The following story comes from Jan in the United Kingdom. Though most of our readers are from the United States, I thought that it’d be great to offer information for those readers who are overseas and Jan agreed to share her story about her Doberman named Fiel. I hope that all of you all find Jan’s story helpful (this will be released in 3 parts).

Jan’s Doberman Pinscher CCL Story (Part 1)

My 6 and half year old Doberman called Fiel (means Loyal/faithful in Spanish) was just recovering from a hematoma of his ear and lying on his sofa when Millie my cat decided to walk past and wave her tail his way for the daily ritual of chase. Except this time Fiel jumped off the side of the sofa and landed awkwardly and yelped straight away. I had heard a sort of dull crack noise so I knew this wasn’t good. He cried and couldn’t put his back leg down.  I rang my vet immediately and his first thoughts were the cruciate ligament. As Fiel was already on Myloxidyl for pain relief and inflammation for his ear, he suggested to carry on with that until I could get him to his office for an evaluation. This took two days as Fiel was in some pain and the joint was not stable so he had to learn a different way of walking and getting in and out of my car.

My vet confirmed that he had the drawer movement of his knee joint which confirmed to him that he had ruptured his cruciate. He booked us in with a Orthopedic Surgeon not far from us who has a fantastic success rate with this particular operation and went to meet him two days later. Sure enough, he had completely ruptured the cranial cruciate ligament (dog ACL) and he explained the tightrope procedure to me and how it is less invasive than other types of surgery but it is likely that arthritis will be a problem in the future because of the nature of the injury. He also mentioned that his knee might have been weakened before and this time its completely snapped. Looking back I suspect he was correct as I do remember Fiel sliding badly on my laminate flooring when he was younger and limping a bit but he healed and I thought nothing more about it.

So he’d had the accident on the Monday, saw his Vet on the Wednesday, the Surgeon on the Friday and the operation was scheduled for the following Tuesday. Eight days from injury to operation. It perhaps would have been quicker but between my Vet and the Surgeon, they were running tests for Von Willibrands disorder and other clotting tests as well as checking Thyroxine levels as he has an under active thyroid. That incidentally was picked up because of a research study on Dobermans as they have a high rate of death due to heart failure, so he has quite extensively tested. Thankfully all of those tests came back negative!

Be sure to come back to read the remainder of Jan & Fiel’s story – Read Part II.

Related Posts

• Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs
• Surgical Procedure for a Ruptured CCL in Doberman Pinschers
• Diagnosing a Cranial Cruciate Ligament (CCL) Injury

The stifle (knee) joint in dogs, is very similar to the knee joint in humans, in that there are ligaments that run through the joint providing stability, and just like in humans, there can be many varying degrees of injuries in the stifle joint which makes it very important to have it properly diagnosed prior to rushing into surgery or treatment.

The injury could be something that happened suddenly as the result of a stressful event, or the injury could develop over time through normal “wear and tear”. Injuries that develop over time can be the result of many different factors, overuse, incorrect stifle joint angle, high impact activities, and many other things can contribute to cranial cruciate ligament injuries that develop over time. Ligament injuries that happen suddenly can be caused by jumping and landing awkwardly, twisting wierd on the leg, or being run into by another dog.

For the injury that happens suddenly, the dog will immediately stop bearing weight on the leg. Every dogs reaction will be different, as all dogs have different pain threshholds, but you as the owner will definitely be able to recognize that your dog has a problem. In stifle injuries that develop over time, the symptoms may not be so obvious, but they will still be noticeable. In slowly developing injuiries, the dog may limp occasionally, sit awkwardly (sloppy sit – sitting on the side, rather than on its legs), etc.

