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The rupture of the anterior cruciate ligament (ACL) is the most common cause of lameness in the dog.
This injury has two common presentations. One is the young athletic dog playing roughly who acutely ruptures the ligament and is non-weight bearing on the affected hind leg. The second presentation is the older, overweight dog with weakened or partially torn ligaments that rupture with a slight misstep. In this patient the lameness may have a sudden onset or there may be a more subtle chronic lameness related to prolonged joint instability. People often times incorrectly think that in an older dog hind leg lameness is either a hip problem or just due to “old age”.
Your veterinarian will perform an orthopedic exam and may take radiographs (x-rays) in order to diagnose this injury. The orthopedic exam involves an analysis of the gait, examination of the joint for swelling and/or pain and the presence of "drawer movement" (the presence of forward instability of the knee joint). Sedation is often required to do an adequate evaluation of the knee, especially in large dogs. Sedation prevents the pet from tensing the muscles and temporarily stabilizing the joint and preventing the demonstration of the drawer sign. Radiographs confirm inflammatory changes in the joint and establish the level of osteoarthritic changes present. Early diagnosis of the condition is of paramount importance. An unstable knee can lead to further painful damage of other structures in the knee and will most certainly lead to development of osteoarthritis which cannot be cured, only managed.
Surgical repair is recommended in all cases to stabilize the joint and prevent further osteoarthritic changes secondary to the joint instability. There are three primary types of surgical repair:
- Extracapsular stabilization,
- Tibial plateau leveling osteotomy (TPLO), and
- Tibial tuberosity advancement (TTA).
The type of surgical repair recommended will be determined by the size, age and activity level of the pet as well as the degree of osteoarthritis already present in the joint and anatomical parameters of the affected leg. The recovery time and recommendation for physical therapy will depend on the type of surgical repair performed.