Cruciate disease - Are you prepared? As a veterinarian in private practice, I am often confronted with patients who do not receive the best possible treatment for their ailments due to cost implications. One such condition which comes to mind is Cruciate disease. Cruciate disease is one of the unfortunate conditions which we see all too often despite the best intentions of the most diligent and caring pet owners. It is also a condition which very often requires surgical treatment and as such becomes very expensive to manage. In my experience, Ive been alarmed at how few owners know of this condition despite how common it is, and even more alarmed at how few people can afford treatment. It is for this reason that the focus of this essay will be on this debilitating but treatable condition. Cruciate disease might sound familiar to the sportsmen out there. And the condition is just as common in dogs. In fact, together with hip dysplasia, it is the number 1 cause of lameness or limping in the dog! In dogs it refers to an injury to the cruciate ligaments of the knee. There are 2 cruciate ligaments in the knee, the cranial and the caudal. Sportsmen know these ligaments as the anterior and the posterior cruciates. The function of these ligaments is to hold the thigh bone (femur) to the shin bone (tibia). They prevent the shin bone from falling away from the thigh bone and also prevent the shin bone from moving forward relative to the thigh bone (drawer sign). The ligaments sit within the knee joint and cross over each other in their natural position, hence the name cruciate ligaments. The cranial cruciate ligament is injured way more often than the caudal. The degree of injury can vary from just a strain, to a partial tear, to a full thickness tear. In sportsmen the injury is usually associated with strenuous activity but in dogs this is not always the case. This is because in dogs it is believed that there is degeneration of the proteins in the ligaments that provide tensile strength. We think that it may be an inherited condition because certain breeds are predisposed to it, such as the Labrador and the Rottweiler. Once the ligaments have torn, the knee becomes unstable which then starts off a cascade of inflammation and pain in the joint that ultimately leads to osteoarthritis of the knee. Many dogs with torn cruciates also have torn cartilages in the knee (menisci) which aggravate the condition even more. Because the degree of injury varies from a mild strain to a full thickness tear, the signs to look out for also vary. In all cases, it is associated with hind limb lameness and stiffness. One will notice limping on the affected leg, especially after exercise, and difficulty in rising or jumping. It is very important to be vigilant for limping, because the sooner the vet sees the animal, the sooner we can intervene and slow down the degenerative inflammatory cascade in the affected joint. Veterinarians diagnose cruciate injuries based on a physical examination. Long standing cruciate injuries are often associated with muscle wasting on the affected limb as well as a thickening of the affected joint. We manipulate the joint and very often feel a grating sensation called crepitus, and when the menisci are torn, we can feel a clicking sensation. The tell-tale sign of a cruciate tear is what we call drawer sign. We can feel the instability in the joint as the shin bone moves forward relative to the thigh bone. This test is definitive but requires practice to be truly reliable. It is often very difficult to perform when the animal is awake as they are painful in the joint and their muscles are all tensed. Which is why we recommend anaesthesia to relax the muscles and dull the pain, while we properly evaluate the joint. We take Xrays at this point. Xrays do not diagnose a torn cruciate but they do tell us how bad the osteoarthritis is. They also help us to make important measurements and calculations needed for the more advanced surgical treatment methods. Once we have diagnosed cruciate disease, the treatment options vary. Smaller breeds of dogs weighing less than 10kg very often dont need surgery and can be managed by restricting exercise, physiotherapy, and pain killing anti-inflammatories. Overweight dogs would be placed on diet to lose weight and reduce the load on the weakened knee. Unfortunately most medium to large breed dogs will need surgery in the event of a torn cruciate. There are more procedures available to us than I can count on my hand and a full description of all of them is simply outside of the context of this essay. Instead I am going to talk about an exciting new surgery available to us, which we at Sunset Beach Vet have been performing for the past 2 years with fantastic results! The surgery goes by the acronym TTA rapid. This stands for Tibial Tuberosity Advancement. The word rapid highlights that this is an advancement of the older TTA standard technique and due to a few intricacies of the procedure itself, is relatively quicker to perform than the older technique. As with all cruciate surgery, the procedure is preceded by opening up the knee joint and removing the torn ends of the damaged cruciate ligament, and inspecting and removing any damaged cartilage (menisci). As the name says, the technique involves an advancement of the Tibial Tuberosity, a projection at the top of the shin bone to which the knee cap and thigh muscles attach too. The theory is that by moving this projection forward, we make the attachment of the thigh muscles more perpendicular to the top of the shin bone and thereby stabilize the forces within the joint and prevent the shin bone from moving forward relative to the thigh bone. The way in which we move this projection forward is by splitting the shin bone at its top end by way of a very precise and calculated cut using a high-tech pneumatic bone saw. We then insert a special laser cut titanium wedge into the gap and secure the wedge with 6 titanium screws. Aftercare is very important after TTA rapid surgery as any strain on the knee can cause the shinbone projection and the titanium wedge to break away from the rest of the shin bone. 6 weeks house rest is indicated whilst the body grows new bone (callus) into the gap created in the shin bone. In my experience, most of these patients, will be walking on the operated leg as soon as 1 to 3 days after the surgery and many of them walk without a limp within a week or 2! This recovery period of course varies from dog to dog. I would like to end with a mention of the financial expense of such a procedure. As anyone can reasonably expect, advanced surgery of this nature does not come cheap, and the sad reality is that so many pet owners out there simply cant afford it in todays economy. It is the absolute best you can do for your beloved pet in the event of a cruciate tear, and I have no doubt in my mind that almost all of my clients at least would want exactly that. And for that reason, we emphasize day in and day out the importance of a reputable pet medical insurance scheme. Being financially prepared to offer the very best treatment to our four legged family members is one of the most important responsibilities of pet ownership. Pet insurance makes this responsibility possible for almost all of us, and as such, there should never be any reason for our pets to suffer from untreated cruciate disease. Dr. Reuben Kotze Sunset Beach Veterinary Clinic
Posted on: Fri, 05 Dec 2014 16:11:44 +0000
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