The cruciate ligaments (cranial and caudal) cross between the femur and tibia, keeping the two bones in place at the stifle (knee) joint, and preventing excess movement and instability. An injury to a ligament is called a sprain and is categorised in four grades.
- Grade one – A minor tear of the ligament which should improve with rest, however the ligament will take some time to fully heal and will be prone to further tearing during this time.
- Grade Two – A partial tear of the ligament. Depending on how much it is damaged it may require lengthy rest and possibly surgery.
- Grade Three – A complete rupture of the ligament which will require surgical repair.
- Grade Four – A complete rupture of the ligament which causes some small pieces of bone to detach also. As with a grade three sprain this will require surgery.
Causes of Cruciate Ligament Disease
Unlike in humans where cruciate ligament sprains are associated with sudden trauma (particularly common in footballers), in dogs they tend to be more associated with wear and tear over time. While one final trauma might cause the noticeable sprain, there is often damage there long before it’s noticed.
Repetitive activity such as ball or frisbee chasing, twisting and turning when running, sporting activity, slipping on laminate flooring and jumping on and off furniture can all cause or worsen cruciate ligament damage. Some breeds are also more predisposed to it such as Labradors, Rottweilers and many giant breeds.
Signs and symptoms
- Inability to fully flex at the stifle
- Not fully weight bearing, or not weight bearing at all on the affected limb
- Toes only just touching the floor
- Crying or yelping in pain as the sprain occurs or when trying to weight bear
- Struggling to get up after rest
- Sitting with the stifle out to the side rather than tucked under
- Swelling / heat around the affected stifle
Unless the sprain is a minor one, or the dog is high risk for surgery, most cruciate ligament sprains are repaired surgically, as the likelihood is that once the ligament has partially torn it will get worse. There are various options for surgery, and the vet caring for your dog will discuss the options and which one they feel is most suitable.
Cruciate Ligament Repair Surgery
This simply aims to repair the cruciate ligament. It is mainly used in small breeds, and is not commonly used now as the success rate can be fairly low.
Tibial Plateau Levelling Osteotomy (TPLO)
This method of surgery bypasses the need for a cruciate ligament. By taking a slice of bone from the tibia, the angle of the bone is changed, stabilising the stifle joint without the need for the ligament. It is then held in place by a plate and screws.
Tibial Tuberosity Advancement (TTA)
This surgery like the TPLO bypasses the need for a cruciate ligament. The top of the tibia (tibial plateau) is cut in to and moved to make it perpendicular to the patellar tendon which makes the stifle joint feel stable and stops the tibia moving forwards. It is then pinned in place.
How can massage help?
- Reduces lymphedema post surgery
- Pain management
- Relieves areas of overcompensation caused by not using the limb fully
- Breaks down protective muscle splinting across the joint
- Increases mobility
- Improves gait