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Dog Leg Injuries: Cranial Cruciate Ligament

The injuries a dog can sustain are mostly comparable with people’s injuries, because we are built in a similar way to dogs; unfortunately, soft-tissue damage and bone damage are common for each. Of course most people can report what has happened and what hurts, because we are good communicators; this makes our life easy in comparison to that of a dog, who can only show us what the problem is; sometimes these signs seem quite subtle, as their body-language isn’t our native tongue! Dog leg injuries are a common consequence of dogs running and jumping, especially in younger dogs where their exuberance can be uncontainable!

If you have more than one dog, there may be large variances in age between them. Be aware of the risks of an elderly dog or puppy over-exerting themselves, as described by Hartpury University: “Owners need to be aware that some dogs may push themselves beyond safe limits, particularly in multi-dog households where young dogs are exercised in a similar way to adult dogs.” and “Working and competition dogs should be given one day off a week to allow their muscles and tendons to recover.”  (Click here for the full article).

dog leg ligament injury examination
A leg examination of a working dog [by Staff Sgt Michael Ellis]

A limp or a lump can be checked out by a vet, with palpation, x-rays (maybe also MRI scans) and ultrasound to discover what has been damaged. After that, our dogs need to recover, and the best way to recover is to rest the limb for a while.

Cruciate Ligament damage

In humans a ‘blown out knee’ is often an Anterior Cruciate Ligament (ACL) tear or rupture; in dogs it is called a Cranial Cruciate Ligament rupture (CCL). Occasionally, the knee Posterior (Caudal) Cruciate Ligament can be injured but this is relatively unusual. Cranial Cruciate Ligament damage is the focus of this article.

Ligament damage around a knee is a common and painful injury, which can lead to joint instability and further damage. Long-term bone and cartilage damage will occur if the injury is not treated and allowed to recover properly. Unfortunately, it seems that osteoarthritis is usually already present when the joint is examined by a vet, and is always present after the injury. Rest for the dog’s leg and joint is essential, which is partly why your dog is holding their leg up! Your dog may show a slight or pronounced limp and could (or could not) have swelling around the knee as a consequence of the injury.

Their limp may progressively get worse over time because the ligament becomes more damaged as it is stressed; alternatively, lameness may suddenly show itself – usually at the point of final ligament failure after prolonged fraying. Bone may have been plucked from the ligament anchor-point as the ligament fibres tore away. You must see your vet if the limping is getting worse or the leg injury seems unchanging, the sooner the better.

Treatment

Surgery is often the best form of treatment but recovery may be slow and difficult; larger dogs will usually need to have surgery whereas smaller dogs (less than 10Kg) or those with minor damage can sometimes recover without surgery. Described below are three main types of surgery performed at present.

First option: the broken ligament is replaced usually by a very strong mono-filament suture (which may break in the end), or more rarely a graft of tendon from the dog; this is in the hope that the ligament will re-grow or the graft will anchor in place. As the damaged ligament is swimming in joint fluid and has no blood supply, this re-growth is difficult and sometimes fails to occur. It is more successful with smaller dogs, though in many dogs, ligament damage will occur again. A tendon graft will take around six months to grow firmly into place (click here , page 3).

Secondly is the option of a lateral suture (LS). This is where a suture (a stitch or row of stitches) or tissue is placed around the joint to replace the function of the torn cruciate ligament and provide some stability to the joint. This may work best with small dogs.

The third option is considered the ‘gold standard’ for overcoming a damaged or torn CCL, particularly in larger dogs. It involves surgery; this is Tibial Plateau Leveling Osteotomy (TPLO). A semi-circular cut is made through the top of the tibia (shin); the top section that has been cut off is then rotated relative to the lower section of tibia and screwed in place using a metal plate. The plate is to hold the position of the bones whilst bone re-growth occurs to permanently heal the cut. The consequent change of angle between the joint-half on the femur (thigh) to the joint-half on the tibia means that the CCL is no longer needed to stop the knee moving horisontally.

