your pet.

Conservative Management Includes:

“Standard” Conservative Management

• Rest – Your dog should remain inactive during the recovery period, abstaining from rough play, prolonged exercise or any movement that may cause any pressure or unwanted movement within the knee joint.
• Weight Control (and reduction if necessary) – One way to reduce stress on the joint is to keep your dog’s weight under control, and if possible, underweight is better during the recovery process.
• Anti Inflammatory Medications – There are a number of Holistic (ex – Yucca Root) and Prescription (ex – Rimadyl) medications available that can help to make your pet more comfortable as the knee heals.

“Optional” Conservative Management

• Dog Knee Brace – There are a variety of dog knee braces available including the orthopets canine stifle brace and atrac dynamic brace.
• Veterinary Acupuncture – Acupuncture for dogs is available, and can help to de-stress your pet as their body heals.
• Veterinary Chiropractic - A chiropractor can work with your dog to make sure your pet is free from any subluxations or other blockages.
• Physical Therapy for Dogs – Working with a certified canine physical therapist can help to ensure your dog maintains muscle tone and range of motion in the leg following their injury.

What Are The Different Types of Surgery for Dog ACL Injuries?

Dog Knee Surgery Options:

TPLO Surgery (tibial plateau leveling osteotomy)

This surgery adjusts the slope of the tibial plateau (preventing unwanted forward motion) by cutting and rotating the top of the tibia, and keeping it in position with a bone plate (which can be removed after healing).

TTA Surgery (tibial tuberosity advancement)

The TTA surgery also focuses on changing the angles of the bones within the knee joint. In a TTA the tibia is cut and moved forward to create stability. The new position of the bone is held into place with a bone plate (which can be removed after healing).

TTO Surgery (triple tibial osteotomy)

The TTO is a combintation of the TPLO and TTA techniques. It moves the tibial crest forward, as a TTA does, and also adjusts the tibial plateau to 90 degrees, as the TPLO does.

Tightrope Surgery

Tightrope CCL is an extra capsular technique using the lateral suture stabilization (LSS) procedure in conjunction with a material called FiberTape to provide bone to bone stabilization.

Extra Capsular Suture (traditional repair, extracapsular imbrication)

This is referred to as a traditional repair because this was once the conventional treatment for CCL tears. The extra capsular suture uses a strong leader line suture in a figure eight pattern around the knee to provide stability and keep the knee in a normal position.

Fibular Head Transposition (fibular head transfer)

The fibular head transfer surgery utilizes another ligament in the knee, the lateral collateral ligament, to take the place of the CCL. In this surgery the fibula is rotated so that the lateral collateral ligament can perform the function of the CCL.

Dog CCL Surgery Recovery

Depending on where the ligament surgery was performed, your dog may stay overnight to be monitored and receive pain medications following the procedure. TPLO surgery recovery can be different from TTA surgery recovery, so it’s important to follow the recommendations of your vet during the post operative period. Your dog’s sutures will be removed within a week or two of the procedure, and follow up appointments are typically done at 2 weeks, 4 weeks, 8 weeks and 12 weeks. Again, depending on the type of surgery done, radiographs may be done during these follow up appointments.

During the 6-14 week period following surgery it is very important to severely limit your pet’s activities. For approximately three months following dog knee ligament surgery your pet should be confined to a crate, small room or enclosed area when you are not able to be with your pet. You will probably want to make use of a dog cone collar – Elizabethan collars or Pro collars are my favorite. Make sure to post operative doggy proof your house and make sure they have no opportunity to slip, slide, jump up onto furniture, climb up stairs or engage in any activity that may damage the healing knee.

While outside you should accompany your dog for bathroom breaks, and they should always be controlled on a leash – you never know when a post operative dog may get the urge to chase a squirrel! You may increase the length of walks during the recovery period under the recommendation of your veterinarian and judging by how well your dog is recovering. I strongly recommend not letting your dog off leash at all during the first few months following surgery just to be on the safe side. Your veterinarian will most likely encourage you to have your pet use the injured limb immediately following surgery, but do not overdo it. Physical therapy during this time can also be very beneficial, and swimming is a great way to ensure your dog gets to use their leg (helping to maintain strength and muscle mass) without engaging in any activities that may be harmful to the knee.

Cruciate Ligament Injury in Dogs is a post from: Dog Knee Surgery and Ligament Injuries

The mechanism for cruciate ligament degeneration prior to rupturing is not clearly understood, but it is clear that certain factors predispose certain dogs to sustaining a cranial cruciate ligament injury. Certain breeds, such as Labradors and Rottweilers (and other large breed dogs), are much more commonly affected than others, as well as dogs that are overweight. This suggests there is an inherited component to the condition, possibly related to conformation or gait and/or the displacement of weight within the stifle (knee) joint. While there is nothing that can be done to prevent CCL injury, by recognizing the symptoms of CCL damage soon after onset you can give your dog a head start with recovery.

What Causes the CCL to Rupture? is a post from: Dog Knee Surgery and Ligament Injuries

Cranial cruciate ligament tears and ruptures can happen to any dog (or cat, although it is not nearly as common), but there are certain risk factors that make particular breeds of dogs more susceptible to this type of damage. CCL injuries are one of the most common orthopedic injuries in dogs, and is the most common cause of degenerative joint diseases in the stifle joint, like arthritis. While there is no way any dog can completely avoid their risk of CCL injury, there are a number of risk factors owners should be aware of, especially if they suspect their dog may have injured their stifle (knee).

Age is also a risk factor for CCL injury, and there are two types of CCL onset related to a dog’s age when the injury occurs. Chronic onset, degeneration over time with subsequent rupture (usually from aging), occurs in 80% of cases and occurs in dogs 5 to 8 years old. Acute onset, a tear caused by injury, is most common in dogs under 4 years old. Young dogs of large breeds are more susceptible to rupture than young dogs of small breeds. Older dogs are also at greater risk for CCL tears if they already have arthritis and/or have decreasing musculature, especially surrounding the knee joints.

To sum it up, there is no way you can protect your dog from a CCL injury, but there are risk factors which make dogs more likely to sustain a serious cranial cruciate ligament tear or rupture. Large and giant breed dogs do more commonly sustain CCL injury, but this is usually compounded with other risk factors, which are mentioned below.

Risk Factors in Dogs for CCL Damage:

• Age
• Arthritis
• Previous injury to knee joint
• Overweight
• Large or giant breed
• Poor musculature, especially surrounding the joints
• Structural abnormalities – luxated patella, etc.

Are CCL Injuries More Common in Certain Dog Breeds? is a post from: Dog Knee Surgery and Ligament Injuries

When there is a joint injury like a cranial cruciate ligament (CCL) rupture, it is important for the vet to try to preserve the menisci to the greatest extent possible. Loss of all or part of a stifle’s meniscus has the potential to accelerate the breakdown of articular cartilage with resultant DJD (Degenerative Joint Disease). The more of the meniscus that is lost through injury or through surgical removal, the less stable the joint will be in future, and the greater the potential for DJD, i.e. arthritis. The risk of further damage to the menisci is minimized by greatly reducing activity after ligament injury while the dog’s body re-establishes stability in the joint.

Whether or not your dog has surgery to temporarily stabilize the joint after ligament rupture, long term joint health is best assured by careful restriction during a slow return to normal activity over a period of at least several months, and by avoiding unnecessary surgical removal of all or part of the meniscus. People are sometimes told that their dog’s meniscus is damaged and that the meniscus cannot heal on its own therefore surgery is always required for meniscal injury. This is not true. In fact, there are two basic methods used by the body to repair meniscal damage:

1) Extrinsic - When meniscal tear occurs, a fibrin clot forms within its margins. This fibrin clot contains factors that act as agents for reparative cells to migrate and develop. Further inflammatory response and angiogenesis result in healing of the lesion in about 10 weeks in the dog. It may take months or even years for the scar tissue to change into fibrocartilage, resembling that of the meniscus. Differences between the newly formed fibrocartilage and mature fibrocartilage are recognizable and include increased cellularity and, at times, increased vascularity in the repair tissue.

