The Cruciate Conundrum

Injury or rupture of the canine cranial cruciate ligament is commonly associated with osteoarthritis. You may have had experience of  a dog with a torn cruciate ligament.  Did you know that there are well over 100 methods described for managing this problem in dogs?

It is an issue that remains controversial despite many studies attempting to show the superiority of one method management over another. There are several levels at which there is both disagreement and debate:

Firstly , what do we call it? Strange I know but this problem is referred to as a cruciate rupture, cruciate failure, torn cruciate, cruciate disease, cruciate deficiency. And, we can’t just use the term ‘cruciate ‘in isolation because there are two cruciate ligaments in the canine stifle (knee) joint. In the dog, these are correctly termed ‘cranial’ and ‘caudal’ although the terms ‘anterior’ and ‘posterior’ are sometimes used because of their human counterparts.

Secondly, what is the best treatment? Predictably, with over 100 techniques described, this is where the debate really gets going. Non-surgical management will be selected in some patients. An affected dog  may be making good progress  at the time they are examined and the clinician will wait to see if progress is maintained. Some patients may have complicating conditions that raise an unacceptable aneasthetic risk and a more conservative path is chosen. In some cases, the degree of arthritis in the joint may reduce the potential benefits of surgery which then becomes less attractive. However, the majority of  patients will be offered surgery to deal with the unstable joint but there is considerable debate about which surgery is best. Surgeries for cruciate ligament rupture/disease can be broadly classified as:

Ligament Substitutes

Traditionally we have tried to either replace the ligament by using a tissue graft into the knee joint or to replace the function of the ligament by placing various materials in the tissues outside the affected joint to make it more stable. The practice of injecting blood into the knee to stimulate scarring has (thankfully) to all intents and purposes been abandoned.

Bone Reconstruction

Newer approaches to cruciate surgery involve changing the shape of the surface of the joint make the joint more stable when it takes weight. The original surgery for this was the Tibial Plateau Leveling Osteotomy or TPLO devised by the late Dr Barclay Slocum. Other surgeries designed to have a similar effect have come along such as the TTA, TWO and TTO !!

From my own clinical experience there are certainly situations where I would actively promote bone reconstruction. My preference was TPLO.

The take home message: Not all cases of lameness related to damage or injury to the cranial cruciate ligament are the same. Some patients will do well with less invasive surgery but the bone reconstructive procedure have become well established and appear to give better results in some groups of patients.