Labrador sprain symptoms. Surgical treatment of anterior cruciate ligament rupture in dogs

It is not uncommon for a dog to limp after an unsuccessful jump, fall, or run on a slippery surface. Most often, this is a sign of sprain or rupture of ligaments and tendons. And although lameness can be a sign of other injuries (dislocation, etc.), we will look at the symptoms of sprains and torn ligaments in dogs, as well as first aid.

Causes of sprains

In adult healthy dogs, ligaments and tendons must withstand active loads in the form of jumps, falls, etc.

However, the connective tissues of puppies of large dogs during growth do not have time to adapt to rapid weight gain.
The cause of weak ligaments in dogs can be a lack of calcium and other trace elements in the diet.
Sprains and ruptures of ligaments also occur with dislocations and fractures.
Congenital disorders of tissue development can cause sprains.
Overweight dogs are prone to torn knee ligaments.
During the overcoming of a high obstacle, a tendon tear can occur in a dog.
A knee sprain can occur in a dog when climbing stairs.

Sprain symptoms

When stretched, stretching or rupture of individual ligaments, fibers and small vessels occurs.Often, when a ligament is ruptured, a nearby vessel is damaged, and hemorrhage occurs in the surrounding tissues (including the joint).

Immediately after the injury, symptoms may be mild.
The dog does not stand on the injured limb, limps.
The function of the joint is impaired when walking.
After a few hours, swelling and soreness may appear in the affected area.
In places of tendon rupture, an inflammatory process occurs, accompanied by severe pain and lameness. When moving, the dog keeps the limb in a suspended half-bent state and does not step on it.
Before the appearance of edema, you can easily feel the place of the tear of the ligament.

First aid for sprains

At the site of damage to the ligament, you can apply (without rubbing) an ointment for the treatment of injuries ("Fitoelita", etc.).
A cold and tight bandage is applied.
Painkillers are not applied as the dog becomes active and injures the limb again.

Sprain treatment

When the tendons are stretched and torn, the next day after the injury, warming alcohol and alcohol-ichthyol compresses are used, combined with warm wraps.
On the third day after the injury, you can apply a light massage and a warm wrap in combination with paraffin applications.
In the following days, the massage is combined with "absorbable" ointments and gels such as "Troxevasin".
When the tendon is torn, ultrasonic phonophoresis with hydrocortisone suspension is used.

If a tendon rupture occurs surgical intervention(on the second day after cold procedures).

Damaged areas of the tendon and blood clots are removed by stitching the tendon.
After the operation, a splint-gypsum bandage is applied to the limb (with the phalangeal joints bent), which helps to bring the stitched ends closer together and relax the flexor tendon.

Naturally, it is better if the dog is shown to the veterinarian in a timely manner. But if such an opportunity is not expected within a few days and weeks, then simple sprains and tears can be cured by yourself, following our advice.

Finally, we want to recommend that your pets do not give puppies excessive physical exertion, do not play games on a slippery surface. The nutrition of puppies and dogs should be balanced, with the addition of a sufficient amount of minerals.

Health to you and your pets!

A. N. EFIMOV,
cand. vet. Sciences, Associate Professor, Ch. doctor of clinic 000 "Lev"
Saint Petersburg

In dogs undergoing surgery, studies over the past three years show that about 3% had an anterior cruciate ligament tear in the knee joint. Among diseases of the musculoskeletal system, this pathology accounts for 6.1% and is inferior in terms of the number of fractures and dislocations.

The literature describes several methods of surgical treatment of rupture of the anterior cruciate ligament of the knee, where the authors often point out their lack of effectiveness. Using Lavsan prosthetics for the cruciate ligament for several years, we were convinced of the low efficiency and potential danger of this method, which was a prerequisite for the development of a new method of surgical treatment.

PURPOSE OF THE STUDY

The purpose of this work is to find a way to functionally stabilize the knee joint after a rupture of the anterior cruciate ligament.

MATERIALS AND METHODS

Anatomical study of the knee joint, reproduction of the rupture of the anterior cruciate ligament, study of the consequences of its loss and development of a method for restoring the functional activity of the knee joint by stabilizing it (using the anatomical elements of the limb itself) were carried out on the corpses of 6 medium-sized dogs.

The implementation of the method developed by us was carried out in a clinic on 85 dogs of different breeds with a rupture of the anterior cruciate ligament of the knee joint.

Long-term results were monitored for 3 years.

Data on the condition of patients after the operation was obtained by questioning the owners both during the re-admission of animals for clinical examination and by telephone at the scheduled time.

Material about this pathology (anamnesis, breed, age, etc.) and the results of surgical treatment was obtained from the case histories.

RESEARCH AND METHOD OF CARRYING OUT SURGICAL OPERATION

During the reproduction of movements on the dissected limbs with a crossed anterior cruciate ligament, a wide amplitude mutual displacement of the articular surfaces in the area of the knee joint was established. It has been established that when the joint is extended, the femur, mainly when pressure is exerted on it from the side of the patella, is displaced plantarly (Fig. 3), while the tibia, moving forward from under the femur due to tension of the direct ligament, dorsally (Fig. Behind). In this case, quite often the medial condyle of the femur overcomes the caudal horn (edge) of the medial meniscus. During flexion of the knee joint, the bones return to their original (normal) anatomical position. Thus, it has been established that the pathological displacement of the bones occurs under the influence of a powerful extensor of the knee joint - the quadriceps femoris, and their return to their original position is carried out due to the posterior group of such multi-articular muscles as the semitendinosus, semimembranosus, sartorius and biceps (its tibial part), as well as popliteal (Fig. 4).

Figure 1. Ligaments of the knee joint.

The described anatomical and physiological conditions made it possible to develop a method for dynamic stabilization of the knee joint, the main principle of which is to enhance the function of flexion by repositioning (displacing) the attachment sites of the legs (tendons) of the biceps and tailor muscles. We called the proposed method of extra-articular plasty biceps-sartoriotransposition.

