Cranial cruciate disease in dogs is one of the most common injuries that animal physios and vet rehab professionals come across. So much so that vets will suspect cranial cruciate disease in a dog with hind limb lameness unless proven otherwise. Although there are many similarities between this type of injury in dogs and humans (ACL in humans), there are also some very interesting differences that can make this condition challenging, but not impossible to treat in our dog patients. If we look at the anatomy of the stifle joint (the knee in a dog), it is easy to see why this is such a common condition and why it is considered a degenerative condition unlike in humans. The stifle joint is made up of 3 bones; the femur (thigh), tibia (shin) and the patella (kneecap). The role of the cranial cruciate ligament is to prevent the tibia (shin bone) sliding forward excessively in relation to the femur bone (thigh bone), so the stifle remains stable with movement and load bearing. Without a stable stifle joint, our dogs cannot load the hind limb comfortably or safely and the limb will become non-functional. It can also be very painful and comes with the risk of injury to other structures within stifle, like the meniscus. Interestingly, unlike in humans, the point where the cranial cruciate ligament attaches to the tibia is quite steep which means that the cranial cruciate ligament is under constant tension. This is why cruciate disease is considered a degenerative disease; constant tension over time, means constant stress to collagen fibres which can result in fraying and then partial or complete rupture without a specific mechanism of injury.

Gold standard treatment of cruciate disease in dogs is surgery. There are many different surgeries that our vets use depending on what is suitable for your dog. There are two main categories of surgical intervention; extracapsular techniques and fracture repairs/osteotomy techniques. Extracapsular techniques aim to create a stable stifle joint by using materials to stabilise the outside of the stifle.  Often sutures are looped around the outside of the joint to prevent excessive movement of the stifle in when the cranial cruciate ligament is damaged. You may have heard of surgeries called lateral suture/Flo, DeAngelis, tightrope or percutaneous capsule repairs. These are all extracapsular techniques and can work well on smaller less active dogs as not only are surgeons relying on stability from pliable softer materials, but extracapsular fibrosis or scar tissue formation once the surgery is complete. For bigger and heavier dogs, sometimes these materials can stretch, break and fail especially if strict post-operative guidelines are not adhered to, and rehabilitation is not pursued.

Fracture repairs or osteotomy techniques aim to change the structure of the stifle joint to make it more stable when the ligament is damaged. These techniques are known as TPLO, TTA, TTO, Modified Maquet technique. Bony landmarks of the stifle joint are broken and moved around to change the incline of the tibial plateau and make the joint less moveable and therefore more stable. These techniques can provide more robust stability but only if post-operative rehabilitation considers bony healing time frames and the risk of complication if the dog is pushed too hard too soon. Again, dogs have better outcomes if strict post-operative guidelines and a rehabilitation plan is followed.

As an animal physio, sometimes I come across dogs who have cranial cruciate disease and surgery may not be an option. With these cases, animal physios and vet rehab professionals can provide an alternative – a conservative rehabilitation approach. This means that the dog is guided through an individualised and specific rehabilitation program that aims to encourage and support tissue healing. We are ultimately relying on the body laying scar tissue down around the joint and encouraging muscle activation and strength building in the surrounding muscles to provide stifle stability. This approach does not come without risks and should only be considered with total commitment and adherence. This process will also take a long time as tissue healing times move through very specific stages in the first 12 months after injury. It’s often much easier to disrupt the formation of new scar tissue in the earlier phases of recovery with the risk being much higher when the dog is bigger, heavier and more active. But when surgery is not an option, it is certainly worth considering so the dog is not exposed to chronic pain and disability. Conservative management involves all the techniques that Physiotherapists utilise in their practice with the most important being prescribed therapeutic and controlled exercise.

When exercise is used in the rehab process, it is important to consider the mode. Sometimes dogs may be very sore and reluctant to start to use their injured limb and therefore hydrotherapy could be very helpful in kickstarting this process. Land-based exercise will always be the most essential component for our dogs though as they are land dwelling animals and specificity matters when it comes to strength, conditioning and return to function. Exercise improves circulation which helps to manage inflammation, swelling and encourages the physiological processes of collagen formation. It encourages collagen realignment to improve strength and flexibility in scar tissue. It aids appropriate muscle activation and strengthening to encourage normal joint movement and joint protection. It promotes gait re-education and pain free weight bearing in the affected limb and it helps to protect other limbs from future injuries. It promotes mental stimulation and mood improvement when activity is restricted and modified. It is also important to note that post-operative dogs must also undergo rehabilitation to achieve optimal outcomes and return to function so that the risk of injury to the contralateral cranial cruciate is reduced – this will happen to many dogs after the first cruciate injury, so it is important for our owners to be aware of this!

So, if your best canine companion is facing life with cranial cruciate disease, know that there are options out there. Talk to your friendly vet and animal physio/vet rehab professional for guidance on the best way to manage this condition. I’ve worked with many dogs who have taken all pathways, have ended up achieving amazing outcomes and have gone on to live wonderful, pain-free and good quality of lives. Me and my colleagues are here to help your dog so don’t forget to reach out!

As it’s currently winter in Australia, I thought it would be the perfect time to shine a spotlight on one of those conditions that can creep up on our pets. Many of us will start to see our pets slow down, limp a little or just generally look a stiffer with their movements at this time of year. Even more so for our older dogs. Often arthritis can be a culprit just as it can be for humans. But what does this mean for our canine companions?