2) Intrinsic - The cells within the meniscus itself have an inherent capability to generate a healing response. The cells of the meniscus are assisted by the fibrin clot, which not only acts as a scaffold, but also provides stimuli to promote healing.

Why should I be wary of a veterinary surgeon removing my dog’s mensicus during ccl repair surgery?

Eventually the more observant doctors woke up to the fact that the menisci were important joint components, and in recent years the more enlightened surgeons have become less aggressive in removing all or part of the meniscus. But there are still many vet surgeons who cut far too much of a meniscus away. Some of these guys just can’t stop themselves from getting in there and excising something. Their approach is often, “When In Doubt, Cut It Out” and is a rule of thumb often used in canine stifle surgery. They won’t usually tell clients that of course. The history of surgery in general is filled with examples like this of too-aggressive surgical intervention. Never be too trusting of a surgeon. They became surgeons to cut; not to tell you no cutting is needed.

Source:

About the Dog Meniscus – http://home.earthlink.net/~tiggerpoz/id16.html

Does My Dog Need a Meniscus? is a post from: Dog Knee Surgery and Ligament Injuries

It is common for dogs with cranial cruciate ligament damage to also have injury to the mensicus. Simply put, the meniscus is a secondary structure in the knee that helps to provide lubrication for the joint, while also functioning in shock absorption and weight bearing. The menisci (plural for meniscus) are pads between the bones of the joint that function in stability, load sharing, transmission of force, and shock absorption, in addition to joint lubrication. It is important to understand that after a ligament injury the menisci are vulnerable to further damage because of the instability of the stifle. Maintaining proper restriction during recovery by avoiding all stressful actions like running & jumping will minimize the risk of further meniscal injury, as well as provide the best conditions for the re-stabilization of the stifle and healing of any meniscal injuries that occured at the time of the original ligament damage.

The menisci are ‘fibrocartilaginous’ structures which can be thought of as spongy elastic pads between the bones at the joint, composed predominately of collagen and open space filled with joint fluid. The menisci contribute significantly to joint lubrication. The fluid of the joint moves through the porous structure of the menisci. Because 70+% of the total weight of menisci is fluid, normal movement causes compression of the menisci which squeezes fluid out from them into the joint space to allow smoother gliding of the joint surfaces. The menisci re-expand when the pressure is reduced, drawing in fluid. This pumping action also helps to distribute synovial fluid throughout the joint and aids in the nutrition of the articular cartilage.

By compressing under a load, the menisci also act as shock absorbers, absorbing energy and reducing the shock to the adjacent cartilage and subchondral bone. The menisci protect the cartilage by acting as buffers between the surfaces of the femur and tibia where they meet and move against each other at the joint. The menisci transmit forces across the knee joint. The menisci provide added mechanical stability to the normal gliding of the femur on the tibia by deepening the surface of the tibial plateau to increase the congruity between the femoral condyles and the tibial plateau.

What is a Meniscus? is a post from: Dog Knee Surgery and Ligament Injuries

TTA is the abbreviation for tibial tuberosity advancement.  The TTA is among the newer techniques for cranial cruciate ligament repair of the canine stifle, making its appearance roughly 10 years ago. The TTA technique was developed in 2002 at the University of Zurich, and, biomechanically speaking, the procedure is very similar to the TPLO, without carrying many of the risks. In fact, the TTA is a simpler procedure for veterinary surgeons to perform than the tibial plateau leveling osteotomy, or TPLO, and works to correct the injured stifle without over correcting the angle – as TPLO often does.

