Cruciate disease (knee ligament tears)

The cruciate ligament is an important ligament in the knee.  Damage to it is a common cause of lameness in dogs.  It can be damaged due to trauma, but far more commonly it has an inherent weakness.

This same ligament can be damaged in people; footballers are common victims of cruciate damage.

Many different repairs have been explored in dogs over the years. The repairs with the best outcomes today are surgical where the shape of the bone (tibia) is altered.  There are two main methods of doing this, either a TPLO or a TTA.  At the moment the TPLO procedures are considered to have a better long term outcome mostly as there seem to be fewer cases of meniscal damage after the operation.  The meniscus is a cartilage pad which sits inside the knee and acts as a shock absorber, it is important in the normal function of the knee joint, and for best long term results should be left in place where possible.  However due to instability of the knee joint when the cruciate is damaged, it is often damaged and then needs removal, there is very little chance of repair.

Before surgery we will first x-ray the knee to exclude other causes of lameness and help decide treatment options are available.

In straight forward cases, in our hands we find TTA surgery works very well.  Dogs recover from the surgery very quickly and are usually back on their feet in a few days.  There are cases where other methods are more appropriate.

Dogs undergo a period of steady return to exercise.  X-rays are repeated 4 weeks after surgery.  We expect full return to exercise 12 weeks after surgery once healing is complete.

On the downside either of these methods can have serious failures, which is not always repairable.

So, can’t we just leave it and let nature take its course?

Each case needs to be approached on its own merits, but generally speaking, dogs over 10kg will do better with surgery.

From a cost point of view this tends to be the increasing cost line:  do nothing, sutures (considerable variation depending on method), TTA and TPLO.

To answer the question, which single method is best?  At the moment if I where asked if I could only choose one way of repair  – I would have to say the TPLO is the best method of repair.