Call 512-548-6412 to schedule an exam and TPLO consultation today!
Cranial cruciate ligament (CCL) rupture or disease is the most common orthopedic condition seen in dogs of all breeds.
The function of the CCL and its opposing ligament, the caudal cruciate ligament, is to stabilize the tibia in relationship to the femur. You may be familiar with the term an ACL tear in people- the CCL is the same ligament; however, our patients walk on four legs thus anatomically we call it a CCL tear in dogs and cats.
Damage to the CCL leads to instability, inflammation, pain, lameness, and development/ progression of osteoarthritis that leads to long term disability, pain and lameness.
When the CCL fails, tears or ruptures, the tibia slides forward in relationship to the femur and often times leads to secondary involvement or tearing of the medial meniscus
The two videos below show what happens when the CCL tears as seen on physical examination and testing with our hands:
Pre-TPLO Tibial Thrust
Pre-TPLO Cranial Drawer
Radiographs may also be used to help the diagnosis through the visualization of signs of inflammation, pre-existing osteoarthritis, and even cranial displacement of the tibia in relationship to the femur.
This pre-operative radiograph shows effusion (*) and pre existing OA changes (##) at the level of joint capsular attachment to the femur.
Tibial Plateau Leveling Osteotomy (TPLO)
There are many treatment options available, both medical and surgical, for the treatment of CCL tears in dogs; however, surgical treatment is the treatment of choice to alleviate instability, pain, prevention of subsequent development of osteoarthritis, and ultimately return to full function.
Note: in the rare case of pre-existing medical conditions that preclude an anesthetic or surgical intervention, then medical therapies include bracing can be discussed.
Tibial plateau leveling osteotomy (TPLO) is one of the most commonly performed surgical treatment options which allow for the early return of weight bearing (typically one or two days after surgery) and return to full function with little or no progression of osteoarthritis post operatively reported.
During the procedure, a bone cut (osteotomy) is performed in the tibia which allows the tibial plateau to be rotated and leveled in relationship to the horizon.
Pre-Operative Radiograph
Note the effusion (*) or inflammatory fluid with the knee as a result of the CCL tear.
Post-Operative Radiograph
Note the implant placement and relationship of the tibial plateau to the horizon now.
Pre-Operative Schematic of the Knee
If F is the CCL and were to tear, then the wagon, or tibia, would slide in the direction of D or down hill, away from the femur.
Post-Operative Schematic of the Knee
If F (the CCL) is torn, now with with weight bearing C, the wagon does not slide down hill any longer, thus achieving a stable knee.
Thus when the patient weight bearings and engages the Gastronemius muscle which attaches both above and below the knee, the leveled tibial plateau now loads the caudal cruciate ligament which stops the cranial translation of the tibia in relationship to the femur thus creating a stable stifle.
Below are the same videos as seen preoperatively now performed after TPLO surgery:
Post-TPLO Tibial Thrust
Note: in the tibial thrust test in which the Gastrocnemius muscle is engaged, the cranial displacement of the tibia has been eliminated.
Post-TPLO Cranial Drawer
Note: in the cranial drawer test, the test is still positive because again the ligament is gone and was not replaced; thus it will always be positive, unless the leg is placed in a weight bearing posture.
TPLO Recovery
Following surgery, your pet will have an eight week rehabilitation and conditioning schedule ahead of him/ her to expedite a full recovery.
We know that for every day of muscle disuse or atrophy it takes 3 to 4 days to build that muscle back; therefore, if your pet recently tore the ligament and had the surgical correction quickly then the amount to atrophy is insignificant and return to full function is quicker; however, if your pet has been limping for say three months and has lost marked muscle, it may take 9 to 12 months to regain full muscle mass. This does not mean after surgery your pet will limp for that long. Rather you may note early fatigue or lack of endurance until such time as full muscle recovery occurs yet your pet will be weight bearing, pain free and happy while building back said lost muscle.
With all this being said regarding surgery, the post operative rehabilitation and conditioning time is equally or more important for a successful and quick recovery. At home exercises will be provided that outline weekly progression and various staged exercise.
Discharge Instructions
Liberty Hill Veterinary Wellness has invested in an underwater treadmill, class four laser, pulsed electromagnetic field therapies, as well as other exercises and modalities to speed your pets recovery.
Cranial cruciate ligament tears are common and we have a great surgical and post surgical rehabilitation plan to provide you and your pets a rapid, fun, and proven return to full function. The only down side is, unfortunately, we see upwards of 20 to 40% of dogs that tear one CCL will tear the opposite CCL within the first year or two. Again, if we can prevent this occurrence through weight management, rehabilitation and conditioning such as strengthening the core, we hope to reduce this ever present risk.
Liberty Hill Veterinary Wellness is excited to be able to provide you and your pets advanced surgical as well as rehabilitation and conditioning services here in Liberty Hill, Texas.
Meet Dr. Murphy
Dr. Murphy has advanced surgical training at the University of Pennsylvania where he completed a 3 year surgical residency program after completing a one year general medicine and surgery internship at the Animal Medical Center in New York City. Dr Murphy’s surgical residency covered all aspects of surgery from general to orthopedic to oncologic (cancer) to soft tissue surgeries, as well as, advanced anesthetic protocols, interventional radiology and interpretation, pain management, and intensive care management of critical and basic level patients.
After many years in referral specialty practice Dr. Murphy began to focus more on overall wellness, rehabilitation and conditioning and regenerative medicine modalities to include platelet rich plasma and stem cell therapies. Dr. Murphy completed his CCRP (Canine Certified Rehabilitation Practitioner) certificate at the University of Tennessee which many consider to be the founding group of veterinary rehabilitation and conditioning. Likewise, the staff at Liberty Hill Veterinary Wellness has benefited form Dr. Murphy’s advanced training and eagerness to train the next generation of veterinarians and technical staff.
Why Choose Us?
Over 2,500 TPLO Surgeries Performed
Dr. Murphy is a residency trained surgeon who has performed well over 2,500 TPLO procedures for canine cruciate ligament repair. He has found TPLO to be clinically superior to the other techniques as evident in the success stories of many working and agility dogs that have gone back into competitive work.
Certified Rehabilitation Practitioner
Dr. Murphy is also a canine certified rehabilitation practitioner (CCRP) which focuses on rehabilitation and conditioning of your pet to optimize pre and post surgical outcomes.
Top Rated Veterinarian
LHVW has a great staff who loves to get involved in your pets recovery from start to finish. Communication is key and we are always phone call or email away.
Contact Us Today!
There are many happy endings we can share with you, and no doubt Liberty Hill Veterinary Wellness is a reputable animal hospital trusted by the community – but don’t take our word for it, click here to read the 5 star reviews on Google!
Call 512-548-6412 to schedule an exam and TPLO consultation today. Our knowledgeable team is here to help you learn more!