In dogs, as in humans, the anterior cruciate ligament often tears. This strong ligament connects the thigh bone to the shin bone in the knee joint and prevents the knee from overextending or twisting. However, while cruciate ligament tears in humans are usually traumatic in nature (caused by sports accidents of all kinds), in dogs the ligament gradually breaks down over a longer period of time (degeneration).
The exact causes of cruciate ligament rupture are still unknown. However, due to specific breed predispositions, it is assumed that genetics play a role in its development. Labrador Retrievers, Golden Retrievers, Rottweilers, Boxers, and Newfoundlands, for example, suffer from cruciate ligament tears at an above-average rate. The fact that dogs that have been affected once also develop the condition in the other limb suggests a genetic cause.
In the majority of cases, the anterior cruciate ligament tears in dogs, which can be explained by the fact that, due to the biomechanics of the dog's knee joint, this ligament is subject to constant tensile force, causing it to fray and eventually tear. As the number of torn fibers increases, so does the instability in the knee joint, which can often lead to osteoarthritis and meniscus damage even before the ligament is completely torn. Other factors such as obesity, hormonal imbalances, and inflammatory joint diseases also contribute to the development of cruciate ligament tears.
The most common symptom of the disease is hind limb lameness, which can vary in severity. Some dogs can hardly put any weight on the affected leg, while others only limp after getting up and then "break in." Dogs with bilateral cruciate ligament rupture find it particularly difficult to stand up and their gait is very stiff. As the disease progresses, the lameness can worsen due to advancing osteoarthritis and possible meniscus damage, and the muscles in the affected hind leg may atrophy.
If your dog suddenly develops severe or prolonged lameness, shows signs of pain when putting weight on the leg, or has swelling of the knee joint, you should take them to a veterinarian immediately.
An experienced veterinarian can make an initial diagnosis based on a detailed preliminary report, typical lameness, and possible joint swelling. With the help of a special passive movement test, they can confirm whether the anterior cruciate ligament is torn. To do this, they try to push the lower leg forward while the upper leg is fixed in place. However, this so-called drawer phenomenon only works if the cruciate ligament is completely torn. At the onset of the disease or if the ligament is only partially torn, this test cannot be performed. In advanced cases, severe osteoarthritis is often already present in the knee joint, which can also make it difficult to perform the test.
For these reasons, and to determine the degree of osteoarthritis, X-rays of the affected knee joint should always be taken. They can also be used to rule out other diseases and to plan surgery. Other imaging techniques such as ultrasound, CT, or MRI may also be used.
Minimally invasive joint arthroscopy is a good way to obtain accurate information about changes in the joint at an early stage, as it can provide information about the degree of osteoarthritis and any damage to the meniscus.
Since an untreated cruciate ligament rupture leads to progressive osteoarthritis due to joint instability, which significantly impairs the affected dog's quality of life, cruciate ligament ruptures in dogs are usually treated surgically. Conservative treatment of cruciate ligament tears is not recommended for dogs weighing more than 10 kg. Smaller dogs can be treated with physiotherapy and anti-inflammatory painkillers, but a complete recovery is not to be expected.
To date, around 50 different surgical techniques have been developed, none of which enable 100% restoration of normal mobility. A distinction is made between ligament replacement methods and methods for changing the biomechanics, which render the cruciate ligament superfluous.
With the help of various replacement ligaments made from either strong muscle bundles, skin, tendons, fascia or synthetic ligaments, attempts were made, especially in the early days of small animal orthopaedics, to replace the torn cruciate ligament. Nowadays, this technique is only used successfully in small dogs on rare occasions, as it involves a healing and rest period lasting several months.
The aim of these methods, which were only developed about ten years ago, is to reduce or completely eliminate the force acting on the anterior cruciate ligament. This can be achieved by raising the lower leg plateau or by advancing the front edge of the lower leg. Both methods require the bone to be cut and reattached, which requires special expertise on the part of the surgeon and special equipment.
Tibial plateau leveling osteotomy (TPLO) is a surgical procedure in which the lower leg bone is cut with a circular incision and screwed back into place at a different angle using specially designed plates. This changes the geometry of the knee in such a way that the tensile forces acting on the anterior cruciate ligament are eliminated.
Tibial tuberosity advancement (TTA) also changes the biomechanics of the knee joint by cutting the bone, but using a much less invasive surgical method than TPLO. Here, the front, non-weight-bearing edge of the lower leg bone is cut, moved forward, and fixed in this position using special plates and screws. This shifts the point of attachment of the patellar ligament so far forward that it is at right angles to the joint surface of the tibia, thereby restricting excessive movement in the knee joint. This operation takes much less time than a TPLO and does not require the knee joint to be opened during surgery, which significantly reduces the risk of anesthesia and infection. The success of this method can often be seen just a few days after the operation when weight is placed on the leg.
Both TPLO and TTA require good and consistent aftercare for several weeks, during which the dog must not jump, run, or play and must only be walked on a leash for short periods to avoid compromising the healing process. In many areas, TTA is now superior to TPLO in terms of earlier weight-bearing capacity, lower risk of anesthesia and complications, and less extensive surgery. Nevertheless, your veterinarian must decide which method is best for your dog in each individual case.
The healing process should be checked approximately two months after the operation with new X-rays. Physiotherapy can be used to support muscle development.
Thanks to modern surgical techniques, the prognosis for recovery from a cruciate ligament rupture is now very good. Dogs that have undergone surgery show hardly any restrictions to their original mobility.
The hereditary nature of this condition makes it difficult to prevent. However, a balanced diet to avoid obesity and malnutrition can make a significant contribution to reducing the risk of cruciate ligament rupture. You can use the petsXL health passport to store and monitor your dog's weight data in a clear overview. Particularly in large dogs and giant breeds, strenuous activities such as cycling or jogging should be avoided and a steady and regular exercise routine should be aimed for.
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