Teddy's Troublesome KneeShare on

Tom Cox

Dogwood’s Case Digest

  • Cranial cruciate ligament disease is a common issue in dogs
  • Large and small dogs benefit most from a surgery called TPLO
  • Outcomes after TPLO are good to excellent in the vast majority of dogs
  • Rehabilitation is important in the recovery phase following surgery for cranial cruciate ligament disease

Meet Teddy! A handsome, 40kg, German Shorthaired Pointer who presented to Dogwood Referrals after his owner noticed he was struggling on his right hindlimb for the past few weeks. There was no noticeable trauma or cause for his limping and although a course of anti-inflammatories had helped with Teddy’s pain, he remained obviously lame and sore.

Handsome Teddy!

 

Teddy’s owner took him to his trusted local vet who was concerned Teddy might have ruptured his cranial cruciate ligament. Knowing the specialist care and transparency of fixed prices available, Teddy’s vet referred him over to Dogwood Referrals.

On arrival at Dogwood Referrals, it was clear Teddy was very sore when walking on his right knee. There was swelling associated with the knee and pain was noted on extension of the knee. The surgeons at Dogwood Referrals have seen thousands of dogs with cranial cruciate ligament disease in their careers, meaning they could put Teddy’s owners concerns at ease and importantly get Teddy on the road to recovery.

Under sedation, X-rays showed classic signs of cranial cruciate ligament disease;

  • Increased fluid in the knee
  • Osteoarthritis
  • Movement of the shin-bone (tibia) forwards

Tests performed to assess the stability of the knee were performed, which confirmed our suspicions that rupture of the cranial cruciate ligament was to blame for Teddy’s limping.

Cranial cruciate ligament disease is very common in dogs and can even be seen in cats. Unlike in humans (where it’s called the ACL), the most common cause of cranial cruciate ligament injury in dogs is a slow degeneration of the ligament. A simplistic explanation for this would be like threads of a rope. In a dog, threads tear over a period of time which may cause no clinical signs because the rope is still strong enough for the dog to walk with. At a point where enough of the threads rupture, the rope is no longer strong enough meaning the knee becomes unstable causing pain. The period of time taken for this is unknown. The cranial cruciate ligament is responsible for stability in the knee and without it, the knee becomes unstable. The instability causes inflammation, pain and eventually osteoarthritis. Whilst surgery can’t stop osteoarthritis, it can help to stabilise the knee reducing inflammation and discomfort.

There are whole books written on a plethora of surgical techniques for management of cranial cruciate ligament disease in dogs. Evidence strongly suggests and in our opinion, a tibial plateau levelling osteotomy (TPLO) gives the best chance of a successful outcome for all sizes of dog. A TPLO aims to stop the forces which cause knee instability and are normally held in check by the cranial cruciate ligament. Think about a kart on a hill held by rope, if the rope tears, the kart falls. Rather than replacing the rope, a TPLO aims to flatten hill meaning the kart doesn’t move forwards or backwards.

After a discussion with Teddy’s owner on the best management treatment option, we decided to proceed with a TPLO. At Dogwood Referrals we have performed thousands of these surgeries, nevertheless each is as important as our first TPLO. Teddy’s surgery went without complication and we were very satisfied with his post-op X-rays. A complete discharge and rehabilitation plan was made with Teddy’s owner including the additional knowledge from one of Dogwood Referrals physiotherapists to guide Teddy’s exercise.

Teddy's post-op X-rays showing his TPLO with plate and screws. (Note the staples used to close the incision)

Teddy's post-op X-rays showing his TPLO with plate and screws. (Note the staples used to close the incision)

Seven weeks after surgery we were pleased to hear that Teddy’s recovery had been very smooth and his strength in his right hindlimb had improved significantly with no limping noticed by his owner. We performed X-rays which confirmed healing of the TPLO and made a further plan for Teddy to continue his recovery back to normal exercise. Well done Teddy!