Full Title: Cruicate Ligaments
Author: Rhea-Anna Price
Date of Publication: January 1, 2017
Research Paper Text:
Ligaments are bands of fibrous tissues that connect two bones or cartilage at a joint. In the stifle (knee), there are four main ligaments. The medial (inner) aspect of the knee is the medial collateral ligament (MCL) and the lateral (outer) aspect of the knee is the lateral collateral ligament (LCL). There are two cruciate ligaments in the center of the stifle joint that function to provide joint stability: the Cranial Cruciate Ligament, often referred to as the CCL and the Caudal Cruciate Ligament. In humans, they are referred to as the ACL or Anterior Cruciate Ligament and the PCL, or Posterior Cruciate Ligament. These are important stabilizers inside the stifle joint. These cruicate ligaments connect two long bones called the femur (large bone in thigh) and tibia (large shin bone). There are cartilage pads in the inside and outside of the joint: Medial Meniscus and Lateral Meniscus, respectively. They sit between the femur and tibia and act as shock absorbers or cushions for the joint also providing stability. The CCL originates from the femur and inserts at the top of the Tibia Plateau between the Medial and Lateral Menisci. It crosses over the Caudal Cruciate Ligament in the shape of a cross or crucifix, thus the name cruicate. The Caudal Cruciate Ligament also originates from the femur, but inserts at the back of the Tibia Plateau to prevent backward movement. These two ligaments can move independently, but work together to keep the tibia and femur aligned for stability (Broadhurst). Tendons connect muscles to bones. The Quadriceps Tendon connects the quadriceps muscles on the front of the thigh to the top of the patella (knee cap), a small sesamoid bone centrally located on the front of the stifle. It slides up and down in a groove in the femur (the femoral groove) as the knee bends and straightens. The patellar tendon, attaches to the front of the tibia. The hamstring muscles on the back of the thigh attach to the tibia at the back of the knee. The quadriceps muscles are the main muscles that straighten the knee. The hamstring muscles are the main muscles that bend the knee (ACVS.org / www.orthopets.com).
A torn CCL is one of the most common orthopedic issues in dogs causing hind limb lameness, pain, and arthritic discomfort (ACVS.org). Cranial cruciate ligament disease is defined as the sudden or progressive failure of the cranial cruciate ligament, which results in partial to complete instability of the stifle joint. Cranial cruciate rupture is the tearing of the cranial cruciate ligament; it is the most common cause of rear-leg lameness in dogs and a major cause of degenerative joint disease (progressive and permanent deterioration of joint cartilage) in the stifle joint. This can be complete or partial rupture (www.petmed.com).
When the CCL is torn, stability of the stifle joint is compromised as the tibia can move forward relative to the femur. This movement can cause damage to the medial and lateral menisci. Dogs with this type of injury have a lame leg that can touch the ground, but won’t bear full weight. Injury diagnosis is done at the vet’s office to observe the abnormal joint movement. The vet will try to recreate a “drawer sign” movement by placing one hand on the tTibia and the other on the fibula to manipulate the joint (Pienaar). If the tibia can be moved forward like the opening of a drawer, the cruicate has been torn or ruptured.
A Tibia Compression Test is another way to check for ligament damage. The femur is held steady with one hand while the other flexes the dog’s ankle. A ruptured ligament allows the tibia to move abnormally forward (www.whole-dog-journal.com).
Radiographs are taken to see ligaments, as they are not visible on x-rays. But, x-rays are often taken as a means to observe other potential associated injuries or conditions like arthritis and to rule out bone cancer. Typically, if the cruciate is completely severed, surgery is the primary treatment, as the stifle can no longer perform as a stable hinged joint. If the injury is only a partial tear, more conservative methods are often implemented first (www.whole-dog-journal.com).
Acupuncture, acupressure, chiropractic and massage are holistic therapies used in pre/ post surgical care as well as non-surgical treatment protocols. “Stimulating specific acupressure points with a thumb or fingertip can help with pain management, clear the effects of anesthesia, minimize the building of scar tissue, and reduce swelling. Acupressure can be learned at home and applied whenever needed.” (Zidonis & Snow)
Veterinary chiropractors facilitate healing by making adjustments to improve skeletal alignment and muscular-skeletal function. “Chiropractic adjustments help restore normal nerve activity by gently moving bones, ligaments, and tendons back into alignment, and when ligaments are injured, adjustments help realign the body to improve balance and speed healing.” (www.whole-dog-journal.com).