Healing from TPLO surgery is generally rapid.

  • Owners must not forget that their dog is recovering from a severed leg bone.
  • About half of all canine patients will begin walking lightly on the injured leg within 24 hours after surgery.
  • At two weeks after the operation, most dogs are bearing moderate to complete amounts of weight on the affected leg.
  • By ten weeks, most dogs do not have an appreciable limp or gait abnormality.
  • At four months after the operation the majority of dogs can begin walking and playing normally, with only the most stressful activities restricted.
  • Within 6 months, most dogs can resume full physical activity.

Smaller dogs and those with minor CCL damage may recover without surgery. Long-term rest (joint immobilisation) and physiotherapy, along with painkillers and anti-inflammatory medications will be required. Food supplements can help the pain, plus the recovery and re-growth process in some cases (see below).

Inflammation and dog leg injuries

About half of all dogs who rupture one CCL (cranial cruciate ligament) will then rupture the other CCL within two or three years; this is because of the extra load that was imposed upon the healthy knee during recovery (study results here). It seems that ligament injury is preceded and accompanied by joint inflammation and that the inflammation is a disease of all their joints and not just one. All joints had become inflamed when tested at a vet’s during diagnosis of a ligament tear in just one joint. One theory is that this is an autoimmune response caused by solvents (research here); heartworm preventatives (check here) or vaccinations (check here); these may lead to a predisposition towards CCL damage.

My article ‘Arthritis in Dogs’ covered the subject of inflammation and soft-tissue damage from other angles; click here to read it. Animals are fantastically complex, and no conclusions should be jumped to without your own research!

dog with injured and bandaged front leg

Pain and the lame dog

Pain-killers are an easy to administer and effective tool for soothing discomfort after leg injuries; medications such as nutraceuticals, NSAIDs (non-steroidal anti-inflammatory drugs), opioids and steroids are being refined all the time. The NSAID’s all seem to have more, and more serious, side-effects than the food supplements that assist in recovery. Be guided by your vet, but listen to your dog as well.

Your dog can use food supplements, some of which have some scientific and substantial anecdotal evidence to support their effectiveness in treating pain in and around joints in dogs. The following dog supplements seem to be two of the best:

YuMove 

This supplement has been tested on dogs by the Royal Veterinary College for effectiveness, and “…. The group that were given YUMOVE showed statistically significant improvements, the college said.” and that ” it has found the first ever clinical proof of the effect of joint supplements on canine mobility. ” The clinical study was two-and-a-half years long, with results published in 2014; the testing method “was developed to provide clear clinical results that veterinary professionals can rely on, and give confidence when recommending joint supplements to dog owners.” Click here to see the full report from the Veterinary College.

This is a highly-regarded supplement with thousands of people loving it for rejuvenating their older dogs with joint issues. Scientific research has shown that Green-Lipped Mussel can be good for reducing pain, that Hyaluronic Acid can help to thicken the synovial fluid in joints and that Glucosamine Hydrochloride can help joint-recovery and lubrication. Glucosamine Hydrochloride is the only variant of Glucosamine proven to work. YuMove also contains Manganese, which research has shown to support collagen formation in cartilage, tendons and ligaments. The Glucosamine Hydrochloride and Hyaluronic Acid in the supplement takes 4 to 6 weeks to reach therapeutic levels in the joints and tissue; patience and persistence are needed! (Click here and read the Appendix to find out more about the research, with links).

“HA [Hyaluronic Acid] plays a vital role in the development of cartilage, the maintenance of the synovial fluid and the regeneration of tendons (Toole, 1997, 2001).” Quoted from: agriculturejournals.cz – click here to see the research.

Turmeric Curcumin 

pain killer for dogs

Turmeric Curcumin is another well-regarded and long-established supplement which research has shown may reduce pain in joints and possibly cancer in scientific tests carried out . Anecdotal efficacy seems to be on a par with taking Ibuprofen for pain relief in people. (Click here and read the Appendix to find out more about the research, with links).

