We see quite a few limping dogs in our emergency clinic. Most of these injuriesinvolve the rear limbs and occur after a dog has been playing or jumping off furniture. The most common injury that we see in the hindlimb is a cranial cruciate ligament tear.
Cranial cruciate ligament (or ACL) ruptures can be complete or partial. Partial tears typically worsen to full tears with time and strain. These injuries are usually diagnosed based on physical exam findings and sometimes radiographs. Animals with ACL ruptures have joint instability that leads to arthritis, other ligament damage, cartilage degeneration, fibrosis, and pain. This injury is seen very commonly with overweight pets. Weight control is very important to reduce the risk of additional soft tissue or orthopedic injuries.
These injuries can be treated with medical management or surgery. Medical management consists of pain medications, anti-inflammatories, and cage rest (usually at least 8-12 weeks). Bloodwork is typically performed before starting anti-inflammatories. This type of treatment can be successful in patients weighing less than 22 lbs. It is typically unsuccessful with patients weighing over 22 lbs or highly active patients. For these patients, we recommend surgical stability. In about 50% of cases, the ACL in the other knee can rupture due to the added weight the patient puts on it.
There are several surgical repairs that can be performed. Each surgical repair changes the mechanics of the knee.
- Lateral Wire Repair: This procedure involves placing a thick suture around the joint to help stabilize it. This procedure is typically used for smaller dogs (under 25lbs).
- Tibial Tuberosity Advancement (TTA): Uses an implant (cage and sometimes plate) to help stabilize the knee. This procedure can be used in a dog of any size but typically works the best in dogs approximately 25 lbs to 70 lbs.
- Tibial Plateau Leveling Osteotomy (TPLO): Uses an implant (bone plate and screws) to stabilize the knee. Can be used dogs of any size but typically works best for dogs greater than 70 lbs.
A TTA and TPLO are both procedures that alter the mechanics of the knee in a similar way. Your surgeon will recommend one of the procedures over the other based on surgeon preference and experience, complicating factors, weight/size, or activity level. Complications of these surgeries include infection, meniscal injury, implant complications, arthritis, or lack of stabilization. Long-term prognosis after these surgeries is good (typically 90% improvement).
Dr. Alec Land is our surgeon who performs all of these procedures. We recommend scheduling a consultation with him to discuss the best procedure for your pet.