Cruciate disease is a very common problem causing lameness in a hindleg of a dog, that we are very used to seeing regularly at Alphapet.
The cruciate ligament is within the stifle (knee) joint, holding the femur (thigh bone) in line and stable with the tibia (shin bone).
Sometimes, a dog can suddenly tear the cruciate ligament, similar to a footballers injury. This could happen when they are running, often when they change direction quickly. The dog can go from appearing fine, to being so lame they hold the leg off of the floor when they are walking. Other times, it can be a more gradual thing, where the dog is a little bit lame for a while but it doesn't improve with rest in the normal way like a muscular sprain would.
If a dog comes to see a vet with a hindleg lameness, the vet will check it for cruciate ligament problems in a few different ways. Firstly, the vet will want to see how lame the dog is, sometimes this is obvious, but sometimes we take them outside to trot up and down to see how they are walking. We will have a feel of the leg generally, checking the muscle tone, whether any areas are swollen, or painful. We will also check the foot, the hock (ankle) and the hip joint for any problems. There are 2 specific tests the vet will need to do to feel whether the cruciate ligament is intact. The cranial drawer test checks whether there is any abnormal movement between the femur and the tibia, it is easiest to perform with the dog laying down on his/ her side. The tibial thrust test is checking the movement of the leg as would occur when the animal weight bears, which can be done standing. Sometimes the dog may need to be sedated for these tests, as if the area is painful they can be difficult to perform.
The next step in diagnosing a cruciate problem would be for us to have the dog in for a few hours for sedation to perform the above tests accurately, and to take some X-rays of the knee joint. Although we cannot actually see the cruciate ligament on the X-rays because it is soft tissue and the X-rays show up bones, we can see secondary changes, such as arthritis, caused by the excessive movement of the joint, and whether the joint is swollen. They also allow us to check nothing else is going on with the joint, and plan for surgery, if required.
When a diagnosis of cruciate disease has been reached, there are a few different options in terms of how it can be treated.
If the dog is a very small breed dog, and it has not been lame for long, sometimes the knee joint will fibrose (scar) to hold itself stable, without the need for surgery, but these dogs require very strict rest and anti-inflammatory medication for this to occur. Some dogs treated in this way may still have ongoing lameness, and thus require surgery at a later date.
The simple way of surgically stabilising a ruptured cruciate ligament, is to place a large suture behind the fabella (a small bone behind the stifle joint) and through a tunnel in the tibia (shin bone) under the stifle joint, which acts as a replacement cruciate ligament. This holds the joint still for a few weeks in which scar tissue to forms around the knee to stabilise it for longer term. This can work well for smaller breeds of dog, but return to full activity can be unpredictable particularly in larger breeds. Several AlphaPet Vets regularly perform this surgery.
The gold standard surgical treatment is a TPLO (Tibeal Plateau Levelling Osteotomy) surgery. This is a more specialist procedure where the top of the tibia (shin bone) is cut, rotated a little, then stabilised with a metal plate and screws. This changes the angle of the joint itself, and therefore stops the dog from needing a cruciate ligament to stabilise the joint when it is weight bearing. This is the ideal surgery for large dogs with cruciate disease to have, they are comfortable very quickly after the surgery and after their postoperative rehab period, can go completely back to normal exercise without any lameness. At AlphaPet, we have visiting specialist surgeons perform these sort of operations at our West Meads hospital. Alternatively, we can refer your dog to an external referral hospital.
With all forms of treatment, a dog will inevitably develop some arthrtitis in the joint after having had cruciate disease. This is minimised by a dog having a TPLO surgery to fix the problem. As part of all forms of treatment, keeping the dog at a healthy slim weight is very important, and we often use physiotherapy and hydrotherapy as a great way to get the dog moving normally again as soon as possible.
If you have any further questions, or think that your dog may be suffering from cruciate disease, then please give us a call on 01243 842832 to discuss this further, or arrange an appointment.