In both of these situations, it becomes necessary to have the injury diagnosed, and this is where things can get a little bit tricky. When consulting most vets and clinics, there will typically be multiple diagnosis methods available, each of which will be the preference of the practicing veterinarian. These are the typical diagnosis options for the stifle joint:

• X-Ray
  One recommended course of action will typically be an x-ray. The problem with an x-ray is that ligaments cannot be seen on x-rays (which I’ve learned through injuries of my own). X-rays basically serve one purpose, and that is to see if there are any broken, dislocated or misplaced bones.
• Manual Joint Manipulation
  Another course of diagnosis is manual manipulation of the joint in which the veterinarian checks for “drawer movement”. Drawer movement is the lamens term for instability in the joint, and comes from the fact that the knee joint will slide back and forth, like a drawer, if there is ligament damage because the ligaments won’t be there to hold the bones in place. Dogs will almost have to be sedated in order to test for “drawer movement” as it would be very painful for the dog to be awake during the procedure.
• MRI
  A common option in human injuries, having an MRI done is not as feasible for our pets, though it would quickly and easily be able to tell us whether there was a torn or ruptured ligament in the knee. The reason that MRI’s aren’t necessarily available for dogs is that the equipment is very expensive, and the cost of the procedure is highly expensive as well.

Of the above diagnosis options, an x-ray is usually recommended to check that there are no broken bones, and once that is verified, the veterinarian will check for drawer movement to determine if there is ligament damage. I’ve heard stories, and read stories of misdiagnosis online, and I’ll try to address that in another post, as this post will strictly focus on diagnosising cranial cruciate ligament injuries.

In a perfect world, we’d all be able to get MRI’s for our dogs if there was any question that they had a CCL injury, however, it’s not a perfect world, so we use the methods that are available to us. Thus, manual joint manipulation is one of the more common diagnosis techniqes, and with it, we have its drawbacks. The biggest drawback of manual manipulation to check for “drawer movement” is the possibility of furthering the injury. The injury can be worsened by any/all of the following:

• Sedation – as mentioned above, the vet will often sedate the dog in order to be able to manipulate the leg without the dog “fighting” it. This can result in over-torquing the joint.
• Rough exam – twisting of the joint

These factors can actually lead to injuries to other parts of the joint as there are multiple muscles, ligaments and tendons running through the knee. You may wish to be present durin the manipulation of the knee joint so that you can read your dogs reaction to the twisting.

Conclusion

I understand that all of the above isn’t necessarily great news if your looking for answers about your dogs recent injury, but I’m just trying to provide as much information as possible to allow you to make an informed decision on the treatment of your dog. If I had known a fraction of what I know now, I may have gone an entirely different route at the time of our dogs injury, but on the same note, I’m very glad that we went the surgical route as our dog has been doing great since her recovery. If you haven’t already, make sure you read our story.

Related Posts

• Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs
• Diagnosing a Ruptured Cruciate Ligament in a Doberman Pinscher
• Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)

The Lateral Fabellar Technique, or Extracapsular Technique, is a common surgery performed on dogs to stabilize the stifle (knee) joint after a tear or rupture in the cranial cruciate ligament (CCL; misspelling cranial crucial ligament). Normally, the cranial cruciate ligament (CCL) prevents backward-forward movement (drawer movement) of the stifle joint. Untreated instability in the knee/stifle joint due to a turn/ruptured CCL can result in a tearing of the meniscus as well. When it tears/ruptures, the stifle joint becomes unstable and the dog suffers lack of mobility, lameness or loss of use and is subject to chronic and progressive arthritis in the stifle if untreated.

In a Lateral Fabellar (Extracapsular) procedure, heavy suture material (monofilament nylon cord) is passed from the lateral fabella to the tibial crest in order to eliminate joint instability (drawer movement). It is this nylon cord that will act as the CCL ligament in the future by holding the joint together and keeping it stable.

The lateral fabellar surgery will not stop the progression of arthritis that is already present in the joint. Your dog may have some stiffness of the limb and may have some lameness after heavy exercise.  Chondroitin sulfate and glucosamine may be given to help with stiffness.

Typical downtime and rehab:

• First 2 weeks, dog should be crated and only let out on a leash to go to the bathroom.
• After about 2 months, lameness should decrease significantly, but it was recommended by our veterinarian to keep our dog crated still.
• After 3 months, our dog had regained full use of her leg.