During the procedure an incision about 4 to 6 inches will be made along the dog’s stifle to provide the surgeon access to the knee tissues. The torn/ruptured cranial cruciate ligament, or CCL, is completely removed and the mensicus is examined. The veterinary surgeon will determine at the time of surgery the extent to which the mensicus has sustained damage and will work to remove the injured tissue. The doctor will take care to only remove meniscal tissue that is damaged, as dogs with some intact, healthy meniscus tend to do better long-term than dogs receiving a complete mensicectomy.

A transverse osteotomy is then performed just behind the tibial tuberosity (a non weight bearing part of the knee), which creates a groove in the bone, allowing the tibia to be advanced to its new position. The tibial tuberosity is then advanced to achieve a perpendicular relationship between the tibial plateau slope and patellar tendon, resulting in a stable joint. Examination of the stifle with a-ray radiography prior to surgery will make sure the surgeon has the proper size implants available for the procedure, and the advanced tibial tuberosity is held in place with titanium implants. Lastly, a bone graft is placed into the area of the osteotomy to stimulate healing and the incision is closed with sutures.

TTA Surgical Procedure is a post from: Dog Knee Surgery and Ligament Injuries

**UPDATE 2/2011 - The information below regarding UPenn Veterinary’s stance on TPLO surgeries is no longer correct. UPenn is, in fact, performing TPLOs on dogs. I will keep up the link to the article below discussing their previous stance toward TPLO so that people may have access to all of the information. Everything else in this post regarding the way the extracapsular repair surgery for dogs is performed remains correct and up to date.

In the extracapsular imbrication, also known as the traditional method and lateral fabellar surgery, your dog will have a strong leader line placed within the knee to provide stabilization. Some veterinarians will only perform this procedure on small dogs and cats, while others will use the technique on dogs of all sizes. There is no definitive study evidence showing that tibial plateau leveling osteotomy, or TPLO, is superior to the extracapsular method in large dogs, in fact, the University of Pennsylvania, one of the nation’s leading veterinary hospitals, will not perform the TPLO procedure as the cost/risk risks do not outweigh the benefits. For more information see the article here – University of Pennsylvania Veterinary Hospital – TPLO Surgery

During the extracapsular imbrication a large, non-absorbable suture is placed in a figure eight pattern within the structure of the knee. The leader line is placed around the lateral fabella through a hole in the tibial crest, mimicking the course of the CCL and preventing forward movement of the tibia, also known as the clinical drawer sign. The monofilament nylon leader line has a range of tensile strengths, and depending on the size of your dog, your veterinary surgeon will select a size between 40-100 pounds. Over time scar tissue will develop on the side of the knee joint where the large suture was placed, providing stifle stability in the absence of the canine cruciate ligament.

Extracapsular Imbrication Surgery, Traditional Repair Procedure is a post from: Dog Knee Surgery and Ligament Injuries

TPLO, also known as Tibial Plateau Leveling Osteotomy, is a surgical procedure in which the head of the tibia is surgically altered and plated to create a new joint angle. A new angle is created in the stifle to prevent the femur from sliding off of the tibia. This is a very invasive procedure, as it involved the surgical cutting and plating of bone, and as with all surgery, there is a risk of both operative and post operative complications which need to be taken into consideration before going forward with a TPLO.

How the TPLO procedure is performed:

First, the torn ends of the cranial cruciate ligament will be completely removed by the surgeon. Next, the medial and lateral meniscus cartilages will be examined for any signs of damage. The medial meniscus is damaged in about 50% of dogs with CCL ruptures, and the damaged meniscal cartilage will also be removed so as to not hinder the healing process or cause any additional discomfort. Your dog’s veterinarian will take care to remove only the parts of the meniscus that have been damaged as a result of the unstable femur bone pinching the meniscus during normal activity. Studies have shown that dogs with partial menisectomies have less arthritis than dogs with complete meniscus removal.

TPLO Surgery Procedure is a post from: Dog Knee Surgery and Ligament Injuries