ORTHOPEDIC MEDICINE/SURGERY & PHYSIOTHERAPY/REHABILITATION
Orthopedic injuries are of the most common injuries in dogs and cats. They can present in a number of ways. Ranging from muscle, tendon, ligament trauma, torn
ligaments and tendons, bone fractures, arthritis, etc. Whether the condition is congenital or hereditary, we at Abbott are here to help your pet's and give them
the best care possible. A thorough evaluation will be performed as well as specific tests to determine the diagnosis and the best treatment options for your pet.
We offer non-invasive treatment options such as physiotherapy/rehabilitation, pain management options such NSAIDs (non-steroidal anti-inflammatories), pain
killers, and muscle relaxers, joint injections, to more advanced therapies such as PRP, Stem Cell Therapy, and Testosterone Therapy. We offer Digital Thermal
Imaging for localized treatment of injuries or pain. We also offer orthopedic surgical procedures for common injuries ranging from cranial cruciate ligament
(CrCL) rupture, patella luxation, and femoral head and neck ostectomy, as well as common fracture repair and limb amputation.
Cranial Cruciate Ligament Rupture
A dog’s knee, also referred to as a stifle, is a complex structure consisting of:
While there are multiple ligaments within the knee, typically a torn knee ligament refers to the tearing of the cranial cruciate ligament. The cranial cruciate ligament (CrCL) is the equivalent of the human anterior cruciate ligament (ACL). This ligament helps stabilize the knee in dogs by keeping the tibia from sliding too far in front of the femur. A CrCL rupture is a snapping of this ligament which decreases the stability of the knee. The degree of lameness noted can vary with the type of damage to the ligament (partial or full tear) and can compound or worsen over time as the disease of the ligament and other internal knee structures progresses. Around 50% of animals that develop a torn ligament and rupture in one knee will develop it in the other knee at some time in the future.
Symptoms of Torn Knee Ligaments in Dogs
Hind-leg lameness is the most obvious symptom of a torn knee ligament. Severity may vary from intermittent lameness after activity to an inability to bear weight on the affected leg. When sudden incidents of full or partial tears occur, you may also notice swelling or pain when touching or manipulating your dog’s knee.
Causes of Torn Knee Ligament in Dogs
There are two potential causes of a torn knee ligament in dogs. Over time, the CrCL develops damage due to wear and tear from physical activity and stress on the knee. This wear and tear is referred to as cranial cruciate ligament disease. Typically, cranial cruciate ligament disease (CrCLD) occurs over a period of months to years. Cranial Cruciate Ligament Disease occurs due to many pre-existing conditions or compounding medical issues throughout the animal’s life, including:
As this damage/wear and tear accumulates, eventually the cranial cruciate ligament will rupture during use. Typically, this accumulation of damage to the cranial cruciate ligament is what leads to the tearing of the ligament. The second potential cause is a sudden traumatic rupture of the CrCL. This occurs due to a trauma (being struck by a vehicle) or an athletic situation (playing rough at a dog park) in young, healthy dogs whose ligaments have not incurred any prior damage. Sudden traumatic rupture is not typically common.
How Veterinarians Diagnose Torn Knee Ligament in Dogs
Veterinarians diagnose a fully torn CrCL by noting cranial drawer. Cranial drawer is instability in the knee that occurs when the knee is manipulated by the veterinarian and is present only when the CrCL is completely torn.
To detect cranial drawer the veterinarian will grasp the thigh bone and shin bone and try to pull the shin bone in front of the thigh bone. An intact CrCL will prevent the shin bone from going past the thigh bone. The cranial drawer test helps to determine if there are any “clicks” between the muscle and joint. Proper radiographs and evaluation for cranial drawer may require sedation due to the strength of the muscles around the knee and compliance of the pet to restraint.
Absence of cranial drawer indicates that there is not a full tear to the CrCL. The veterinarian will also do the following:
Typically, radiographs (X-rays) are required to evaluate the internal structures of the knee to assess for the presence and severity of joint effusion or arthritis, and for surgical planning, if needed.
There are currently three options for surgical correction of a torn knee ligament in dogs:
Physical therapy and Necessary Follow-up Treatment
Discussion with your veterinarian/surgeon will help determine which procedure is best for your pet. Multiple variables, such as size, activity level, knee stability, age, and finances are used to decide which procedure is the most beneficial.
Recovery and Management of Torn Knee Ligaments in Dogs
Lameness is usually present for up to a month after surgery but improves over time. A three- to four-month period of strict cage rest is typically required for proper healing after the surgery. Strict cage rest refers to the pet being always confined to a small room/kennel - except for short leash walks for the bathroom, laying with family members or eating. All unconfined activity should only be allowed under strict observation by a family member to prevent the pet from overusing the affected knee. Increased or excessive activity prior to healing can result in surgical complications and failure of the procedure performed.