Operation technique

The skin incision is made from the upper third of the thigh to the upper third of the lower leg along the dorsal surface of the limb, focusing on the lateral edge of the patella and its direct ligament. Thus, we expose the broad fascia and the tendon part of the biceps femoris and the fascia of the leg. Loose connective tissue (subcutaneous tissue) is dissected in the lateral and medial (to the point of attachment of the tailor's muscle) directions in relation to the incision line. Then we dissect the fascia lata along the dorsal edge of the biceps femoris, simultaneously cutting off the tendon (peduncle) of the latter from the patella and direct ligament. Then we continue the incision in the distal direction to the fascia of the leg 1 cm laterally from the crest of the tibia. After that, the biceps femoris muscle is separated from the fascia in the transverse direction at the level of the articular fissure line. Separating the leg of the biceps femoris muscle from the capsule of the knee joint in the latero-plantar direction up to the middle caudal artery of the thigh, we take the latter to the side. Using an arcuate incision from the crest of the tibia, following along the direct ligament, patella and the lateral edge of the rectus head of the quadriceps femoris, we open the knee joint. We shift the kneecap together with the direct ligament and the quadriceps femoris towards the medial surface, thereby widely opening the cavity of the knee joint. After a thorough examination, we remove fragments of the anterior cruciate ligament and, if necessary, the anterior horn of the medial meniscus and bone formations (exostoses) along the edges of the articular surfaces. We wash the joint cavity with physiological saline, reposition (restore to its original position) the patella, and suture the incision of the capsule with a two-row suture. Then we mobilize the legs of the tailor's muscle. We dissect its caudal part from the loose connective tissue and separate it from the tibia. After that, we carry out reimplantation of the biceps and tailor

Figure 2. Mechanism of action of the anterior cruciate ligament.

muscles in a new place. We fix the distal end of the pedicle of the biceps femoris muscle with loop-like sutures to the fascia flap of the lower leg on the crest of the tibia (Fig. 5). Here we hem the leg of the tailor's muscle. After extension of the knee joint, we suture the incision of the wide fascia of the thigh (due to the strong tension of the tissues, the suture material must be strong). The completion of the surgical operation is carried out by layer-by-layer stitching of tissues (superficial fascia, subcutaneous tissue, and skin). In all cases, except for the skin, we use nonreactive absorbable suture material.

In the postoperative period, we do not immobilize the operated limb. During the first week after the operation, we prescribe antibiotics and carry out symptomatic treatment. The stitches are removed after 7-10 days. To prevent detachment of the reimplanted muscles, we restrict the movement of the animal for 3 weeks. In general, the operation is well tolerated by the patient. Improvement of the general condition and swelling of the operated limb are completed by the end of the first week (during this time the animal begins to lean gradually). With a positive dynamics of recovery, lameness disappears after 3-6 weeks without the use of additional therapy.

REMOTE INVESTIGATION

A retrospective analysis of the results of treatment of anterior cruciate ligament rupture in 86 dogs with the surgical method described above was evaluated as follows (Table 1):

Figure 3. The mechanism of the occurrence of pathological mobility when the limb is supported.

An excellent result is a complete restoration of the function of the operated limb without any restrictions;

A good result - the dog moves freely, but with heavy loads there is a slight transient lameness without treatment;

Satisfactory result - periodically occurring mild lameness, which requires a short prescription of non-steroidal anti-inflammatory drugs;

Table 1. Evaluation of the results of surgical treatment of anterior cruciate ligament rupture in 85 dogs using extra-articular plasty of the legs of the femoral and sartorius muscles.

*Grade* *results* *operations*	*Quantity*	*Interest* *(%)*
Great	66	77,6
Good	15	17,6
Satisfactory	3	*3,5*
Unsatisfactory	1	L3
Total:	85	*100*

Unsatisfactory result - permanent lameness.

When analyzing the case histories of dogs subjected to extra-articular plasty, it was found that this pathology spread among various breeds (Table 2).

It has been noted that the lameness that occurs in animals due to rupture of the anterior cruciate ligament was found during a normal walk. From the survey of owners it follows that the dog "stumbled", "twisted his leg", etc. Sometimes the animal began to limp the next day, and its owner recalls that the day before, during a walk, it squealed. Quite often after this episode, the dog's short-lived lameness was reported to resolve spontaneously, or the treatment was short-lived, but after physical activity it resumed and became more pronounced.

Therefore, if the dog begins to limp “out of the blue” and the owner cannot assume that serious damage lies behind this, such a late arrival of the animal for a consultation with a veterinarian is explained. According to our study, in most animals, the time of manifestation of the above symptoms ranged from two weeks to several months. Unfortunately, as it was established from the anamnesis, one of the reasons for the late admission of patients to the clinic with this pathology was the unsuccessful conservative therapy due to an incorrect diagnosis.

The diagnosis of an anterior cruciate ligament rupture of the knee joint is usually not difficult, since its formulation is based on data from the anamnesis, the presence of lameness, usually of the second degree, and inflammation of the knee joint. The final diagnosis is made when an anterior drawer symptom is found in the knee joint. It consists in free forward displacement of the proximal tibia relative to the distal femur, which is easier to establish in an animal in a state of relaxation. An x-ray examination of characteristic signs indicative of this pathology is usually not detected, but its conduction is necessary, since this allows to exclude other damage at the level of the bone tissue of the knee joint.

It has also been found that the use of anti-inflammatory therapy usually leads to a temporary improvement, after which the pathology worsens, and lameness becomes more pronounced. Often, upon repeated treatment, this group of patients showed signs of meniscus damage (clicks in the joint during walking and forced movements of the limb).

DISCUSSION

The knee joint is a complex, uniaxial anatomical structure. The articular surfaces of the condyles of the femur and tibia (form the femoral joint) have a convex shape and giving them congruence is provided by the lateral and medial articular menisci (biconcave cartilaginous plates). The medial meniscus in the region of the posterior horn (edge) is connected to the joint capsule by a rather loose connective tissue.

Figure 3 a. The mechanism of occurrence of pathological mobility during extension.

The presence of two anatomically isolated condyles complicates the ligamentous apparatus of the knee joint. In addition to the collateral ligaments of the knee joint, which play an important role in its stabilization, there are also cruciate ligaments (Fig. 1). The latter, located in the middle of the joint, prevent dorsoplantar mutual displacement of the femur and tibia due to the rounded shape of their condyles involved in the formation of the articular surfaces. On the dorsal surface of the knee joint there is a sesame-shaped bone (patella) enclosed in the tendon of the quadriceps muscle. When the quadriceps muscle of the reed is contracted, the kneecap slides along the block of the femur, while during the tension of the direct ligament of the kneecap, a force occurs that is transmitted to the crest of the tibia. Our studies on dissected limbs have established that if the knee joint is in a physiological half-bent position, the forces are decomposed according to the parallelogram rule, where the kneecap simultaneously exerts significant pressure on the femoral block. Under the influence of this pressure during the burden of the limb (supporting it on the substrate) in the conditions of fixation of the knee and hock joints by the gastrocnemius muscle, the femur could be displaced in the plantar direction, but this is mainly prevented by the anterior cruciate ligament. In extension of the knee joint of the hanging unencumbered limb, the tension of the direct ligament could not only rotate the tibia at its articulation with the femur, but also displace it dorsally in relation to the latter, but this is also mainly limited by the anterior cruciate ligament. It can be concluded that the most pronounced load on the anterior cruciate ligament at the most critical moments in the functioning of the knee joint predetermines its damage (Fig. 2).

Our anatomical and functional studies have shown that flexion and extension of the knee joint is associated with a constant tension of the anterior cruciate ligament. In this case, the main load occurs in connection with the opposition to the pressure of the patella, which it exerts on the block of the femur. It is logical to assume that one of the reasons for the frequent occurrence of this pathology is the body weight and well-developed muscles of dogs. Data from a retrospective study among dog breeds show that the most common rupture of the anterior cruciate ligament occurs in Rottweilers, Staffordshire Terriers and Chowchow, which was respectively 17.65; 17.65 and 11.8% (Table 2).

Figure 4. Initial location of the biceps femoris.

Table 2. The frequency of occurrence of anterior cruciate ligament rupture of the knee joint among different breeds of dogs.

*Breed*	*Quantity* *dogs*	*Interest* (%)
1. rottweiler	15	17,65
2. Staffordshire terrier	15	17,65
3. chow- chow	10	11,8
4. mastiff	9	10,6
5. dobermanpinscher	6	7,0
6. Central Asian shepherd dog	5	5,9
7. Germangreat dane	4	4,7
8. east- Europeanshepherd dog	4	4,7
9. boxer	3	3,5
10. cocker- spaniel	3	3,5
11. Airedale	2	2,3
12. giant schnauzer	2	2,3
13. poodle	1	1,2
14. Frenchbulldog	1	1,2
16. pit bullterrier	1	1,2
17. Bordeauxgreat dane	1	1,2
18. Moscowsentry	1	1,2
19. Americanbulldog	1	1,2
20. Newfoundland	1	1,2
*Total* :	85	*100*

The study of the functional activity of the knee joint after an artificial rupture of the anterior cruciate ligament shows that with the contraction of the quadriceps femoris muscle during extension of the limb in the knee joint, both when moving it forward and while maintaining body weight, there is a mutual displacement of the femur and tibia in the plantar and dorsal directions, respectively. During flexion of the knee joint, a reverse displacement occurs, and the bones return to the anatomically correct position. In this regard, the main idea of the proposed method of surgical treatment is to enhance the function of the knee joint flexors by replanting the knee part of the tendon (pedicle) of the biceps femoris and the leg of the sartorius muscle on the crest of the tibia. This method of surgical operation prevents the negative effect of the quadriceps femoris muscle, which causes mutual displacement of the femur and tibia. To prevent abduction (abduction) of the limb, we displace the point of attachment of the leg of the sartorius muscle distally. The damaged anterior cruciate ligament is not restored, and we do not prosthetize it. As you know, antagonism of muscle tissue is manifested by a state of constant tension. Movement in the joints is provided by a synchronous increase in the tone of one muscle group and a decrease in the other. Thus, it can be assumed that when the knee joint is extended, the quadriceps femoris contraction occurs, which is simultaneously accompanied by greater resistance to relaxation of the biceps femoris muscle, which thereby prevents the tibia from shifting dorsally relative to the femur. Active dynamic stabilization of the knee joint by applying the proposed method of surgical treatment is confirmed by the fact that in recovered animals in the normal state, it is not possible to reproduce the symptom of the "anterior drawer", while during relaxation, as a rule, this is possible.

In addition to the replantation of the legs of the above muscles, the complete removal of fragments of the damaged ligament and medial meniscus from the joint, if possible, is of great importance. Without this, aseptic arthritis may continue despite anti-inflammatory therapy.

Having many years of experience in prosthetics of the cruciate ligament with a lavsan cord, it can be said with confidence that this material does not have sufficient strength to withstand the loads that continue to act in the knee joint after surgery. Malygina M.A. with co-authors indicates that "after the craze for lavsan plastic surgery for ligament restoration, disappointment came" due to the large number of complications. It cannot be said that in all dogs the lavsan ligament is ruptured, however, quite often the implant ruptures after a certain time and the problem recurs. At the same time, the method of extra-articular plasty proposed by us is more reliable in contrast to intra-articular plasty, an artificial material intended to replace the cruciate ligament.