Related Posts

• TPLO vs. TTA vs. Lateral Fabellar Traditional Technique – Cranial Cruciate Ligament Repair
• TPLO – Tibial Plateau Leveling Osteotomy – Cranial Cruciate Ligament Repair
• Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)

When our dog tore her CCL, she imediately came up lame and was unable to put any weight or pressure on her right hind leg. She had minor hip problems previously, so at first we thought that she just overdid it while playing at the beach, so we took her home, gave her some MetaCam and let her rest overnight. When nothing had changed the next day (Sunday), we decided to take her to the pet Emergency Room.

At the ER, they told us that to diagnose the problem with her knee they were going to have to do 2 things:

1. Take x-rays of the stifle (knee) joint to make sure that there is no bone damage and/or arthritis.
2. Manipulate the joint while the dog is sedated to check for instability (drawer movement)

So we left our dog at the emergency clinic so that they could sedate and diagnose her injury, and when we next heard back from them, they told us that she most likely has a torn cranial cruciate ligament (CCL; misspelling: cranial crucial ligament) and that we should take her to her primary care veterinarian to discuss repair options.

Image by anearthling.

Related Posts

• Diagnosis – How We Determined Our Dog Had A Torn/Ruptured Cranial Cruciate Ligament (CCL)
• Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
• Diagnosing a Ruptured Cruciate Ligament in a Doberman Pinscher

When it comes to caring for our pets, we all want the best possible option, however, most veterinarians will have a single method that they prefer to perform, thus leaving you to find another vet if you do not agree with having a specific CCL surgery. Prior to committing your dog to a surgery, you’re going to want to find out what option your veterinarian will perform, the recovery time, what percent of normal activity level will the dog return to when fully recovered, etc. Of all the surgery options, I’d say that any would be better than going without the surgery (see my post on my friend who did not get the surgery for his dog), but in the end, the choice is going to be up to you – the dog owner. Without the surgery, your dog will have an unstable stifle (knee) joint, and will probably show lameness terminally.

Cranial Cruciate Ligament (CCL) Surgery Options

• Traditional Repair – Lateral Fabellar Technique
  This technique is typically recommended for smaller dogs (we went with this option on our 60lb pit bull). With this technique, a monofilament nylon cord of about 80-100lb tensile strength is passed from the lateral fabella to the tibial crest, in what was explained to me as a figure 8 pattern, basically wrapping the knee joint to eliminate and prevent joint instability (drawer movement). Scar tissue will, over time, develop around the joint, which will further stabilize the joint, but will also begin to restrict range of motion.
• Tibial Plateau Leveling Osteotomy (TPLO)
  The TPLO CCL repair technique is generally recommended for larger breeds of dogs, as well as active dogs, such as agility dogs. This technique is also thought to cause less degenerative arthritis around the stifle joing. Key things to note about the TPLO surgery are a quicker recovery time, better range of motion, less arthritis and a return to athletic (working) activity levels. TPLO surgery involves cutting the bone and slightly rotating it before re-attaching it with a plate. By rotating the top of the bone, less pressure is put on the joint.
• Tibial Tuberosity Advancement (TTA)
  This is a new, less invasive option to the TPLO surgery, but will not be an option for all dogs. Since this surgical option is less invasive, it allows for a quicker recovery time. TTA also puts a cut in the tibial bone, however it shaves off the front of the bone and extends it with a spacer. Also like the TPLO surgery, the TTA option depends on the angle of the stifle joint and is not recommended for dogs with a steep angle in the stifle.
• Tightrope Surgery (Tight Rope Surgery) (Updated June, 2009)
  Tightrope surgery is a very new procedure that is based on a similar procedure performed in human ankles. It is far less invasive and is performed through small incisions in the skin, and woven through small holes drilled in the bones of the stifle joint. Tightrope surgery is an arthroscopic procedure and thus far seems to have very positive results.

As you can probably tell, each option has advantages and disadvantages, and all options should be discussed with your veterinarian after x-rays are taken of your dogs knee joint.

Related Posts

• Cruciate Ligament in Dogs, Canine Cranial Cruciate Ligament (Crucial)
• Diagnosis – How We Determined Our Dog Had A Torn/Ruptured Cranial Cruciate Ligament (CCL)
• Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs