Cruciate disease is a chronic degeneration of the ligament in the stifle (knee joint).
The cruciate ligament degenerates slowly over time and often goes unnoticed initially. The weakened ligament will tear easily during normal activity. A tear or full rupture of this ligament can cause instability of the stifle joint. The instability of the joint can cause damage to the pad of cartilage (meniscus) inside the joint. The damage to the meniscus can cause discomfort, significant lameness and will cause osteoarthritis.
A diagnosis of a torn or ruptured cruciate ligament is made by manipulating the joint; in some cases this requires sedation. Radiographs can be taken to assess levels of osteoarthritis in the affected joint; this will require a general anaesthetic.
There are a number of options available for treating cruciate disease. Smaller breed dogs may benefit from a period of rest and pain relief, physiotherapy and hydrotherapy. However surgery can be considered to offer a quicker recovery in combination with physiotherapy.
Larger breed dogs are always advised surgery as they are less likely to do well without surgery and will result in osteoarthritis. Physiotherapy and hydrotherapy are always advised for the post operative recovery period.
There are two types of surgery which may be advised at Girling and Bowditch:
∙ Lateral Suture Repair – this involves replacing the damaged cruciate ligament with an artifical, nylon implant. The implant is threaded through the joint to mimic the natural position and tension of the cruciate ligament. This will stabilise the stifle and allow the joint to repair.
However this type of surgery is not recommended for all patients. Small breeds, miniature and toy breeds may be advised this type of surgery but physiotherapy is highly recommended for the recovery period. Smaller breeds of dog find it easier to carry painful limbs than larger breed dogs. The recovery period with this surgery can be lengthy and extensive muscle wastage can occur if the affected limb is not used. Many patients will benefit from physiotherapy and hydrotherapy to strengthen the joint and surrounding muscles.
∙ TTA, Tibial Tuberosity Advancement Surgery – this surgery involves modifying the weight bearing angle of the joint to create stability. This removes the need for a cranial cruciate ligament. The joint is modified by cutting down through the Tibia and advancing the front section forwards. The strong ligament which holds the knee cap then prevents the joint from slipping during exercise. Titanium implants are used to hold the cut section of the Tibia in place.
This surgery is much more complex and time consuming, and is therefore more costly than the lateral suture surgery. However the long term prognosis following TTA surgery is better, resulting in better limb function and less arthritis in the future.
This surgery is recommended for most cruciate tear and rupture patients as the recovery time is much shorter than the lateral suture repair. Patients can start weight bearing on the affected limb 24-48 hours post-op. Physiotherapy is still highly recommended during the recovery period to strengthen the muscles surrounding the joint.