It is impossible to ignore the increased risk of infection when a sufficiently massive implant is introduced into the cavity of the knee joint. In this regard, foreign material has to be removed, and the problem of restoring the dynamic function of the joint remains insoluble. Movshovich I.A. insists on the strictest observance of the rules of asepsis during the implantation of Dacron, which is difficult to implement in the real conditions of a veterinary clinic.

Figure 5. Movement of the leg of the biceps femoris to the crest of the tibia.

Replacement of the damaged anterior cruciate ligament of the knee joint with fascia flaps and other ligaments is also considered unpromising, as evidenced by studies in humanitarian medicine, which show that the implanted material deprived of blood supply atrophies, and a decrease in its strength inevitably leads to rupture. Klepikova R.A. in the experiment showed that the lengthening of the reimplanted flaps leads to repeated destabilization of the knee joint.

Using transposition of the biceps and sartorius muscles for anterior cruciate ligament rupture, we also observed several complications.

1. In one dog, on the fourth day after the operation, the reimplanted muscles were torn off from their attachment sites as a result of increased physical activity (the animal was attacked by another dog).

2. Two dogs showed signs of meniscus damage in the coming weeks after the operation, although this was not observed during the revision of the joint during the operation (repeated operation - meniscectomy ended with the recovery of patients).

3. Septic arthritis was observed in three dogs. In two, chasing occurred 1.5-2 months after the operation, when lameness was not observed in animals, and they passed exhibitions. During bacteriological examination, Staphylococcus aureus was isolated in two patients and Escherichia coli in one. Conducting rational antibiotic therapy made it possible to quickly cope with the inflammatory process and restore the function of the limb. In the third dog, the inflammation was complicated by damage to the articular cartilage and, although the septic process was eliminated, she continued to limp despite additional treatment. The owner of the animal refused arthrodesis.

It should be noted that the operation according to the proposed method is possible, and it is better to use absorbable suture material, such as Dexon, Vicryl, and even catgut. This is due to the fact that there is no foreign material left in the operated area, which could, due to random circumstances, become a source of an infectious inflammatory process.

The data of a retrospective study, shown in Table 1, indicate that in 95.6% of the animals the function of the knee joint was completely restored, while in 3.8% of the dogs, the good functioning of the limb was associated with the need for periodic mild therapy. One unsatisfactory surgical outcome was associated with an accident.

Our own studies on the relationship between the age of animals and rupture of the anterior cruciate ligament do not give grounds to agree that the injury is preceded by degenerative changes in the knee joint. As can be seen from Table 3, the highest incidence of this pathology occurs at the age of 1 to 3 years, for which degenerative changes in the knee joints are doubtful.

Table 3. Incidence of Anterior Knee Ligament Rupture in Dogs by Age.

*Age*	*Quantity*	*Interest*
	*dogs*	*(%)*
1 year	9	10,6
2 of the year	29	34,1
3 of the year	17	20
4 of the year	10	11,8
5 years	7	*8,2*
6 *years*	9	10,6
7 years	1	*1,2*
8 years	3	*3,5*
*Total* :	85	*100*

On the contrary, in older individuals, for whom this type of joint damage is most common, rupture of the anterior cruciate ligament is quite rare. An additional argument against a secondary rupture of the ligament is usually the optimal condition of another, not injured, joint. The often observed sequential rupture of the anterior cruciate ligament, first in one and then in the other knee joint, in our opinion, is associated with an additional burden on the uninjured limb in the context of the continuing action of the same causative factors.

An analysis of the anamnesis obtained from the medical history in our clinic regarding the rupture of the anterior cruciate ligament in dogs shows that injuries in animals occurred in the same type and completely safe environment for their health. The resulting lameness, as a rule, was not accompanied by a visible deformity of the limb and any pronounced pain symptoms, which, in fact, was the main reason for the late appeal of animal owners for advice. It should be borne in mind that the news of a rather serious injury in their pets and the need for complex surgical intervention caused distrust among some owners. Despite the fact that the rupture of the anterior cruciate ligament of the knee joint is manifested by pathognomonic symptoms, the examination of the animal should be complete and requires a final diagnosis.

CONCLUSION

A long-term study of the results of treatment of anterior cruciate ligament rupture in 85 dogs by the method described above of reimplantation of the legs of the biceps femoris and sartorius muscles on the knee joint for 3 years allows us to draw the following conclusions:

1. The proposed method is the simplest and less time-consuming in comparison with prosthetics of the anterior cruciate ligament of the knee joint in dogs with artificial materials and own tissues.

2. Inflammatory reaction in the postoperative period is less pronounced and manifests itself within a week.

3. Complete recovery of the operated limb generally occurs within 3-6 weeks from the date of the operation without the use of additional treatment.

4. Complications that arise do not affect the final result of treatment and are easily eliminated.

5. The result of the operation does not depend on the body weight of the animal and the conditions of its maintenance.

6. Excellent and good results of treatment, which were obtained in 95.6% of the operated animals, as well as positive feedback from colleagues who have mastered the proposed method, allow us to recommend it for the treatment of rupture of the anterior cruciate ligament.

Literature

1. Akaevsky A.I. Anatomy of pets M., Kolos, 1975.

2. Klepikova R.A. Auto- and homotransplantation of fascia in the experiment: Abstract of the thesis. dis.cand. honey. Nauk.-M., 1966.-14 p.

3. Malygina M.A. and others. What is more important: the strength of the ligament prosthesis or its isometric location in the knee joint? Collection of scientific works. Transplantation and implantation in surgery of large joints. Nizhny Novgorod. 2000, pp. 68-72.

4. Bags P.M. Plastic surgery of the ligamentous apparatus of the knee joint with various plastic materials: Abstract of the thesis. dis... cand.med.sci.- Baku.-1968.- 18 p.