It also is important to avoid slippery surfaces and sudden large changes in elevation (such as stairs and getting on and off furniture). After the initial rest period, a slow progressive workload of the limb is recommended, with expected full recovery and limb use after six months.
Torn Knee Ligament in Dogs FAQs
Can a dog recover from a torn ligament without surgery?
A dog can live with a torn ligament, but arthritis and lameness in the knee and hind leg will progress without surgical correction.
Can a dog’s partially torn ligament heal on its own?
A partially torn CrCL will not heal on its own due to a poor blood supply to the ligament.
A luxating patella in dogs is a common condition in which the kneecap (patella) shifts sideways, or luxates, away from the normal position at the front of the knee. You may also refer to it as a dislocated kneecap. About 75% of the time, a luxating patella in dogs tends to occur inward, or toward the other hind limb. This version of a luxating patella is called medial patellar luxation (MPL) and is more common in smaller dogs. Sometimes the shift occurs outward, or away from the other leg. This condition is known as a lateral patellar luxation (LPL) and is more commonly seen in larger dogs, although MPL is still more common overall.
The main symptom of a luxating patella in dogs that is not commonly seen with other conditions is the sudden lifting of one hind limb. Some dogs will yelp when this occurs, but others will show no signs of discomfort. In this brief, sudden limp, a dog will hold their hindlimb off the ground for a short period of time before walking normally again. The affected leg may be held close to the body or extended backwards. This is often termed a “skip” by owners and vets alike.
The following symptoms of patellar luxation, however, can also be seen in other orthopedic conditions:
· Limp that comes and goes
· Bowlegged stance in the hind limbs
· Hunched lower back
· Cracking or popping noises when the knee is bent
Your veterinarian will combine these symptoms with the findings of their physical exam to make a definitive diagnosis.
A luxating patella in dogs is generally hereditary and has to do with the unusual knee anatomy of dogs that are affected. In some cases, trauma causes the luxation. Although body weight does not directly cause a luxating patella in dogs, it can contribute to the severity of the disease and can increase complication rates if surgery is pursued.
How Vets Diagnose a Luxating Patella in Dogs
Usually, a physical exam is the only thing needed to diagnose a luxating patella in dogs. In fact, a luxating patella is often diagnosed incidentally during a routine wellness exam, or during an exam for a different problem. A luxating patella in dogs can also show up on imaging like x-rays, CT scans, or MRIs, but these diagnostics are not usually used to make the diagnosis.
As with many orthopedic conditions in dogs, treatment options for a luxating patella can be divided into medical and surgical.
Medical treatment of a luxating patella in dogs often involves anti-inflammatory medications, weight loss, and temporary exercise restriction. Exercise restriction varies based on the severity of your dog’s condition. For patellar luxation, it might be as simple as not letting your dog run up the stairs or jump on furniture, and only going on leash walks long enough for your dog to go to the bathroom. If your dog needs to be confined to their crate, the duration can vary based on the severity of your dog’s condition. Crate rest usually lasts at least 6 weeks, and sometimes more than 12.
Surgery for a luxating patella in dogs is significantly more involved. Pet parents may pursue surgery in severe cases, or in cases where medical treatment has failed. As with any surgery, it comes with risks and the potential for complications. The most common postoperative problem in MPL surgery is that the luxating patella will come back. Rates of recurrence are as high as 36% for the most severe cases, but often are less than 10% for milder forms. Implant failure, under-/overcorrection, avulsions (separations or detachments), fractures, infections, seromas (fluid-filled pockets), and progressive arthritis are other potential complications. Large-breed dogs and obese dogs are at higher risk for these issues. Interestingly, older dogs have fewer complications.
Medical management of a luxating patella in dogs can take several weeks to show improvement. This option may also need to be repeated periodically throughout your dog’s life, depending on how often flare-ups occur. Exercise is a common reason for flare-ups, but sometimes flare-ups occur for no apparent reason.
Surgical correction has a much longer recovery period—at least 8 weeks, often longer. Regular rechecks with the veterinary surgeon are a crucial part of your dog’s recovery after surgery.
Is a luxating patella painful for dogs?
Mild or incidentally detected cases of patellar luxation in dogs are probably not painful, and therefore do not require surgical correction. However, moderate to severe cases, as well as chronic cases, can be painful. Having your veterinarian grade the luxation is the first step in determining whether your dog’s luxating patella is uncomfortable and whether treatment is warranted.
Can a dog live with luxating patella?
Certainly. A luxating patella in dogs does not affect life expectancy, and mild cases do not affect your dog’s quality of life at all. In moderate to severe cases, dogs may limp chronically due to pain and discomfort. If left untreated, arthritis and other orthopedic abnormalities can develop that will significantly affect the quality of life, even if life expectancy is not affected. The pros and cons of medical management versus surgery should be discussed with your veterinarian to develop a plan that maximizes your dog’s comfort and overall health.
