In day to day lives, injuries to joints, muscles, and tendons are common occurrences. Sometimes these are acute after a traumatic injury. Pain and lameness affect our ability to work or simply move around the house. In the long term, injuries can be debilitating and irreversible. Fortunately, humans can verbalize their discomfort or pain. Pets have similar issues; yet, their ability to tell us can be limited. This requires us to observe body language.
WHAT IS THE MOST COMMON INJURY LEADING TO HIND LIMB LAMENESS IN DOGS?
Cranial cruciate ligament disease.
COULD YOU BETTER DEFINE THE CRANIAL CRUCIATE LIGAMENT (ACL)?
It is the primary ligament that stabilizes the knee (stifle). As it degenerates, it leads to pain, instability, and arthritis.
IS THERE A COMMON DENOMINATOR OF OWNERS WHO PRESENT COMPLAINTS?
Lameness in one or both hind legs, that can be acute or chronic, with the affected leg being held up or in what is commonly called the “tippy toed stance." It may get worse with exercise and improve with rest. Unfortunately, it may be more difficult to diagnose if it occurs simultaneously in both rear knees at the same time. The knee is kept flexed, rotated out, and appears swollen or puffy. A pet may sit asymmetrically to protect the painful knee.
ARE THERE SIGNS THAT VETERINARIANS OBSERVE IN RADIOGRAPHS?
Yes, it has some classic radiographic presentations: swelling, joint fluid accumulation, and eventually arthritis.
IS IT TRULY AN ACUTE INJURY?
Although it can appear in many dogs acutely, more often the radiographs indicate degenerative changes meaning a silent, chronic, compensated problem is suddenly acutely exacerbated.
WHAT IS THE DIFFERENCE BETWEEN A PARTIAL AND A FULL ANTERIOR CRUCIATE LIGAMENT TEAR?
A partial tear will often appear to have more stability to the joint (less buckling or veterinarians say “lack of a drawer sign”) as in one joint the shin (tibia) sliding against the thigh(femur) bone. In either case, arthritis or degenerative joint disease can be present depending on the duration of the problem.
CAN THIS DEVELOP IN CATS?
YES, but more commonly due to trauma.
ARE THERE CERTAIN DOG BREEDS AT RISK?
In dogs, it is more common in large breeds: Rottweilers, Labrador Retrievers, Newfoundlands, Boxers, Golden Retrievers. However, it can occur in any dog.
WHAT ARE THE RISK FACTORS?
Obesity, inactivity, over activity, trauma, medical conditions that weaken joints/immune system, confirmation, collagen degeneration, and genetics of the breeds mentioned above.
DOES NEUTERING AN ANIMAL INCREASE THE RISK?
There is controversy in how much is lifestyle versus the hormonal protection from remaining intact male (not neutered).
ARE THER OTHER DISEASES THAT CAN LOOK SIMILAR?
Slips or patella (knee cap) luxation, hip dysplasia, lower spine or lumbar-sacral degeneration, bone tumors, sprain of groin muscles (Iliopsoas strain), infectious joint disease, immune mediated disease, and torn meniscus can look similar. In cases where both knees are involved, the weakness can mimic a neurological disorder.
DISCUSS THE RECOMMENDED TESTING?
After the physical exam, bloodwork, radiographs, and possible testing for infectious diseases are the most common. Occasionally joint taps will be recommended.
NORMAL RIGHT KNEE
Yes, it has some classic radiographic presentations: swelling, joint fluid accumulation, and eventually arthritis.
IS IT TRULY AN ACUTE INJURY?
Although it can appear in many dogs acutely, more often the radiographs indicate degenerative changes meaning a silent, chronic, compensated problem is suddenly acutely exacerbated.
WHAT IS THE DIFFERENCE BETWEEN A PARTIAL AND A FULL ANTERIOR CRUCIATE LIGAMENT TEAR?
A partial tear will often appear to have more stability to the joint (less buckling or veterinarians say “lack of a drawer sign”) as in one joint the shin (tibia) sliding against the thigh(femur) bone. In either case, arthritis or degenerative joint disease can be present depending on the duration of the problem.
CAN THIS DEVELOP IN CATS?
YES, but more commonly due to trauma.
ARE THERE CERTAIN DOG BREEDS AT RISK?
In dogs, it is more common in large breeds: Rottweilers, Labrador Retrievers, Newfoundlands, Boxers, Golden Retrievers. However, it can occur in any dog.
WHAT ARE THE RISK FACTORS?
Obesity, inactivity, over activity, trauma, medical conditions that weaken joints/immune system, confirmation, collagen degeneration, and genetics of the breeds mentioned above.
DOES NEUTERING AN ANIMAL INCREASE THE RISK?
There is controversy in how much is lifestyle versus the hormonal protection from remaining intact male (not neutered).
ARE THER OTHER DISEASES THAT CAN LOOK SIMILAR?
Slips or patella (knee cap) luxation, hip dysplasia, lower spine or lumbar-sacral degeneration, bone tumors, sprain of groin muscles (Iliopsoas strain), infectious joint disease, immune mediated disease, and torn meniscus can look similar. In cases where both knees are involved, the weakness can mimic a neurological disorder.
DISCUSS THE RECOMMENDED TESTING?
After the physical exam, bloodwork, radiographs, and possible testing for infectious diseases are the most common. Occasionally joint taps will be recommended.
NORMAL RIGHT KNEE
ABNORMAL KNEE
WHAT ARE THE ACUTE MANAGEMENT TOOLS?
Pain medications (NSAIDS), reduced food intake, and exercise restriction for a month. Fifty percent of dogs under 30 pounds and most cats will return to full function with rest, while only 20% of large dogs will be okay without surgery.
ARE THERE SURGICAL TREATMENTS?
Surgical management is considered the standard of care with an 85% success rate. The results can vary based on the age of the pet, weight, and degree of pre-existing arthritic changes. No single treatment is felt to be superior.
There are 3 main types.
1. Intra-articular (within the joint) surgery to create a new ligament.
2. Extracapsular (outside the joint).
3. Biomechanical surgery that changes the angles of the knee. Examples include tibial plateau-leveling osteotomy(TPLO) and tibial tuberosity advancement(TTA).
Newer, experimental treatments investigate the use of stem cell implants.
IS THERE FOLLOW-UP CARE?
Weight loss, pain medications, REST for eight to 10 weeks, followed by an incremental increase in exercise levels (rehabilitation), and monitoring for relapse of use of the leg(limping), infection, or pain.
1. Intra-articular (within the joint) surgery to create a new ligament.
2. Extracapsular (outside the joint).
3. Biomechanical surgery that changes the angles of the knee. Examples include tibial plateau-leveling osteotomy(TPLO) and tibial tuberosity advancement(TTA).
Newer, experimental treatments investigate the use of stem cell implants.
IS THERE FOLLOW-UP CARE?
Weight loss, pain medications, REST for eight to 10 weeks, followed by an incremental increase in exercise levels (rehabilitation), and monitoring for relapse of use of the leg(limping), infection, or pain.
Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary PractitionersCreature Comforts Animal Hospital
Cary,NC
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