5. Movshovich I.A. Operative orthopedics M., "Medicine", 1983., Articles 13-14, 255-259.

6. NimandH.G, Suter P.F. etc. Diseases of dogs. A practical guide for veterinarians M., Aquarium, 1998, pp. 215-217.

7. Shebits X., Brass V. Operative surgery of dogs and cats. M., "Aquarium", 2001., pp. 452-458.

8. H.R. Denny, A guide to canine orthopedic surgery, Oxford, 1991.

9. Paul GJ. Maquet Biomechanics of the knee With Application to the Pathogenesis and the Surgical Treatment of Osteoarthritis 2 nd Edition, Expanded and Revised. With 243 Figures Springer-Verlag. Berlin Heidelberg New York Tokyo 1984, pp. 59-62.

10. Wade O. Brinker, D.V.M., M.S. Handbook of small animal orthopedics & fracture treatment, Philadelphia, 1990.

Magazine "Veterinarian" 6/2003

A review of the methods of treatment of anterior cruciate ligament (ACL) rupture is presented. Both conservative treatment and extra- and intra-articular techniques are possible. Various surgical techniques have been described. There is no consensus among veterinarians on techniques for repairing ACL in dogs after rupture.

Introduction

Surgical repair of a torn anterior cruciate ligament (ACL) in dogs is described in detail in veterinary publications. However, there is still a lot of controversy regarding the treatment of ACL rupture in dogs. The fundamental justification for the operation is to restore the stability of the knee joint and prevent further damage after surgical debridement. The huge variety of techniques described in the literature indicates that none of them has proven to be fully effective. The outcome may vary and appears to be relatively independent of technique. So far, over a hundred techniques have been described. Surgical techniques can be broadly classified into three main categories: extracapsular, intracapsular, and tibial tilt techniques.

The main principle of extracapsular techniques is to increase support from tissues lateral to the joint using craniocaudal sutures. Another way of extra-articular stabilization of the knee joint with damaged cruciate ligament is the transposition of the head of the fibula.

Various materials have been studied for intracapsular replacement of a damaged ACL. The first prosthesis in history was a strip formed from the fascia lata.

The use of other autografts has also been described: skin,6 tendon of the long peroneal muscle or long extensor of the fingers, a fragment of the bone of the patella connected to the direct ligament of the patella. On the other hand, synthetic prostheses can also be used. One study described the use of nylon implants, as well as Teflon and terylene. Recently, collagen-inducing materials, such as carbon fiber and polyester, have attracted great interest. Techniques for changing the angle of inclination of the articular surface of the tibia consist in orthopedic reconstruction of the proximal part of the tibia to neutralize its cranial displacement when resting on the limb.

Therapy

In 1926, a ruptured ACL in a dog was first mentioned in a publication by Carlin. This gave rise to a whole cascade of studies and publications about possible reasons and methods of treatment. The first truly extensive scientific study was published in 1952.

Video. Rupture of the PCS. Arthroscopy.

Conservative treatment

According to Paatsama and Arnoczky, conservative treatment in dogs only wastes time. The authors recommend immediate surgical stabilization. However, the results of other researchers show a successful non-surgical treatment of dogs weighing less than 15 kg in 90% of cases. In larger dogs, the efficacy is lower, with only 1 out of 3 cases producing an acceptable clinical result. It is possible that such surprisingly good results of conservative treatment in small dogs are due to less demand and less stress on the unstable joint. Most of these animals are elderly and therefore less active. Conservative treatment of such patients should be considered as an acceptable alternative to surgical stabilization, at least initially. In generalized joint diseases, such as rheumatoid arthritis or systemic lupus erythematosus, surgical treatment is completely contraindicated.

Conservative treatment consists of limiting activity (short walks on a leash) for 3 to 6 weeks, weight control, and pain medication during periods of discomfort. For arthritis pain, a short course of anti-inflammatory drugs may be given.

Surgical correction

Instability leads to progressive degenerative changes in the affected knee joint that appear soon after the injury. For this reason, conservative treatment is often only a waste of time. The need for surgical treatment for ACL rupture depends on functional as well as objective criteria.

In case of severe instability, especially in large or working dogs, as well as the duration of the process (more than 6 - 8 weeks), surgical treatment is strongly recommended. There is no unanimous opinion about the possibility of regeneration and healing of ACL with a partial rupture. It has not yet been clarified whether such ligaments need to be replaced and whether further ruptures can be avoided. Several studies have shown that lameness and pain during manipulation of the affected knee joint are observed with a partial rupture of the ACL, even if instability is minimal or not detected. Thus, in such cases, surgical intervention is required. Meniscus pathology, in all cases requiring surgical treatment, often accompanies ACL rupture or develops as a consequence of it. Usually, symptoms appear when the medial meniscus is damaged.

Meniscal surgery is performed after arthrotomy before ACL reconstruction. Most meniscal injuries can be treated by partial resection with only the damaged fragment removed (Figure 1A). If possible, the meniscus should be removed partially rather than completely, as this causes less degenerative changes in the joint. Other surgeons prefer total meniscus resection because of the lower risk of iatrogenic injury to the articular cartilage or caudal cruciate ligament with a scalpel blade (Figure 1B).

Recently, a method has been developed to release the meniscus to prevent damage to the knee joint with a failed cruciate ligament if the meniscus is intact at the time of arthrotomy. The caudal horn of the medial meniscus is released using a sagittal incision just medial to the lateral attachment to the intercondylar tubercle (Fig. 2A) or an incision caudal to the medial collateral ligament (Fig. 2B). The release of the meniscus is carried out in order to shift it away from the crushing effect of the medial condyle of the femur during cranial movement of the tibia.

The first surgical treatment for ACL rupture in dogs was introduced in 1952 and was based on ligament replacement with an autograft. Many years later, a new surgical concept was developed to correct craniocaudal joint instability without any attempt to replace a torn ACL. Several comparative studies have shown the effectiveness of different stabilization techniques. In 1976, Knecht published a comparative review of surgical treatments. Subsequently, several modifications were developed. According to Arnoczky, none of the techniques has proven to be superior for all categories of patients.

