Crainial Cruciate Ligament Injury

The crainial cruciate ligament is located within the stifle joint (knee) and is partially responsible for maintaining the joints stability. Most of all, the ligament prevents forward and backward sliding of the femur on the tibia. Unfortunately, injury to this ligament is one of the most common orthopedic injuries in dogs affecting all breeds, ages, and sizes. The ligament can be slowly injured over time or be torn acutely due to trauma to the joint. Once the ligament is compramised or torn it allows abnormal sliding of the stifle joint, pain, and eventual arthritis. 

                                                

Stifle Joint

C = Crainial Cruciate Ligament

M = Medial Meniscus

This diagram shows a ruptured cranial cruciate ligament in figure 4. When pressure is placed on the knee from stepping this causes the tibia to go forward and the femur to slide down the back of the tibia (figure 4a).

Treatments

When the crainial cruciate ligament is injured or torn the disfunction of the joint will cause pain and with time arthritis. The degree and time frame of arthritis is dependant on the activity, size, weight and extent of the injury. There are two catagories of treatment that can be considered. Consevative and surgical. 

                                                                    Conservative

Conservative treatment of cruciate ligament injury consists of rest, protection of the joint, and pain management. With conservative managment of this injury arthritis will develop over the first few months and progress for the rest of the animals life. This can lead to debilitation to the point of not being able to use the leg in the future. Large beed and overweight pets tend to progress to this point much faster that smaller and lighter pets. 
                                                
                       Normal                             Arthritic

Typically, pets that rupture the cruciate ligament will be acutely lame and non-weight bering on the affected leg for 1-2 weeks. Slowly the lameness improves and by 2-4 months may have a fairly normal gait. By 1 month after the injury arthritis has already developed. Anti-inflammatory medications can control discomfort related to the injury and arthritis and are the main mode of long term treatment for this injury. A severely arthritic joint may eventually not respond to these pain medications. 

                                                                         Brace
WoundWear makes a brace that is designed to support the knee that has a cruciate injury. This support can improve function of the knee as wellas slow down progression of arthritis. However, the brace needs to be on during any activity to be most effective. Measurements of your pets body dimentions and an x-ray of the tibia must be taken to assure the proper fit of the brace.                                                   
                                                           


                                                                      Surgical Treatments

Surgical treatment consists of sugical techniques that either try to restore the function of the cruciate ligament with implants or change the forces on the knee to prevent abnormal movement of the joint during normal activity. The most common proceedures performed are Lateral suture, TPLO (Tibial Plateau Leveling Osteotomy) and TTA (Tibial Tuberosity Advancement).

With instability of the joint, secondary injury to the menisci (cushions within the joint) are common. With any surgical treatment of a cruciate ligament the menisci should be checked for damage and damaged portions removed. This will prevent future lamesses post surgery due to damage to the manisci. 
                                                               Lateral Suture

The Lateral Sutue technique involves placing a prosthesis, or suture, on the outside of the joint in a plane parallel to the cruciate ligament. This suture helps restore stability to the knee and with time scar tissue that forms around the suture provides further stability. With good stability abnormal movenet of the joint is minimized and thus arthritis is also minimized. Overactivity, obesity and limitations of the strength of the suture can cause failure of stability of this surgery.
                                              


                                                                       TPLO

The Tibial Plateau Leveling Osteotomy (TPLO) is a technique that changes the weight beaing surface of the tibia this stoping the abnomal movement of an injured joint during normal activity. The weight bearing surface is altered by creating a controlled fracture and rotating the top of the tibia to a more neutral or level position. A bone plate and screws stabilize the surgical site until healing is complete. The complexity of the surgery is moch more than that of the lateral suture but long term results are much better with little to no arthritic advancement noted. Overactivity and obesity can be just as detramental to this type of surgery causing failure of the plate. Infections and inadequite bone healing can be complications of this technique as well. 
                               
                               

                              Before Surgery                               

                               

                              After Surgery

             Home Care

Reguardless of what is done for a cruciate ligament injury several priciples apply.

Rest - Minimal to no activity for 2-4 weeks is recommended. Walks outside on a leash to urinate and deficate are allowed. Confining to a cage or small room may be necessary to restrict activity. Absolutely no running, jumping, climbing, or quickmovenents. 
Physical therapy - Iceing the joint 2-3 times per day for 10 minutes will minimize swelling and inflammation. Moving the joint back and forth to limits that the pet is not uncomfortable 2-3 times per day will help mantain flexability and muscle tone. 
Pain and anti-inflammatory medications - Reduction of pain and inflammation will speed up the bodys healing as well as make your pet much happier.