How do you know if your dog has a luxating patella?
The classic picture of a luxating patella in dogs is a small dog that will suddenly lift one of its hind limbs off the ground while walking or running. Your dog may go a short distance on three legs before placing the fourth leg back on the ground, seemingly unaware of and unbothered by the issue. In more serious or more chronic luxating patella cases, your dog may display a chronic limp or a crouched back. Their knee may crack or pop when flexed. However, these signs are not entirely specific to patellar luxation and can be seen in other orthopedic conditions. Your veterinarian will be able to confirm the diagnosis.
Will a brace help a dog with luxating patella?
No, braces are typically not useful for dogs with luxating patella. Although many brace products are marketed as nonsurgical solutions to a luxating patella, veterinarians do not commonly recommend braces to help this condition, for several reasons. First, orthopedic braces for dogs are costly, often several hundred dollars. Some vets would say that money would be better spent toward surgical correction. Second, these products typically recommend that your dog be “fitted” by your veterinarian. However, most general practitioners simply are not trained to do this. Third, your dog could become so bothered by the brace that they will shred or otherwise destroy it, setting them up for foreign body obstructions, a much more serious condition than a luxating patella.
Femoral Head & Neck Ostectomy (FHNO) in Dogs and Cats
Dogs and cats can develop hip problems due to genetics, injury or simply old age. For example, canine hip dysplasia is a genetic disease that causes abnormal hip joint development. Legg-Perthes disease, which is a lack of blood flow to the top of the femur, is an uncommon hip condition affecting dogs and cats. These hip problems and others, including arthritis in cats, may cause enough pain and mobility problems to require veterinary orthopedic surgery.
The hip joint is a “ball-and-socket” joint. The femur, which is the long thigh bone, has a “ball” at its top (head of the femur) that sits snugly inside the hip bone’s acetabulum, which is the “socket” portion of the hip joint. This ball-and-socket anatomy allows easy hip movement in all directions. Injury or disease of the hip joint disrupts its normal anatomy. This leads to abnormal joint function, decreased mobility, and chronic pain and inflammation, all of which can reduce quality of life for your pets. A femoral head ostectomy (FHO) is a type of veterinary orthopedic surgery that treats hip disease by relieving hip pain and restoring mobility, thus improving quality of life.
FHO surgery in dogs and cats is a relatively inexpensive procedure. During an FHO, a surgeon removes the femoral head, leaving the acetabulum empty. Initially, the leg muscles hold the femur in place. Over time, a “false joint” is created as scar tissue forms between the acetabulum and femur. This scar tissue provides a cushion between these two structures.
The following hip conditions can benefit from an FHO:
· Hip fractures
· Severe arthritis
· Legg-Perthes disease
· Hip dysplasia in cats and dogs
Dogs who weigh less than 50 pounds and cats who are at a healthy weight are good candidates for an FHO. The false joint can more easily support the weight of smaller pets than larger or overweight pets. If your dog is over 50 pounds, your veterinarian will discuss whether an FHO surgery would be appropriate.
Surgical Recovery From FHO
Recovery from an FHO occurs in two general phases:
Phase 1
Phase 1 occurs in the few days immediately following surgery and primarily involves pain control. Pet pain medication, such as a nonsteroidal anti-inflammatory drug, helps reduce pain, inflammation and swelling. Your veterinarian will prescribe this prescription pet medication. This first phase also involves strict activity restriction. For your dog, this will involve only short dog leash walks to go to the bathroom. Your cat will need to be crated or confined to a small room where she cannot run or jump (In this case, a cat pen may help). If your pet is not in too much pain, your veterinarian may recommend passive range of motion exercises to gently move the hip joint through its natural range of motion.
Phase 2, starting about one week after surgery, involves gradually increasing physical activity to rebuild muscle mass and strength around the hip joint. Physical activity also improves mobility and prevents the scar tissue from becoming too stiff. Examples of appropriate physical activity include walking up the stairs and walking on the hind legs while you hold the front legs in the air. High-impact physical activity, such as rough play, should be avoided during the first 30 days after surgery. Your veterinarian will advise you on increasing your pet’s physical activity after surgery. Most dogs and cats recover fully within six weeks after surgery. Pets who do not fully recover in this timeframe may need formal physical therapy or rehabilitation. Be aware that pets who are relatively active before surgery tend to recover more quickly because they already have more muscle mass around the hip joint. At any point during recovery, contact your veterinarian if your pet is in a lot of pain or is not doing well for any reason.
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CONTACT INFORMATION
Phone:
508-336-4430
Email:
receptionist@abbottanimalhospital.net
48 Fall River Avenue
Rehoboth MA 02769
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