Rice. 1. Principle of meniscectomy in a dog with a damaged medial meniscus.
A. Partial meniscectomy. The torn fragment of the meniscus is captured by a curved hemostatic forceps, and the remaining peripheral parts are cut off.
B. Complete meniscectomy. Section of the ligament and attachment points to the capsule CaCL - caudal cruciate ligament, CCL - anterior cruciate ligament, LM - lateral meniscus, MM - medial meniscus, TT - tibial tuberosity.

Rice. 2. Principle of meniscus release in a dog with an intact medial meniscus.
A. Incision just medial to the lateral insertion of the caudal horn of the medial meniscus
B. Incision caudal to the medial collateral ligament.

Extra-articular techniques- in small dogs and cats, extra-articular stabilization of knee joints with incompetent cruciate ligaments provides satisfactory results. Even in larger dogs, techniques for suturing the joint capsule from the lateral side of the overlap are used.

Despite the existence of various extra-articular stabilization techniques, the main principle of joint stabilization is the strengthening and thickening of the soft tissues around it by suturing, oriented cranio-caudally. In general, these techniques are easy to implement. From a biomechanical point of view, such extra-articular techniques are far from ideal. In this case, the tibia also loses the ability to normal internal rotation in relation to the femur, which can lead to abnormal loading. Complications such as soft tissue or suture material ruptures have been described.

One of the first techniques described is the application of several Lambert sutures of chromium-plated catgut to the lateral part of the joint capsule. Pearson and others have improved this technique with three layer sutures. At the same time, De Angelis and Lau described a single polydeck mattress suture from the lateral fabella to the lateral third of the direct patella ligament, or through a bony tunnel in the tibial crest (lateral fabello-tibial loop). In a modified version of this technique, an additional suture is placed on the medial side. To restore normal biomechanics of the knee joint in dogs weighing less than 15 kg, the synthetic material can be replaced with a strip of extra-articular fascia lata. Olmstead describes 5 years of experience with stainless steel wire for lateral tissue support in dogs of various weights. A few years ago, a nylon material curved clip system was developed to eliminate the need for large knots when creating a buttonhole. However, regardless of the material used, any lateral sutures between the fabella and the tibia may tear or loosen after surgery. However, it is believed that due to short-term stabilization, fibrosis of the periarticular tissues develops, providing long-term stabilization of the joint. In practice, lateral joint stabilization is still considered the preferred recovery method for small dogs.

Another technique that provides lateral and medial support was developed by Hohn and Newton in 1975. It consists of medial arthrotomy, incision of the caudal belly of the sartorius muscle, and transposition cranially to the rectus patella ligament. From the lateral side, 2 mattress sutures are applied to the capsule. Then, the biceps muscle and its broad fascia are placed over the patellar ligament and secured with sutures.

Later, a simple extra-articular technique introduced by Meutstege appeared. He recommends overlapping of the lateral fascia with an absorbable suture after debridement of the affected joint.

In the latest extra-articular technique, the head of the fibula is secured in a more cranial position with a taut wire or cortical screw. With this method, the orientation and tension of the lateral collateral ligament is changed in order to stabilize the knee joint with cruciate ligament failure.

Intra-articular techniques- theoretically, such techniques are preferable to extra-articular ones, as they allow for a more accurate replacement of a torn ACL. Even in cases of fresh rupture and excellent reposition, the ACL never regains its original strength. It is possible to restore the normal function of the ligament in any position of the knee joint only if there is a fresh fracture with avulsion of the ACL and anatomical restoration.

Extensive research has been carried out to study the properties of the ideal replacement material, as well as the correct anatomical position. The prosthesis should imitate a natural ligament, preventing cranial displacement of the tibia and excessive extension in the knee joint. Misalignment of the graft can lead to material wear and eventual failure.66 In 1952, a modification of Hey Groves' medical technique was described as a treatment for dogs with cruciate ligament failure. At the same time, a strip of fascia lata is formed to recreate the ligament. It is pulled through the joint through a hole drilled in the lateral femoral condyle towards the intercondylar groove and through a tunnel formed from the ACL insertion to a point medial to the tibial crest. This strip is stretched and sutured to the direct kneecap ligament. Since the first publication, minor changes in the technique have been described. Singleton describes fixation of the graft to the proximal and distal end of the bone tunnels using orthopedic screws. The technique has been significantly modified by Rudy. At the same time, osteophytes are removed, the meniscus is excised, regardless of its damage, and an orthopedic wire is installed, which serves for internal fixation, from the lateral fabella to the tibial tuberosity.

Instead of a fascia graft, Gibbens used chemically treated skin that was pulled through bony tunnels oriented in the same way as described in Paatsama's original work. In addition, with concomitant dislocation of the patella, the latter is excised. There have been other experiments using raw skin (Leighton), more cranial bone tunneling without opening the joint (Foster et al.).

In the technique with external fixation of the implant (“over-the-top”), the flap includes the medial third of the patella ligament, the craniomedial part of the patella and the fascia lata. The loose loop is pulled proximally through the intercondylar groove and sutured to the soft tissues over the lateral femoral condyle. To better model the anatomic attachment, the graft can first be passed under the intermeniscal ligament. Another option is to use a lateral strip, as described by Denny and Barr, which can be passed through an oblique tunnel in the tibia, starting at the original ACL insertion site.

In addition, there are other methods of tendon transposition: the tendon of the peroneus longus, the tendon of the long flexor of the fingers and the long extensor of the fingers. Experimental studies have been conducted on the reconstruction of the cruciate ligaments using fresh and freeze-dried allografts of the patellar tendon and fascia lata. Freeze-dried specimens were well tolerated, while fresh allografts may cause a foreign body reaction. The effectiveness of implantation of frozen bone allografts and ACLs has not yet been confirmed by clinical data.

