Rehab for a
torn CCL
Key symptoms to watch for Typical signs include acute three-legged lameness or toetouching, and barely any use of the limb. Occasionally, the lameness will be intermittent and chronic, then progressively worsen as the joint disease worsens. A CCL tear can also lead to injury of the meniscus. This is a cartilage cushion that sits inside the knee and serves as a shock absorber when a dog walks. “If the meniscus tears, it can very painful for the dog and must be treated surgically,” says Kurt Schulz, DVM, MS, DACVS, associate professor of surgical and radiological sciences at the University of California-Davis School of Veterinary Medicine. “About 50% of completely torn cruciate ligaments lead to meniscal injury. When the meniscus is torn, the knee will make a characteristic popping sound when the dog is walking.” A CCL rupture is usually diagnosed by manipulating the femur and tibia and detecting knee instability. X-rays may determine if there is any pre-existing arthritis and joint effusion, and to look at the positional relationship of the femur and tibia.
Surgical options Treatment typically involves surgery with post-op rehabilitation. Some patients benefit from rehabilitation and medical management alone, if the condition is not severe, and depending on how unstable the knee is. However, if there is a lot of laxity in the stifle joint and/or a meniscal tear as well, then it is imperative to correct the situation with surgery.
Whether or not surgery is needed to correct a ruptured cranial cruciate ligament, a combination of mechanical, physical and energetic rehabilitation therapies is necessary to get an injured dog back to normal again.
by Julie Mayer, DVM, CVA, CVC, CCRP
The purpose of any surgery for the cranial cruciate deficient knee is to eliminate too much movement between the femur and the tibia, and remove the whole or part of the meniscus if needed. Because this is a disease and progression usually results in osteoarthritis, correcting the biomechanics of the knee can help slow down degeneration.
forward under the femur, and also prevents internal rotation of the tibia. In dogs, unlike humans, cranial ligament rupture is typically not a result of trauma. The fibers of this ligament may fray over time from wear and tear, and when there is chronic mild inflammation and disease in the joint, enzymes deteriorate and weaken these tissues. Joint instability ensues and leads to osteoarthritis and/or a rupture/ tear of the ligament. Genetics and neutering pets too early may cause weak ligaments that can lead to rupture.
There are two categories of such surgeries performed in dogs. Repair with suture/rope material (Lateral Suture Stabilization, Tight Rope). Holes are drilled through the bone to thread synthetic material from the femur to the tibia. Repair with a cut in the bone (Tibial Tuberosity Advancement, Tibial Plateau Leveling Osteotomy) or repositioning the fibula bone (Fibular Head Transposition). TTA and TPLO involve cutting part of the tibia and repositioning it with plates and screws to change the anatomy and biomechanics so the stifle can function without the CCL. FHT surgery repositions the fibula and the attached lateral collateral ligament to mimic the CCL.
An exercise ball can be used for rehabilitation purposes.
M
any orthopedic surgeons and rehabilitation veterinarians report that cranial cruciate ligament ruptures or tears are the most common limb issues they treat. There are two cruciate ligaments – cranial and caudal – inside the stifle (knee) joint. They connect the femur to the tibia, which is needed for weight bearing. They form an “X” pattern relationship with each other to stabilize the knee. The cranial ligament is injured the most. This ligament prevents the tibia from gliding
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integrative veterinary care
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