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Cruciate Ligament Damage ? Bernese Mountain Dogs

    Updated - November, 2010

    Websites to Bookmark:

    Dog knee injury (blog)
    ► http://dogkneeinjury.com

    Cruciate Ligament Rupture and Associated Injuries. Steven P. Arnoczky
    ► http://cal.vet.upenn.edu/projects/saortho/chapter_80/80mast.htm#sect1

Overview:

Joint affected: the knee (stifle)

A dog's knee joint works like a hinge. Ligaments hold the bones in proper position. The cranial cruciate ligament stabilizes the knee joint when the leg bends which allows the Berner's leg to bear weight and remain stable when in motion. When the dog?s knee has a damaged cruciate ligament, the "hinge" becomes loose and no longer functions effectively. A Berner with a ruptured or partially torn cruciate ligament may not be able to put any weight on the affected leg or be hesitant to put weight on the leg and toe touch the ground rather than placing full weight on the affected leg. Lameness caused by cruciate ligament damage worsens with exercise.

Damage to the cruciate ligament involves complete or partial ruptures or tears. In early stages an astute observer might notice subtle evidence that the dog?s knees are not functioning properly when the Berner gaits. Lack of efficient flexion or mild stiffness in the knee joint may be evident prior to the dog exhibiting significant lameness due to cruciate ligament tears or ruptures. Mild swelling or thickening in the knee joint may be detected. The knee may make a ?clicking or crunchy? sound. Partial tearing of the cruciate ligament may occur gradually resulting in noticeable low-level lameness that may improve with management including limited exercise and administration of anti inflammatory medications. In severe cases, tears or ruptures involve the sections of cartilage in the knee joint called the medial and lateral menisci (the "shock absorbers" of the knee) which tear or become crushed because of exposure to abnormal stress that occurs when the knee is loose. Berners with this condition often are experiencing significant pain, are severely lame and require veterinary intervention, surgery and a lifetime of management involving medications, or other therapies. Progressive trauma and inflammation in the knee joint caused by cruciate ligament tears (partial or complete) leads to arthritic changes in the joint which only grow worse with continued weight bearing and over time. Early diagnosis of damaged cruciate ligaments with appropriate therapeutic intervention may minimize degenerative joint disease but does not prevent it in all cases.

Causes

Causes of cruciate ligament damage include trauma, such as injuries resulting from rough play or jumping, cavorting on rough terrains or on slippery floors. Cruciate ligament damage may have underlying genetic or disease related origins that predispose the ligament to rupture. Knee joint defects including luxating patella or osteochondrosis, and inflammatory disorders including rheumatoid arthritis, lupus, or immune mediated polyarthritis are contributory. Additionally cruciate ligament damage may be influenced by obesity, poor body condition due to lack of exercise or body structure/unbalanced conformation which place additional stress on the knee joint.

Prevention

Prevention of cruciate ligament injuries may not be possible; but, there are some factors that can decrease the likelihood that your Berner will rupture a cranial cruciate ligament.

1. • ► Fat dogs are at greater risk - avoid obesity.
   • ► Dogs in poor physical condition are at greater risk - provide your Berner with opportunities for sensible daily exercise.
   • ► Do not allow dog pals to roughhouse, slam.
   • ► Do not encourage jumping or running on rough terrains or slippery floors.
   • ► Teach your Berner to calmly navigate stairs.

Diagnosis and Treatment

If your Berner is intermittently lame or can?t bear weight on a rear leg, have the dog examined by a vet to determine the reason. Inexperienced owners may incorrectly diagnose cruciate ligament damage as "hip dysplasia" or "arthritis" if they notice mild or intermittent rear end lameness which allows the condition of the knee to deteriorate making correction and long term management of the problem more difficult and expensive.

Your veterinarian will check for instability within the knee joint by observing the gait/lameness and by manual palpation of the joint.

Manual palpation involves two tests - the positive cranial drawer test, and the positive tibial compression test. The positive tibial compression test may be more sensitive in detecting looseness in large, heavily muscled dogs like Bernese. Some vets may need to sedate the dog before performing the palpation tests. (Chronic injury to the cruciate ligament using the cranial drawer and tibial compression tests may be less effective since the knee will have built up scar tissue in the joint capsule in an attempt to limit the abnormal motion.)

