Cruciate ligament rupture in small animals

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Torn anterior cruciate ligament in a dog, surgical site.

The cruciate ligament rupture , also known as a cruciate ligament tear , is a rupture of one of the two cruciate ligaments . In some small animals - especially domestic dogs ( Canis lupus familiaris ) - the cruciate ligament tear is a common disease. In most cases, the anterior cruciate ligament ( ligamentum cruciatum craniale ) is affected. In veterinary medicine one speaks of a cranial cruciate ligament rupture . The posterior cruciate ligament ( ligamentum cruciatum caudale ) is affected much less often. Also, the effects of a torn posterior cruciate ligament are not as serious as the anterior one.

Anterior cruciate ligament rupture in domestic dogs

In domestic dogs, the anterior cruciate ligament rupture is a commonly diagnosed orthopedic disease and one of the most important causes of lameness . Statistically speaking, larger breed dogs are more likely to be affected than smaller breed dogs. The pathogenesis for this disease is still largely unclear. In most cases - as is the case with humans (see cruciate ligament rupture ) - the cruciate ligament tears caused by injuries , which is why the term "injury" in the case of cruciate ligament ruptures in dogs does not adequately reflect the situation. Cruciate ligament ruptures caused by trauma can occur, for example, from falling deeply, jumping over high fences, traffic accidents or similar external influences. Statistically, they are less common than cruciate ligament ruptures of other origins. In these cases, the rupture of the cruciate ligament is progressive rather than sudden, as is the case with an injury. The integrity of the band structures slowly decreases and initially leads to an overstretching of the band, which loses its tensile strength more and more. After partial tears in the belt, a slight overstressing of the belt can ultimately lead to its complete tear. The degenerative changes in the anterior cruciate ligament increase with advancing age and increasing body weight of the dog. There is a clear correlation here . The dog's level of training also plays a role in its predisposition. Inactive dogs are more prone to cruciate ligament ruptures, presumably due to ligament degeneration caused by their inactivity. The presence of other degenerative processes in the dog's knee, such as various forms of arthritis , also promote degeneration of the anterior cruciate ligament. An inward displacement of the kneecap can also cause a cruciate ligament rupture due to the associated inward rotation of the tibia. There are contradicting studies about a possible gender-specific disposition. However, the majority of studies show an increased number of cases in bitches.

A tear in the anterior cruciate ligament quickly leads to degenerative changes in the affected knee joint in dogs. In comparison, a tear in the posterior cruciate ligament shows only minimal damage to the knee joint.

The Anglo-American technical term for the anterior cruciate ligament rupture in domestic dogs is canine cranial cruciate ligament rupture .

Cruciate ligament rupture in domestic cats

Ruptures of the anterior cruciate ligament are significantly less common in cats than in dogs. Here, too - as in domestic dogs - there are two different pathomechanisms: the traumatic rupture and the progressive degenerative rupture. Both pathomechanisms are assumed to have the same etiology as in domestic dogs. Age, body weight and physical activity also play an important role here.

The Anglo-American technical term for anterior cruciate ligament rupture in domestic cats is feline cranial cruciate ligament rupture .

Diagnosis

A rupture of the anterior cruciate ligament can often be recognized based on the symptoms, i.e. the lameness of the affected animal. The palpatory examination ( drawer test , tibial compression test ), with which the instability caused by the rupture of the cruciate ligament can be determined, is considered reliable evidence. A comparison with the unaffected knee joint is recommended in order to have an intra-individual reference.

therapy

There are a number of different conservative and surgical procedures for treating rupture of the cranial cruciate ligament . They all aim to restore adequate stability in the affected joint. Neither of these methods offers an optimal solution. No procedure can restore the condition of a healthy knee joint. Future arthritis in the knee joint cannot be prevented. While dogs usually have to be treated surgically, cats can first wait.

Conservative treatment

Conservative treatment aims to avoid undesirable development of the musculoskeletal system through feeding and exercise. Above all, dislocations should be avoided . This form of therapy is recommended for large breeds. In young animals, growth can be specifically inhibited by giving them hormones in order to also prevent dislocations. The results of conservative treatment are usually described as unsatisfactory.

Operative treatment

For the most part, human medical techniques are used for surgical treatment, but these often do not do justice to the special features of the biomechanics of the knee joint in animals. The operational procedures can be divided into three groups.

Cleaning up

With the cleaning up ("clearing up") according to Nilsson (1949) only the remnants of the torn cruciate ligament and damaged meniscus parts are removed. Today this procedure is no longer used as the only form of therapy.

Ligament replacement techniques

In the techniques with ligament replacement (cruciate ligament plastic), the body's own connective tissue structures or artificial materials are used. Either a fascia strip of the fascia lata , tendons of the semitendinosus muscle , gracilis muscle or the patellar ligament are used on the body's own replacement material. They are guided obliquely forward and down through a drill channel through the knee joint and attached to the tibial bulge ( tuberositas tibae ).

