“Cranial cruciate ligament disease, with or without concomitant meniscal injury, is the most common cause of lameness in the dog.”
The term cranial cruciate ligament disease covers a spectrum of pathology ranging from stretching to partial or complete rupture. Osteoarthritis (OA) of the stifle joint is almost always a feature of this disease and must be managed. As with many conditions in veterinary science cranial cruciate ligament disease (CCLD) is not without controversy in terms of aetiology, pathogenesis and the most appropriate method of management. Recent research supports the use of physical therapy to manage all cases of CCLD.
Management of CCLD is a complicated and controversial topic when all aspects are taken into consideration. The simplest manner of discussing options is to choose between conservative management or surgical intervention. The decision-making process is not easy, however, and each patient presenting with CCLD must be managed as an individual. The client’s needs and circumstances must be considered (small children, stairs, travel plans and finances). There are also dog-related issues (concurrent disease, behavioural problems, other animals in the home) which have bearing on the decision. Finally, there are factors relating to the surgeon (experience, equipment, training and preference). Following CCL rupture the stifle will not be the same again. The goal should be to return to as close as possible to normal function.
Rehabilitation Following Cranial Cruciate Ligament Injury and Surgery
“Physical rehabilitation may be at least as important as surgical technique in affecting functional outcome.”
When managing a dog with CCL injury, the initial emphasis is on the best surgical technique. Surgery may not be a feasible option. Any rehabilitation program for CCL deficiency (surgical or not) must address the following:
- The phases of tissue repair and the type of tissue. Chosen exercises and modalities need to be stage appropriate.
- Muscle atrophy. This will occur with CCL damage.
- Joint mobility. Stifle instability will cause OA which will impinge on joint mobility. Programs must incorporate exercises to retard the development of OA and maintain ROM.
- Altered gait. This will result in a reduction of weight bearing of the affected limb which will have long term repercussions. Proprioceptive exercises are invaluable in managing dogs with CCLD.
Goals of any program for CCL deficiency which will return the dog to full function are:
- To manage pain and swelling.
- To normalize ROM.
- To normalize flexibility.
- To achieve full weight bearing.
- To strengthen core musculature and the dynamic stabilisers of the stifle (quadriceps and hamstring groups).
- To retain the proprioceptive feedback loop to stimulate the contraction of the semitendinosus and semimembranosus muscles at the correct time and for the right amount of time to be protective, specifically when the dog is standing.
- To develop a home exercise program.
The following practices are fundamental to achieve success in any CCLD rehabilitation program:
- No running, jumping or playing.
- Manage in a harness and on a leash for 3 months.
- Ensure confinement when there is no supervision.
Creating a healthy stifle begins in puppyhood. Appropriate growth rates, body weight and body condition scores should be maintained throughout all life stages. Controlled exercise, appropriate strengthening and relevant muscle conditioning become the mainstay of both prevention of CCL damage and management after injury. The controversy surrounding manners in which to treat CCLD will probably remain but the benefits of physical therapy in managing the cruciate deficient stifle, no matter the chosen treatment, will definitely remain.