X-rays or arthroscopic examination can help confirm the diagnosis and determine the overall status of the joint and extent of damage done.

If the vet suspects a disease such as polyarthritis may be the underlying cause for your Berner's the ruptured cruciate ligament, he/she may analyze a sample of joint fluid.

Surgical methods for treatment are available.

There are advantages and disadvantages to surgical techniques used to stabilize the knee. For a good description of the various surgical procedures see http://www.vetcision.com/rcclrecommend.html. Surgical procedures available for treatment fall into three basic categories: intracapsular stabilization, extracapsular stabilization, and Tibial Plateau Leveling Osteotomy® (TPLO). Only veterinarians that have been trained and licensed by the developer of the TPLO technique are permitted to perform TPLO surgery. The TPLO surgical procedure creates stability within the dog stifle by altering the angle of the knee. TTA is a modified version of the TPLO. For a comparison of TPLO and TTA see http://dogkneeinjury.com/2008/tplo-vs-tta-for-cranial-cruciate-ligament-repair/.

Costs for surgical procedures and recovery times are variable as are treatment protocols and choice of procedures used by treating veterinarian.

Rehabilitation and Prognosis

Post surgery rehabilitation may influence the success of the surgical outcome. Prognosis: The prognosis for a dog with cruciate ligament damage depends on a number of factors including how long the injury has been present, the extent of arthritic changes in the joint, whether the meniscal cartilage is torn, the weight, age and general condition of the dog and whether underlying diseases such as rheumatoid arthritis, lupus, or immune mediated polyarthritis are factors.

1. • Rehabilitation regimens vary. They include:
     • 1. range-of-motion exercises
     • 2. Gradual return of activity (4 - 6 weeks restricted activity)
     • 3. Swimming, water therapy
     • 4. Weight reduction
     • 5. Administration of pain medications include NSAID'S (aspirin, acetaminophen, or ibuprofen, Rimadyl, Zubrin, Metacam, Piroxicam) and Steroids (Prednisone, DepoMedrol, or as a last resort Winstrol, Deca-Durabolin).
     • 7. Chondroprotective agents (orally or through injections) including Adequan, Cosequin
     • 8. Dietary supplements include Synovi G3, glucosamine sulfate, chondroitin sulfate, Omega-3 fatty acids, antioxidants, Vitamin E, and MSM.
     • 9. Veterinary Neuronal Adjustment (VNA or VOM) See: (http://www.lbah.com/vom.htm or http://www.vomtech.com/SAT-01-99.htm or http://www.drchirovet.com/faqs.htm.
     • 10. Laser Therapy to reduce inflammation, improves blood flow and releases natural endorphins
     • 11. Stem-cell treatment to provide growth factors and chemicals that help the injury heal. See: Vet-Stem.

COST

Costs to treat cruciate ligament tears may include surgery and rehabilitation therapies, drugs and supplements can range from $1500 - $6000.00 (per knee).

Dogs with a ruptured cranial cruciate ligament in one knee have a 20 to 40 percent chance of injuring the other side.

Recovery Management

Managing dogs post surgery involves limiting activity and confinement to ensure healing. Young exhuberant Berners can become anxious if confined for an extended period of time. Good suggestions for mental stimulation during the recovery process (post surgery) are found at http://www.lauriebryce.com/tplo/.

Supplemental Therapies Booklist:

Consult your vet when applying massage or range of motion therapies.

Canine Rehabilitation and Physical Therapy by Darryl Millis MS DVM
Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals by Catherine McGowan
Canine Massage by Jean-Pierre Hourdebaigt

Berner-Garde lists 221 records found for Diagnosis = CRUCIATE LIGAMENT RUPTURE as of June 1, 2009.

Resources/References:
Website: http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/CranialCruciateLigamentRupture
Website: http://www.veterinarypartner.com
Website: http://ukpmc.ac.uk/
Website: https://www.vetcentric.com