Cranial cruciate ligament (CCL) disease is one of the most common orthopaedic conditions we see in dogs. Located within the stifle (knee) joint, the cranial cruciate ligament is one of the structures that prevents abnormal movement between femur and tibia bones. Rupture of this ligament causes instability of the stifle joint, resulting in severe pain, damage to cartilage within the joint, and ultimately osteoarthritis. In most cases, surgery offers the best prognosis for cranial cruciate ligament disease with most dogs regaining full use of their leg within a few months.
Causes of cranial cruciate ligament rupture...
Cruciate ligaments can rupture when subjected to excessive forces or trauma, but in most cases is due to Cranial Cruciate Ligament Disease. Cranial cruciate ligament disease is a chronic condition resulting in deterioration and weakening of the ligament, leading to persistent lameness and gradual tearing of the ligament, or in some cases a sudden complete rupture. For this reason, dogs that rupture a cruciate ligament have a high probability of rupturing their other cruciate ligament sometime after the first.
Treatment options...
The treatment options for cranial cruciate disease will vary depending on your pet's individual situation. When assessing your pet, we will take into account their age, size, medical and physical health, and radiographic findings. Although some dogs will do well with conservative treatment, surgery will offer the best prognosis for most dogs with cruciate ligament disease. At the Mornington Veterinary Clinic we routinely perform two different surgeries for ruptured cruciate ligaments; the Extracapsular Repair and the Triple Tibial Osteotomy (TTO).
EXTRACAPSULAR REPAIR
The extracapsular technique involves multiple steps. Firstly the stifle joint is inspected and the damaged cranial cruciate ligament is removed along with any damaged cartilage. The joint is flushed, joint capsule sealed and then infused with a long acting local anaesthetic to numb the joint. A nylon filament is then attached specific locations on the femur and tibia bones so that it emulates the function of the cranial cruciate ligament. Finally, the fascia/tissue that runs alongside the joint is altered slightly to further stabalise the knee when fibrosis develops.
Although most dogs will do extremely well with this surgery, certain dogs are at risk of breaking the nylon filament before fibrosis and healing has completed resulting in instability and need for repeat surgery. Those and highest risk are medium to large breed dogs, very active dogs, and dogs with abnormal joint conformation. These dogs usually do much better with the Triple Tibial Osteotomy technique.
TRIPLE TIBIAL OSTEOTOMY
The Triple Tibial Osteotomy (TTO) is a much more complicated surgery and one of the newest techniques developed for the stabilisation of knees with ruptured cruciates. This procedure results in stabilisation of the stifle joint by altering the shape of the tibia bone, hence changing the mechanics of the joint. The inside of the joint is inspected and the damaged ligament and cartilage removed similar to the extracapsular technique. The tibia bone is then cut in precise location and a wedge of bone remove prior to the tibia being realigned fixed with a stainless steel plate and screws. The location of the bone cuts are determined prior to surgery by measurements and calculations taken from XRays of the affected knee.
At the Mornington Vet Clinic, we have been achieving fantastic results performing the TTO surgery, with most dogs gaining almost complete normal usage of the affected leg within a few weeks.
If you would like further information on Cruciate Ligament Disease and its treatments, please feel free to call Dr Adam Stefani at 5975 3811