Alternative methods of knee stabilization for ACL failure are still in the experimental phase. The possibility of using various synthetic materials as a replacement for a torn ACL is of great interest to both medical and veterinary orthopedists. Despite the positive results of preliminary studies, synthetic prostheses are still not widely used in veterinary medicine. Reconstruction materials should be as strong as or better than normal ligament. Of course, it is necessary that the prosthesis be biologically inert and implantation should cause only a minimal tissue reaction. It may be necessary to remove the synthetic implant at any time after surgery.

Another disadvantage is the relatively high cost of implants. Data confirming the possibility of reconstruction with a two-beam graft in clinical practice are not yet available.

Several synthetic replacement materials have been explored. In 1960, Johnson began using braided nylon. In the same year, a publication was published describing the use of Teflon tubing. Since then, many materials have been described, although a significant number of them have been used without prior research. In addition to Teflon meshes, supramide, terylene, and dacron were used for implantation.

For dogs, a special prosthesis was developed from the polydek material. Opinions about the fragmentation of carbon fiber substitutes are opposing. According to some researchers, as the synthetic mesh weakens, a new ligament is gradually formed, while others argue that a permanent inflammatory response is the only result. In addition, the polyester acts as a support frame. It can be used in the form of a bundle of fibers or a ribbon.

More recently, an intra-articular technique for arthroscopically guided replacement of a torn ACL has been described and is gaining popularity in veterinary medicine.

Techniques with changing the angle of the articular surface of the tibia- the main goal of classical extra- and intra-articular techniques is to eliminate the "drawer" symptom. In 1984, a new concept emerged based on the results of a study of wedge osteotomy of the cranial part of the tibia. To stabilize the joint, an orthopedic reconstruction is needed to enhance the action of the knee flexors on the hip. Another stabilization technique is needed to control the internal rotation of the femur. Tibial articular angle osteotomy using a curved osteotome and a special fixation plate was developed in 1993. A modified technique uses a wedge osteotomy at the level of the tibial articular surface and fixation with screws. The purpose of osteotomy with a change in the angle of the articular surface of the tibia is to eliminate the cranial displacement of the tibia during support on the limb and movement. The "drawer" symptom persists with passive manipulation.

The principle of the operation is to rotate the articular surface of the tibia to the desired level, so that the force acting when resting on the limb is directed only to compression. However, a recent paper states that this procedure results in caudal displacement of the tibia, making the stability of the joint dependent on the integrity of the caudal cruciate ligament. To avoid excessive load and damage to the caudal horn of the medial meniscus, the latter is additionally released by crossing the lateral site of the attachment of the caudal horn.

In medicine, the importance of rehabilitation programs is generally recognized. It seems that training of the antagonist muscles (muscles of the hamstrings) plays a large role in the stabilization of the knee joint without ACL. Until now, little attention has been paid to the postoperative rehabilitation of dogs and its impact on outcome.

Prognosis after treatment

Conservative treatment gives a satisfactory clinical result in about 85% of dogs weighing less than 15 kg, but only in 19% of larger patients.

All animals develop osteoarthritis (OA). In addition, the risk of damage to the medial meniscus in the future increases.

The likelihood of successful surgical treatment depends on many factors, such as the experience of the surgeon and the study population. Also, the result is influenced by the subjectivity of the surgeon when evaluating clinical and radiographic results.

A correlation between joint stability after surgery and the progress of osteophyte formation has not been shown. Obviously, OA increases in the postoperative period. To date, there is no method that can stop its development. On the other hand, the clinical outcome appears to be independent of the degree of OA-specific changes seen on imaging.

The percentage of patients with concomitant meniscus injury appears to be related to the duration of the presence of an untreated cruciate ligament injury. This phenomenon is not related to age or sex of dogs. Strong attachment of the medial meniscus entails the risk of its compression between the moving articular surfaces of an unstable knee joint. Associated damage to the medial meniscus adversely affects the final prognosis. It accelerates the progress of changes associated with OA, both before and after surgery.

There is no consensus on the success of the treatment of chronic cases with severe OA.

Other authors suggest that degenerative joint diseases already present before surgery adversely affect the final results. Older dogs have a worse prognosis; perhaps in such cases it is better to choose conservative treatment with anti-inflammatory and analgesic drugs. In some cases, the opposing ACL ruptures due to chronic overload. In about a third of patients with cruciate ligament injury, damage occurs on the contralateral side after a few months. This relatively high incidence of bilateral damage further supports a degenerative etiology.

Conclusion

A large number of techniques and materials for the manufacture of prostheses suggests that the ideal method for treating ACL rupture has not yet been invented. All surgical techniques provide only temporary stabilization. Fibrosis of the periarticular tissues is responsible for the final stabilization of the knee joint, regardless of the technique used. So far, there have been no significant achievements in the field of preventing the progress of degenerative changes in the joint after surgery, but the clinical result, apparently, does not depend on the severity of joint changes.

Cruciate ligament disease remains a mystery; it can be expected that many more reports and publications on this topic will appear in the future. Since there is no perfect technique, the choice of treatment depends largely on the preference of the surgeon.

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Dogs are very curious, active and energetic pets. Often, an unsuccessful jump, running on a slippery surface, falling from a height, or any wrong movement lead to an injury in the form of a sprain, fracture, or rupture of the limb ligaments.

Signs of Torn Ligaments in Dogs

In case of violation of the integrity of the ligaments, the clinical picture of the disease may be different depending on the type of rupture and the degree of inflammation in the joint. The symptoms of the disease also depend on how damaged the menisci in the knee joint are.

An injured dog with a torn cruciate ligament experiences severe pain in the knee joint with any movement. In the case of a partial rupture, the animal does not feel severe pain and only limps slightly on the injured limb. Due to the lack of a small number of signs, pet owners confuse a partial rupture with sprain and do not go to the veterinary clinic. But over time, the smallest, it would seem, gap often leads to disastrous consequences.