The term arthritis is defined as inflammation to a joint complex, but did you know that there are many different forms of arthritis and sometimes figuring out which form is making our dogs uncomfortable can be a challenge in the veterinary world. Arthritis is the result of many pathophysiological processes and many different influencing factors that cannot just be attributed to the physical wearing down of a joint. Sometimes arthritic conditions can be genetic or sometimes they can be linked directly to a mechanism of injury. Osteoarthritis (OA) involves the wearing down of joint cartilage and remodelling of bone in the joint capsule. What is clear about OA though is that it is not just a simple ‘wear and tear’ process. Research has shown that OA is the result of the interplay between complex stress processes, inflammation and immune system dysregulation and this can mean that managing your dog’s OA can be more complicated. This is by far the most common form of arthritis that an Animal Physiotherapist will see because it can cause significant discomfort, changes in movement patterns and impact on your dog’s quality of life. There is also well-established evidence around the effectiveness of physiotherapy interventions in the successful management of this condition.

Dogs can also suffer from other arthritis conditions that are caused by overactivity of the immune system. This results in the body’s immune cells attacking and degrading its own tissues which can cause inflammation, pain and destruction of the joint. This form of arthritis is referred to as reactive arthritis or immune mediated polyarthritis. Although less common than OA, Animal Physiotherapists are also involved in the management of this type of arthritis because it ultimately results in similar signs and symptoms that can impact on your dog’s quality of life.

A large percentage of my canine clients present with an OA diagnosis but not all these clients are older dogs. Yes, it is true that older dogs are more likely to experience OA as this can be a part of normal aging, but it is not a condition exclusive to this canine population group. Older dogs may have experienced injury and comorbidities in the past that may have resulted in damage to joint tissue and therefore we see adaptive postures and gait patterns and secondary compensation in other areas of the body. Over time, this can result in enough stress and damage to a joint that the dog ends up with OA. It is also common to see younger dogs with earlier onset OA because of a pre-existing condition. An example is hip dysplasia. Hip dysplasia refers to the malformation of the hip joint which then results in abnormal movement and wear overtime. This very often leads to OA of the hip which can happen much earlier on in the dog’s life if not diagnosed and managed appropriately. Sometimes the hip dysplasia is only diagnosed because a young dog has presented to their vet with changed gait, joint stiffness/pain, reduced joint range of motion and muscle wastage – all hallmarks of OA. Diagnostic imaging may then be pursued because these signs and symptoms are unusual for a young dog, with the result being a diagnosis of hip dysplasia usually with early signs of OA in the hip.

The strongest evidence for managing OA in dogs is the multi-modal or holistic approach. This means that many professionals in the veterinary field collaborate and utilise their skills to achieve the most optimal outcomes. From a pharmaceutical perspective, nonsteroidal anti-inflammatory (NSAID) medications are gold standard. Following this, weight management and omega-3 fatty acid supplements to support joint health are also supported in the literature.

When it comes to exercising our dogs with OA, it is a little more complicated. This is because there is a lack of high-quality research in this field of vet rehab and therefore, often recommendations are taken from human research as there is a strong body of evidence supporting exercise in the management of OA in humans. Anecdotally, outcomes for targeted and controlled exercise programs for OA dogs are positive and will often result in improved pain, muscle mass/strength, joint range of motion and lameness. This is because when we look at OA research in the human population, the physiology of exercise has been proven to be beneficial for OA management. For example, exercise causes the suppression of low grade, systemic inflammation associated with OA which can ‘calm’ the activity of destructive enzymes within the joint complex. Gentle load bearing exercise causes improved fluid circulation within the joint space which can help circulate nutrient rich synovial fluid and encourage healthy cell activity to preserve remaining tissue. Exercise also promotes strengthening of the surrounding muscles which can help better manage and absorb forces that may otherwise overload the affected joint. With all these effects, exercise can greatly help improve comfort levels and function in humans, and based on smaller clinical trials, case reports and objective information collected from Animal Physiotherapists, also in dogs. Having said that, the type of exercise that we prescribe our dog patients is specific and should be guided by your vet rehab professional. We do need our dogs with OA to be doing a degree of load bearing exercise for all the above reasons, but intensity needs to be carefully prescribed. If load bearing exercise is too high and too intense, we run the risk of increasing pain and joint degradation. If we utilise no load, such as with swimming, we run the risk of losing our anti-inflammatory properties of exercise specifically for affected OA joints and preservation of the remaining cartilage in the joint. This is why Animal Physiotherapists are so important in guiding your dog through an appropriate therapeutic exercise program because this is what we specialise in. We can also utilise many of our other skills such as manual therapy and electrotherapeutic devices to target pain and stiffness if needed, to enhance the effect of exercise.

If your dog has OA and is struggling to get through this winter comfortably, it could be very beneficial to touch base with your local Animal Physiotherapist or Vet Rehab professional. We can provide invaluable guidance and treatment options to keep your pooch happy in the cold weather and moving forward into their senior years.

References used to help write this blog post;

NIH.gov, canine arthritis.org, vetruvianpb.com, dpi.com, veterinary partner.vin.com, bpvet.com.au, avma.org, vettimes.comibah.com, todaysveterinarypractice.com,qvs.com.au