Guest Article - Canine Cruciate Case Study

By Sue Thompson
AMCUK HSC 2018

In April 2016, one of our mal girls Rio (almost 6) began holding up a hind leg, the result of my thinking a 2-tier platform bed for her and her sister, would be a good idea. Rio being hyperactive, obviously misjudged it in one of her mad moments.

Our vet diagnosed a torn ACL and gave us the option of pain relief and rest (not in Rio’s vocabulary) but assured us that in his opinion she would be back within the week for a very expensive op.

Here’s a bit of info on the canine cruciate ligament, the injury and options for repair, which I hope you will find helpful should your mal experience this all too common problem.

The canine cruciate ligaments

Two ligaments (bands of tough fibrous tissue) connect the femur and the tibia and are arranged like a crisscrossing letter ‘x’ on the dog’s knee (stifle), one being the anterior cruciate ligament (ACL) or cranial cruciate ligament (CCL), the other being the caudal or posterior ligament. The ACL (cranial) is the one dogs rupture more often and attaches the back of the femur (thigh bone) to the font of the tibia (shin bone), preventing the tibia from shifting forward relative to the femur.

There is an increased risk of tears with certain factors such as degeneration due to ageing, joint abnormalities, arthritis, jumping and twisting, jumping down (landing holds a higher risk for rupture) and overweight.

Precautions

Avoid having your dog run on slippery surfaces including wet grass/ice.

Be careful of your dog jumping on and off furniture and out of high car tailgates, etc.

Try to maintain a fit, not fat, bodyweight.

If your dog has a familial predisposition to torn ligaments, it may be advisable to consider laser or light therapy to help strengthen ligament attachments and also on the opposite leg of dogs already dealing with a cruciate tear.

Surgical procedures

There is no ‘one size fits all’ procedure and surgical techniques are advancing all the time.

ECLS – Extracapsular (outside the joint) ligament suture

This particular technique for fixing a torn ACL in dogs is considered the most conservative of all the approaches, but it addresses the main problem with the dogs ACL. The traditional ECLS technique is the oldest surgical correction for cruciate ligament injury in dogs. The name of the procedure originates from the fact that the joint is stabilised outside the joint capsule (externally). Traditional ECLS is considered adequate for smaller dogs. Extracapsular repair is a major procedure that requires a recovery period of up to 12 weeks.

TPLO – Tibial Plateau Levelling Osteotomy

By cutting, plateauing and plating the tibia, the femur movement is stopped, preventing pain and joint degeneration. The TPLO is recommended for medium to large or giant breeds of dogs.

Aftercare – Taking a number of months, pain relief, antibiotics and very restricted exercise (toilet breaks) with cage rest for the first few weeks, then restricted lead walks, maybe hydrotherapy, probable follow-up X-rays.

TTA – Tibial Tuberosity Advancement

TTA surgery involves cutting the top of the shin bone (the tibia), moving it forward and stabilising it in its new position in a number of ways. The aim is to make the tibial plateau perpendicular to the patella tendon to prevent the shin bone moving forward. The knee then feels stable for the dog when weight-bearing, despite the fact that the ligament has been ruptured and not directly repaired. Aftercare following TTA surgery is very important, with rehabilitation taking a number of months.

Negatives for surgery

Cost – ECLS is probably the cheapest option at around £1,000 plus, but also probably not adequate for our heavily built malamutes.

Both TPLO and TTA will start around £2,000 and without insurance will be prohibitive for many owners.

Rehabilitation – many households may struggle because of work constraints, etc., to deal with the supervised aftercare, medication, then a restricted exercise regime over a number of months.

Age and health status – the operation itself may be problematic for a dog with other health issues. An old dog may not cope well with the long rehabilitation process.

Is there an alternative to surgery?

If you were wondering what would happen if your dog skipped the surgery in favour of resting, the prognosis appears to depend on great part on how large your dog is and how committed you are to the time it takes for the rehabilitation. Obviously any movement of the joint will cause pain, usually, your dog will keep the leg up. A severe ACL injury will be inflamed and require an anti-inflammatory (from your vet or a natural alternative) and rest until the pain is reduced. Reducing pain and pressure will allow the body to heal itself. If your dog is overweight, a diet is in order to relieve the pressure on the joint when moving. Specialised hydrotherapy may help by increasing muscle strength. Cryotherapy and laser therapy are offered by some vet surgeries or can be sourced elsewhere.

Orthotics

An external orthotics or knee brace can be used to support the joint. The purpose of using an orthopaedic brace is to support the joint and ligaments by allowing the relaxation of the injured legs. Braces are often made with hard elastic materials supporting between the femur and tibia and preventing unwanted movement of the knee joint. There is a huge variation in cost, shop around.

Dogs that are advanced in age or too young for surgery are often the ideal candidates for an orthopaedic brace. Braces can also provide an alternative when surgical treatment is not affordable for the owner.

Prolotherapy

Also known as nonsurgical ligament reconstruction is a medical treatment for chronic pain. ‘Prolo’ is short for proliferation, because the treatment causes the proliferation (growth, formation) of new tissue in areas where it has become weak. A proliferant (a substance that promotes tissue rebuilding) is injected into the affected ligaments or tendons causing a localised inflammation which ‘turns on’ the healing process and directly stimulates the growth of new collagen, strengthening damaged and weak ligaments and tendon tissue.

Prolotherapy is primarily used to treat joint pain and has been shown to increase joint ligament strength by 30-40% in humans. Clinical results using prolotherapy in dogs and cats appear to indicate the same response. As the tendons and ligaments grow stronger and more capable of supporting and maintaining normal joint stability, the pain is alleviated.

Prolotherapy is a possibility to consider particularly if your dog is older or could not undergo anaesthesia. Approx £250 an injection requiring a course of three treatments.

Stem Cell Regenerative Therapy

A relatively new treatment. It has been successfully used to treat arthritis and other degenerative conditions in dogs, with very exciting results. However, this therapy does require minor surgery to harvest the stem cells and anaesthesia for both the harvesting and the injection of the stem cells. Approx £2,000 per procedure.

Phototonic Light Therapy

So, how does red light actually help animals? Very simply, it delivers an energy boost to the cells, which provides wide-ranging health benefits. Red and infrared light can penetrate your pet’s tissue, muscles, tendons and even bone to increase blood circulation, further promoting and boosting the healing process. It increases oxygenation in the cell, cell generation and migration, circulation and lymphatic drainage, antibody production in the bloodstream, collagen production, which strengthens tendons, bones, cartilage, and skin, and suppression of enzymes that cause inflammation. Photizo Vetcare costs approx. £279.

So what did we decide with the hyperactive Rio?

We took into consideration that she was an outside dog, living with her sister, never still. She would not have taken well to cage rest for weeks and the probability of her returning amicably to life outside with her sister was remote in the extreme. So we opted for an OrtoCanis leg brace and invested in a Photizo light therapy device, which was used twice daily. Her leg brace was only removed for treatment and overnight (as it may be eaten). Her kennel activity was not restricted and no meds were given. As soon as the leg was braced she walked normally, after two weeks the brace was removed and – touch wood – she has had no further problems.