Cruciate ligament surgery

What is the cruciate ligament?

The cruciate ligaments are located within the knee joint and play a crucial role in stabilising the joint during movement. 

Cruciate ligaments can become injured and cruciate ligament disease is a common orthopaedic condition in dogs. 

When a dog suffers from cruciate ligament disease, it can cause lameness, pain and impaired mobility.

Causes

Trauma: Acute injury or trauma to the knee joint, such as twisting or hyperextension, can lead to a cruciate ligament tear.

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Degeneration: Over time, wear and tear on the ligament can weaken it, making it more susceptible to injury. This degeneration may occur gradually and can be exacerbated by factors such as obesity, genetics, conformational abnormalities and repetitive stress on the joint.

Symptoms

Lameness: Dogs with a cruciate ligament injury typically exhibit lameness, which may be sudden or progressive. The lameness may initially be intermittent and worsen with activity.

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Difficulty bearing weight: Affected dogs may have difficulty bearing weight on the affected limb, and they may hold the limb up or avoid putting weight on it altogether.

Swelling: Swelling and inflammation around the knee joint may be present, particularly in the acute phase following injury.

Stiffness and pain: Dogs with cruciate ligament disease may show signs of stiffness, discomfort or pain when moving, especially when attempting to rise from a resting position or after exercise.

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Muscle atrophy: Over time, muscle wasting (atrophy) may occur in the affected limb due to decreased use and mobility.

Diagnosis

Physical examination: We will perform a thorough physical examination, including palpation of the affected joint, assessment of range of motion and evaluation of gait.

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Diagnostic imaging: X-rays may be taken to evaluate the structure of the knee joint and rule out other causes of lameness. Additionally, advanced imaging modalities such as MRI or CT scans may be recommended in certain cases.

Cruciate ligament tests: Several specific tests, such as the cranial drawer test and the tibial compression test, may be performed to assess the stability of the cruciate ligament and confirm the diagnosis.

Treatment options

Conservative management: Conservative treatment may be considered for smaller dogs or those with partial tears. It typically involves rest, anti-inflammatory medications, physical therapy, and weight management.

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Surgical intervention: Surgery is often recommended for larger dogs, active dogs or those with complete ligament tears. Surgical options include extracapsular repair, tibial plateau levelling osteotomy (TPLO), tibial tuberosity advancement (TTA), or lateral suture stabilisation. We will advise you of the most suitable procedure for your pet.

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Rehabilitation: Following surgery or during conservative management, rehabilitation exercises, physical therapy, and controlled exercise programs may be prescribed to improve strength, mobility, and joint function.

Prognosis

The prognosis for dogs with cruciate ligament disease varies depending on the severity of the injury, the chosen treatment approach, the dog's size, age, and overall health. With appropriate treatment and rehabilitation, many dogs can regain function and lead comfortable, active lives. However, untreated or inadequately managed cruciate ligament disease can lead to chronic pain, joint instability, and osteoarthritis.

Before and after the procedure

If your pet is coming in for surgery on their cruciate, it is important that you follow our general advice on preparing for the day, which you can find here.

After undergoing surgery on their cruciate, dogs typically undergo a period of rehabilitation, including controlled exercise, physical therapy and pain management, to optimise recovery and joint function. 

This is usually a twelve week program of reduced physical exercise, which we will provide. 

We are also fortunate to be able to offer regenerative therapy which will help with healing, reducing inflammation and pain – which you can find out more about here.

Post-operative care following cruciate surgery is crucial to ensure proper healing and a successful outcome for your dog. You can read our general post-op advice here, but carry on reading below for our advice specific to recovering from cruciate procedures.

You should provide a quiet, comfortable and confined area for your dog to rest and recover. This may involve using a crate or small room to limit movement.

Restrict your dog's activity to short leash walks for bathroom breaks only. Avoid running, jumping, climbing stairs or engaging in strenuous activity.

In week three introduce five minute walks, two or three times a day.

Week four increase this to 10 minute walks, in week five increased to 15 minutes – and so on. Continue this pattern of increasing by five minutes every week unless we advise otherwise.

Administer any prescribed pain medications to keep your dog comfortable during the recovery period. Monitor your dog for signs of pain, such as restlessness, panting or vocalisation, and contact us if you have concerns.

We strongly recommend starting physiotherapy within the first week of surgery. We are lucky to have a physiotherapist, Lucy Walsh, visit our practice every Wednesday. Please let us know if you would like to book in with Lucy.

We will need you to book follow-up appointments to monitor your dog's progress, remove any sutures or staples, and assess joint healing. 

We recommend the first appointment two to three days after and the second 14 days after – and there is no additional cost for these check ups. If you were referred to us, you may be able to have these checks with your usual vets. We also recommend a follow up with your surgeon six weeks later and radiographs to check the healing of the surgery