Curcuminoid is a part of the ginger spice called Turmeric, which has been used by people for thousands of years for health purposes. It is a potent antioxidant and anti-inflammatory which has been proven effective in both people and animals. Turmeric may help slow cancer and improve heart-health as well as being a powerful pain-reducer; it needs to be given with healthy fat (eg dog food) or a component of black pepper to ensure effective absorption in a dog’s gut.

For other non-drug natural treatment options, plus clinical proofs and references, see my Nutraceuticals article – click here.

Other treatment possibilities:

Holistic alternatives, acupuncture, cold-packs and expert massage have been used successfully in place of – or along with – pain medication. Some dogs demonstrate their pain far more than others; it can be very difficult to know how much discomfort your dog is in because some will suffer in silence. In pain, your dog may become grumpy and snappy, be reluctant or struggle when trying to climb steps or arise from the floor; they may also be snappy towards other dogs and shy of playing – and sometimes off their food. Chronically pained dogs can be grumpy, without anyone realising why, or that they are even hurting. We cannot leave our dog in chronic pain though, and chronic pain usually gets worse with time.

Rehabilitation

First stages

Rehabilitation needs discipline from you, because sometimes your dog won’t be convinced of the delicacy of their damaged body; re-injury can easily occur, especially when playing, without defined and enforced activity boundaries. This inattention is often true of us as well, but as responsible owners we have a duty of care towards our pets. Keep giving the pain-relief until you and your vet are sure that no more are needed; sometimes a lifetime supply for your dog may be required!

Bandages, braces, splints, casts or just anti-worry collars can be used at first depending on the injury severity and location. After treatment, your dog’s movements will need to be restricted; using a dog-crate/cage may well be necessary to prevent re-injury. Stopping your dog from ‘attending’ to a wound site and then removing the dressings can be difficult.

Physiotherapy for your dog

Rest, physiotherapy and treatment for inflammation and pain should be used to help dog leg injuries or surgery heal; this is a very long process and not always with a satisfactory outcome. Many dogs retain a limp. Arthritis will thereafter always be present in the injured knee, and adding a supplement to help joints from then on would be wise.

recovering dog in pool hydrotherapy
Dog Pool Animal Physiotherapy

Your dog will need physiotherapy to recover proper limb-use as recovery progresses; because the soft tissues will be weakened and shortened by the injury, these need strengthening and stretching again. This will gradually improve joint motion, also strengthen muscles and ligaments, encourage healing and reduce pain; a reduction of swelling and spasms will then occur. Your dog may benefit greatly from ice-pack compresses applied soon after the injury or surgery; this can be followed by electrical stimulation, laser stimulation, exercise on land or in a pool (hydrotherapy). Recovery will take between two and ten weeks, or sometimes more. This is a specialised field; incorrect application of therapies can cause damage to the recovering area and a slower recovery-time.

Other important ideas

Subsequent weight management for your dog is critical; an over-weight dog will load their joints far more than ideal. As a result, the damaged joint may never recover properly.

Strength training when appropriate will be of great benefit for your dog when recovering from cruciate ligament injury; see my article discussing this – click here!

Your dog on the move

For travel, your dog may need special consideration because of their reduced mobility. Use a ramp when they are climbing up a step or into the car; go on outings with your dog with the help of a stroller (click here for an example) – especially if their rehab is prolonged, or because they will be permanently physically limited. Because of your dog’s limitations, they may need more room to lie down and a really non-slippery surface to get up from; this is true whether they are in bed or on the floor. If squatting to poo or pee is an issue – discuss this with the vet! Be patient and persevere with treatment – a good recovery is likely in the end but allow a few months before full function is recovered.

Innopet 5 in 1 dog stroller

I have written an article just about Dog Ramps – click here to read it.

There is also an article I have written just about dog strollers – click here to read that!

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