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Cruciate Disease Overview
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Information on the condition and its management options.

The knee (stifle joint)

The stifle has four ligaments which provide stability to the joint, the cranial and caudal cruciate ligaments, and the medial and lateral collateral ligaments. The cranial cruciate ligament prevents hyperextension of the stifle, internal rotation of the tibia with respect to the femur, and cranial drawer (the tendency of the femur to slide backwards on the surface of the tibia when weight bearing).

There are also two fibrous discs (menisci) that are located between the femur and the tibia. These act as shock absorbers and secondary stabilisers within the joint.

Cruciate disease

Cranial cruciate ligament (CrCL) disease is the most common cause of hind limb lameness in the adult dog. Unlike in the human where cruciate ligament damage is most often caused by an acute traumatic event/injury (footballers who hyperextend or excessively rotate their leg for example), in our pets, it is typically as a result of progressive degeneration of the ligament (over 90% of patients). The ligament weakens over time and eventually starts to tear.

It is still unclear as to the exact reasons why some dogs are more susceptible to this condition than others but theories suggest degeneration can be attributed to a variety of factors such as genetics, conformation, environmental, immune – mediated & inflammatory, none of these however have definitely been proven to be causative.

Studies have shown that overweight pets are over 3 times more likely to develop cruciate disease.

Symptoms:

The signs associated with the initial stages of cranial cruciate ligament disease can be subtle and are not always recognised. These signs can include stiffness after rising from rest or occasional lameness. It is often not until the ligament weakens to the point where it tears completely that obvious signs of lameness and a reluctance to bear weight on the affected leg are evident.

Most animals will start to use the leg within 2-3 weeks of the injury if no surgical repair is performed. However, the body’s natural healing of the area is no substitute for the ligament and, over time, secondary meniscal damage and/or osteoarthritic changes develop which contribute to a further reduction to the function of the limb.

Diagnosis:

This can often be achieved through an examination by your vet. Palpation/manipulation of the joint can reveal instability which is an indicator of cruciate ligament damage.

Radiographs are often advised to support the diagnosis Characteristic changes include those associated with increased fluid (effusion) in the joint and the presence of arthritis.

Early cases can be difficult to diagnose (if the ligament has not fully torn) and the joint still has relative stability. However the characteristic changes on radiographs support the diagnosis, and as we know degeneration of the ligament will progress, surgery is also recommended for cases of partial ligament rupture.

Treatment:

Occasionally small dogs and dogs with other health problems can be managed non-surgically by means of exercise control, physio/hydrotherapy, diet modifications and anti-inflammatory drugs. Long-term medication is not recommended however and if the patient requires this for a pain free life then surgery should be considered to correct the problem.

The majority of dogs, however, require surgery to enable a good return to function and long-term comfort.

The stifle joint is anatomically complex and as a result there are a number of surgical techniques available. Your surgeon will select the most appropriate for your pet -this may include one or a combination of the following:

  • Lateral suture
  • Isometric lateral suture
  • Tibial Tuberosity Advancement
  • Cranial Closing Wedge Ostectomy

Outlook:

This can be variable depending on the treatment option. Please view our information sheets on the different surgical techniques for more detailed information regarding expectations on recovery.

KEY POINTS

  • Progressive degeneration of the Cranial Cruciate ligament.
  • Multifactorial causes – genetics, conformation, environmental, immune – mediated & inflammatory.
  • Overweight pets are 3 times more likely to develop cruciate disease.
  • Often first signs are mild lameness & reluctance to weight bear on the affected leg.
  • Most animals require surgery to correct the problem.
  • Secondary osteoarthritis will develop.