One of the most common orthopaedic problems we treat at the Oak is ‘cruciate disease’ (rupture or sprain of the cranial cruciate ligament – CCL) of the dog’s stifle. The dog’s stifle is very similar in anatomy to the human knee, but the mechanics are quite different as dogs spent most of their time with their stifle held in ‘flexion’ (ie slightly bent), whereas us humans tend to stand with our knee straight. In humans cruciate ligament t rupture often happens as a result of a sporting injury, especially during those sports where we hold our knees bent and then twist them – football, rugby, skiing for example. In dogs cruciate ligament disease is usually a result of constant pressure and wear-and-tear of the ligament as it is constantly under stress. In certain breeds of dog there are additional strains on the ligament due to the angle of the bones (the ‘tibial plateau angle’) and the physics occurring within the joint. This includes many of the larger dogs, such as Labradors (and crosses), Golden retrievers, Rottweilers, Poodles (and crosses) so their cruciate ligaments ‘give up the ghost’ at quite a young age. Often both stifles are affected, though not necessarily at the same time.
A typical cruciate case might start with occasional or mild limping in one or both of its back legs, which then becomes persistent. We will recommend radiographs which will show us any inflammation, increase in the joint fluid, secondary changes (osteoarthritis) and the position of the femur and tibia in relation to each other. Based on the size, age and personality of your pet we will discuss the options with you, to allow you to make the best choice for them. We will take into account whether or not you are able to participate in your pet’s post-op rehabilitation programme, and will support you and your dog every step of the way – until every step is sound again.
Due to the reasons behind the pathology there are different tactics we can use to deal with cruciate disease – we need to take an approach that suits the particular dog (it’s size, age and lifestyle), and the owner (your lifestyle and finances). It is important that we chose the technique that will best suit each individual.
For example, in small dogs some cases can improve without surgery, but may need intensive physio or rehabilitation exercises to make sure the muscles of the leg build up without damaging the unstable joint. Hydrotherapy with aquatic treadmill can be extremely useful for this.
In smaller and older dogs we may use a ‘leader line’ surgery, where we stabilise the joint using a line of nylon secured behind the femur and through a tibial bone tunnel. This acts as a prosthetic ligament allowing the inflammation in the joint to reduce and the muscles to build back up. However for young, lively, large-breed dogs this does not give enough stability for the long term, especially as the cranial cruciate ligament is not a simple ‘band’ that can be replaced, but a complex structure which cannot be easily mimicked.
For these larger dogs we perform a TTA surgery (Tibial Tuberosity Advancement), which changes the physics within the stifle so that it can become pain-free without needing a cruciate ligament. By altering the physics between the pull of the quadriceps muscle through the patella and the tibial plateau, the stifle no longer requires its CCL, so the inflammation and pain reduce, allowing muscles to build up and gait to improve. We use titanium implants to hold the parts of the tibia in the correct position, which then takes 6-10 weeks to heal. A TTA surgery generally results in better long term outcomes in large dogs than a leader line surgery, and dogs will use the leg much sooner after surgery – usually putting the foot down within 2 days of the operation. And some dogs walk out on 4 legs on the day of the surgery.
A stifle joint with CCL rupture, prior to surgery: (photo A)
Here is how a TTA operation looks on post-op radiography: (photos B and C)
In all types of surgery it is important that we look inside the joint for any damaged ‘meniscus’ (cartilage). A damaged, folded or torn meniscus can cause persistent pain and, if not removed, can affect long term mobility. We can also use platelet-rich-plasma or stem cell therapy in adjunct to surgery, or later in the dog’s life to assist with the inevitable osteoarthritis – both techniques are available at The Oak.
But for all CCL disease we cannot underestimate the power of non-surgical techniques – pre-operative, post-operative, or instead of surgery. Long gone are the days when we performed a surgery and expected the patient to improve on its own. At The Oak we use laser, acupuncture, massage, physio techniques and our aquatic treadmill to improve outcomes, all carried out by familiar staff who know your pet, in our own surgeries in Pembrokeshire. Our staff are well trained to administer these techniques, and we now have 3 hydrotherapists, 2 nurses with BSAVA Merit Awards in rehabilitation and 3 vets using acupuncture for acute and chronic pain conditions.
All TTA procedures are currently carried out by Caroline Gardner BVSc CertSAS MRCVS, RCVS Advanced Practitioner in Small Animal Surgery. All hydrotherapists are Level 3 qualified in Hydrotherapy. All Veterinary acupuncturists have completed the Western Veterinary Acupuncture introductory course.
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We care for your pets and farm animals providing the best quality service possible. At The Oak Vets, we deal with emergencies, preventative healthcare, and everything in-between.