Swimming is also considered to be a great therapy for injured joints. It allows the dog a way to move the joint with gentle exercise and without weight bearing activity. Floatation vests are used for poor swimmers or older dogs who prefer less exertion. Deep wading is a good alternative for swimming. This would have the dog in water deep enough to support most of his weight to lighten the burden on the joint, but still keep his feet on the ground (http://www.tiggerpoz.com/id3.html).
Swim and massage therapy can also:
- Maintain an optimum body weight
- Support reeducation (or use) of the effected limb
- Reduce swelling and inflammation
- Provide relief for developing arthritis
- Relieve muscle tension
- Increase mobility
- Offer pre-surgery support and post-operative recovery
- Provide a fun and safe way to exercise
“Canine massage therapists used to be unusual, but now they play an important role in maintaining and improving our dogs’ health. Efflurage, passive touch, kneading techniques, and stroking increase circulation, release muscle tension, reduce pain and soreness, relieve stress, and accelerate the repair process.” (www.whole-dog-journal.com).
In this rehabilitation plan, massage is recommended as post-surgical treatment.
Rehabilitation Plan for a Cranial Cruciate Ligament Repair POST SURGERY Massage: Reduces pain, muscle spasm, swelling and helps your dog to relax. Using a kneading circular motion, work on the muscles starting from the toes up to the hip. Work for 5-10 minutes 3 times per day prior to starting exercises. We have a massage video that is available to teach you how to better massage your dog (http://thespaw.com/blog/rehabilitation-plan-for-a-cranial-cruciate-ligament-repair).
Although, no breed of canine is in the clear to avoid cruicate injuries, it is believed that larger, athletic type dogs seem most susceptible. German Shepherds, Rottweilers, Labradores, and Golden Retrievers are commonly treated for this injury. “Veterinary studies show that up to 60 percent of dogs who tear one CCL will tear the opposite one in the following 1-2 years.” (http://www.petinsurance.com). Other sites also include Poodles, Bichon Frises, Bernese Mountain Dogs, Bull Mastiffs, Chows, and Saint Bernards to the list of susceptible breeds (www.dogheirs.com / (http://www.healthcommunities.com). Some research indicates that spayed/ neutered dogs over the age of 4 and dogs that have been on corticosteriod medication for long periods of time are more susceptible to CCL injuries than dogs that are sexually intact (http://www.ncbi.nlm.nih.gov/pubmed/18598150). “Chronic onset (degeneration and rupture usually from aging) occurs in 80% of cases and occurs in dogs 5 to 7 years old. Acute onset (tear caused by injury) is most common in dogs under 4 years old. Young dogs of large breeds are more susceptible to rupture than young dogs of small breeds” (http://www.healthcommunities.com). Risk factors for injury include: age, arthritis, stifle joint injury, breed size, overweight, poor muscle structure near joint, and structural skeletal abnormalities.
The CCL is an important stabilizing ligament in the stifle that is a frequent injury for many dog breeds. In some cases surgical treatment is necessary and in others rehabilitation and holistic techniques are recommended. PetMassage can be one of the therapies made available to provide whole dog wellness following one of these injuries. The stimulation of lymph, increased circulation, tissue manipulation, and positional release techniques are just some examples of the benefits provided. In this growing industry, this is another example of how we can make a difference in the lives of many of our fury friends.
- Snow, Amy, Zidonis, Nancy. Whole Dog Journal. “Post-op acupressure: use your hands to help your dog recover more quickly from surgery.” August, 2006. http://www.highbeam.com/doc/1G1-149365790.html Pienaar, Morkel, BVSC Cert Opthal MRCVS. “Cruciate Ligament Rupture in dogs- Symptoms & Diagnosis.” www.vetstoria.com
- Broadhurst, Henry. “Canine Cranial Cruciate Rupture- 3D Animation for Veterinary” www.youtube.com/watch?v=CNymdzyRavs