If we are talking about a complete rupture of the ligaments, the pet is very lame or is constantly in a supine position with a paw bent under the body. May also whine strongly from pronounced pain. Complete rupture of the anterior cruciate ligament in dogs is characterized by acute pain, swelling in the area of the knee joint, a gradual increase in body temperature. A high temperature may indicate a progressive infection in the diseased joint.

Self-treatment in most cases leads to the development of atrophy of the muscles of the extremities and other pathological changes. Therefore, it is so important to seek veterinary help when detecting the first signs of ligament rupture.

Diagnosis of torn ligaments in dogs

Ligament rupture is diagnosed in the clinic by a qualified veterinarian. At the first appointment, an anamnesis is collected to determine the clinical picture and an examination of the injured pet is carried out. For an accurate diagnosis, the following diagnostic measures are used:

Calf compression test. The dog is wearing a muzzle. The pet is laid on the couch on its side so that the injured limb is in an extended state. The knee joint is fixed in the desired position and gently flexion/extension in the hock joint is performed. If the lower leg moves forward, this indicates a complete rupture of the ligament. Before the procedure, anesthesia is performed to relax the muscles.
Cranial tension test. The dog is laid on its side so that the injured paw is on top. The femur and lower leg are fixed with the help of hands, and then the lower leg is slowly displaced in the cranial direction. Cranial displacement of the tibia in relation to the condyles of the femur indicates a strong rupture of the ACL. The test is most often performed with the use of sedatives.
X-ray examination. In most cases, the two tests described above are sufficient to determine a ligament break. But in order to avoid consequences in the form of inflammatory processes and the development of pathological conditions, an x-ray is prescribed. X-rays allow you to determine the presence of defects on the articular surface of the knee. As a rule, with a complete rupture of the ligaments in the picture, you can see pathological changes on the surface of the sesamoid bones, patellas and joint cavities.
CT scan. With a significant rupture of the ligament, computed tomography is appropriate. Diagnostic examination allows you to study certain changes in the bone structure of the knee joint, to identify the presence / absence of osteophytes. Computed tomography, like x-rays, cannot be used as the basis for diagnosis. For an accurate picture, arthroscopic examination is performed.
Arthroscopy of the knee region. A torn partial anterior cruciate ligament in large dogs is determined by arthroscopic examination. Diagnosis consists in the introduction of a device equipped with a microvideo camera into the joint cavity. This method allows you to most effectively and quickly determine the pathological condition of the meniscus and other structures of the knee joint.

All of the above methods allow you to make an accurate diagnosis and prescribe the appropriate treatment.

Therapeutic treatment of torn ligaments in dogs

Treatment involves a number of health-improving measures: anti-inflammatory therapy, restriction of pet mobility and the use of special dog knee pads.

Anti-inflammatory therapy

If a cruciate ligament rupture is diagnosed, anti-inflammatory drugs are prescribed to relieve the inflammatory process and reduce pain in the knee joint. The course of treatment and dosage are determined taking into account the weight of the animal and the course of the disease. So, for example, young dogs weighing up to 5 kg are prescribed Loxicom in suspension for a course of up to 10 days (the dosage depends on the specific weight). Large pets - preparations Rimadyl or Previcox in the form of tablets.

It is not recommended to offer an animal non-steroidal anti-inflammatory drugs without the advice of a veterinarian. Incorrect use of them leads in most cases to severe irritation of the mucous membrane of the intestines and stomach, and in case of overdose and frequent use - to ulcers and erosions. Use medications only as directed by your veterinarian.

Restriction of pet movements up to 1 month

With a torn knee ligament, you will need to take strict measures to help limit the movement of your pet. With a partial break, walks on a short leash for short distances are allowed. With a complete rupture of the ligament, the sick pet is kept in a small enclosure to avoid its increased activity. The dog is strictly forbidden to make sudden movements, jumps, and even more so for a while it is worth forgetting about active games.

Use of knee pads for pets

This measure is effective only in complex therapy. Properly fixed medical knee pads allow you to provide additional support for the joint during active actions and movements of the pet. It is important to remember that improper fixation can lead to deformation of the knee joint and the development of pathological conditions. Therefore, it is so important to entrust this procedure to professional veterinarians.

Surgical treatment of torn ligaments in dogs

The most effective treatment for a cruciate ligament tear in a dog is surgery. To date, there are a large number of ways. But not all of them are effective. In our country, the following modern methods of treatment are actively used, which allow maintaining a high level of mobility of pets for many years.

Intracapsular method

The use of intracapsular technique allows you to restore the performance of the knee joint. The essence of the method is to replace the anterior cruciate ligament with a reliable graft. The rehabilitation period lasts for all dogs in different ways, from 1 month or more. The graft eventually takes root in the knee joint and is a healthy ligament.

Extracapsular method

If a torn cranial ligament is diagnosed in a hind paw dog, an extracapsular treatment may be used. Its use allows you to stabilize the performance of the knee joint with the help of soft tissues or lateral sutures. The effectiveness of the method has been proven for dogs weighing from 12 to 15 kg. The animal calmly steps on the damaged paw already 14 days after the operation.

Muscle transposition is suitable for all dogs without exception. The pet freely stands on the diseased limb 6 weeks after surgery. Lameness with proper rehabilitation and proper care disappears after 5 months.

osteotomy

The use of this method of treatment allows you to correct the anatomical structure of the knee joint and fully restore the performance of damaged paws. Surgery is indicated for all types of dogs, from dwarf breeds to the largest pets. The advantage of the method lies in the high speed of conduction and rapid rehabilitation. After the operation, the limb is not fixed with a bandage. The recovery period lasts no more than 1 week.

If your dog is injured, don't delay visiting the veterinarian. Soberly assess the situation, if possible, provide first aid, but in any case do not treat yourself. Only a veterinarian can make an accurate diagnosis and prescribe the right treatment! Remember, the future health of your pet depends only on you!