Techniques without ligament replacement

The capsule gathering techniques are based on an incision in the joint capsule, which is then gathered with surgical suture material. In the weeks after the operation, fibrosis of the joint capsule occurs, which stabilizes the knee joint.

Complex osteosynthesis methods have recently been developed to correct cruciate ligament tears . When the head of the fibula is shifted forward, the attachment of the lateral collateral ligament is also shifted forward, so that it functionally replaces the anterior cruciate ligament and prevents internal rotation in the knee and forward displacement of the tibia. This can also be achieved by shifting the origin of the extensor digitorum longus muscle . In the tibial plateau leveling osteotomy (TPLO), the tibial head is sawed off and osteosynthetically fixed again with a different incline, so that the drawer phenomenon is prevented. The tibial tuberosity Advancement (TTA) based on a displacement of the tibia bump. The triple tibial osteotomy ( triple tibial osteotomy ) performs the tibial bump to a flattening of the tibial plateau and advancement. However, clinical studies do not attest these techniques better restoration of limb function than simple ligament replacement procedures.

Individual evidence

  1. ↑ a b E. Gielen: Radiological investigation of the inclination angle of the tibial plateau as a possible predisposing factor for the rupture of the anterior cruciate ligament in the dog. Dissertation . Justus Liebig University Giessen, 2005.
  2. ↑ L. Brunnberg: Clinical and experimental investigations on the etiology, pathogenesis and therapy of the rupture of the cruciate ligament in the dog's knee. Habilitation thesis . LMU Munich, 1987.
  3. ^ S. Reese: Investigations on the intact and ruptured ligamentum cruciatum craniale of the dog. Dissertation. FU Berlin, 1995.
  4. ^ PB Vasseur: Clinical Results Following Nonoperative Management for Rupture of the Cranial Cruciate Ligament in Dogs. In: Veterinary Surgery. 13, 1984, pp. 244-246. doi: 10.1111 / j.1532-950X.1984.tb00801.x
  5. ↑ Henderson RA, Milton JL: The Tibial Compression Mechanism: A Diagnostic Aid in Stifle Injuries. In: Journal of the American Animal Hospital Association. 14, 1978, pp. 474-479.
  6. ↑ a b Daniel Koch: The filled knee joint - what is possible? In: Kleintiermedizin 4-2016, pp. 166–170.
  7. ↑ J. Harari et al.: Evaluation of experimental Transection and Partial Excision of the Caudal Cruciate Ligament in Dogs. In: Veterinary Surgery. 16, 1987, pp. 151-154. PMID 3507134
  8. ↑ GL Harasen: Feline cranial cruciate rupture: 17 cases and a review of the literature. In: Vet Comp Orthop Traumatol. 18, 2005, pp. 254-257. PMID 16594395 (Review)
  9. ^ JM Johnson, AL Johnson: Cranial Cruciate ligament rupture. Pathogenesis, diagnosis and postoperative rehabilitation. In: Vet Clin North Am Small Anim Pract 23, 1993, pp. 717-733. PMID 8337786 (Review)
  10. ↑ U. Matis, R. Köstlin: On the cruciate ligament rupture in cats. In: The practical veterinarian. 8, 1978, p. 585.
  11. ↑ TD Braden: The dog's unstable knee joint. In: Small Animal Practice . 2, 1980, pp. 417-427.
  12. ↑ a b D. Kraus: Luxatio patellae congenita medialis and rupture of the ligamentum cruciatum craniale in the dog - a CT-osteoabsorptiometric study. Dissertation. LMU Munich, 2006.
  13. ↑ a b Michael G. Conzemius et al: Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. In: Journal of the American Veterinary Medical Association. 226 (2005), pp. 232-236.
  14. ↑ S. Paatsama and others: Genu valgum, a contribution to the clinic of the knee joint in dogs. In: Small Animal Practice. 26, 1981, pp. 181-186.
  15. ↑ C. Weber: Studies on the therapy of the rupture of the cruciate ligament in dogs with and without meniscus injury. Dissertation. FU Berlin, 2006.
  16. ↑ F. Nilsson: Meniscal injuries in dogs. In: North. At the. Vet. 30 (1949), pp. 509-516.
  17. ↑ RJ Boudrieau: Tibial plateau leveling osteotomy or tibial tuberosity advancement? In: Vet Surg. 38, 2009, pp. 1-22. PMID 19152613 (Review)
  18. ↑ SE Kim et al.: Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. In: Vet Surg. 37, 2008, pp. 111-125. PMID 18251804 (Review)
  19. ↑ AD Moles et al .: Triple tibial osteotomy for treatment of the canine cranial crucial ligament-deficient stiffle joint. Surgical findings and postoperative complications in 97 stifles. In: Vet Comp Orthop Traumatol. 6 (2009), pp. 473-478.

further reading