Cruciate Ligament Damage

What is ?

A cruciate ligament injury is damage to one (or both) of the cruciate ligaments, either a small tear or a complete rupture. The cruciate ligaments, both cranial (toward the head) and caudal (toward the tail), are bands of tough fibrous tissue that connects the femur to the tibia. Their job is to prevent the forward shifting of the tibia relative to the femur and they prevent over rotation and twisting. Cruciate ligaments can become damaged and break after being weakened over time, like a rope that is being frayed over time, or they can rupture suddenly, often due to a knock or a fall. There are 4 levels of sprain that can affect the cruciate ligament that are detailed below.

how does it progress?

limping or lameness is the most common sign of cruciate ligament damage and this can be quite mild to begin with. As the damage to the ligament progresses and the ligament becomes more worn (in the event of degenerative damage) the lameness will become more evident. If the joint is continued to be used without adequate rest and control over activity it will lead to a rupture of the ligament (Cruciate Ligament Rupture in Dogs, 2022). The 4 grades of sprain are:

Grade 1 - this is a minimal tear or sprain of a ligament with a degree of internal haemorrhage - improves with rest, lead walks and accompanied by a review of the daily living of the animal. Can take up to 2-3 months to fully heal. Any slight twist can take this sprain from grade 1 to grade 2. 

Grade 2 - this is a partial tear of the ligament

Grade 3 - this is the complete rupture of the ligament - this will require surgery to rectify. This will require several weeks of rest and a slow and controlled return to exercise.

Grade 4 - these are ligament tears and takes a small piece of bone with it when it tears - this will require surgery to rectify. This will require several weeks of rest and a slow and controlled return to exercise.

Image from PDSA. Please note that BelMar Canine Massage Therapy is not affiliated with PDSA.

what are the causes ?

In the majority of dogs the cranial cruciate ligament ruptures as a result of degeneration over a long period of time. The precise cause for the degeneration of the ligament is not known however research would suggest it is genetic. Other causes for cruciate ligament damage are:

  • Obesity

  • Conformation of the individual dog

  • Hormonal imbalance

  • Some inflammatory conditions of the joint 

  • Damage caused by excessive or sudden twisting, fir instance when chasing and catching a ball

  • Landing from a jump incorrectly

  • Trauma

  • Slippery floors, such as laminate flooring, will cause the dog to struggle to maintain good posture or gait

what are the symptoms?

limping or lameness are the first symptoms usually seen when there as cruciate ligament damage. Other symptoms include:

  • Crying out in pain

  • Unable to weight bear equally

  • Unable to weight bear at all

  • Inflammation, swelling and heat around the capsule

  • The toes will only just touch the floor in semi flexion

  • The stifle would be abducted (held out) when sitting/standing

  • Abnormal gait

  • Muscle atrophy in the affected leg

  • A popping noise, which may indicate a meniscal tear

WHAT ARE THE SURGICAL OPTIONS?

TPLO Surgery:

(Tibial Plateau Leveling Osteotomy): The TPLO surgery has become one of the most popular orthopaedic surgeries performed on dogs who have torn their cranial cruciate ligament. This surgery involves changing the angle of the top of the tibia, which is the tibial plateau, by cutting the bone, rotating it, and stabilising it in a new position with a plate and some screws. TPLO is only carried out on dogs where the benefits of the surgery outweigh the possible risks. Dogs that are good candidates for this surgery are dogs with a ruptured cranial cruciate ligament that have persistent lameness and and stifle joint instability.

TTA surgery:

(Tibial Tuberosity Advancement): Cruciate surgery is performed to repair a torn cranial cruciate ligament (CCL) in the stifle (knee). This procedure is used to treat cranial (or anterior) cruciate ligament rupture by cutting the top of the tibia, the tibial plateau, then moving it forward and stabilising it in a new position. The aim is to make the tibial plateau perpendicular to the patella tendon, and in doing this, it will prevent the tibia from moving forward (in relation to the femur). This then makes the knee feel more stable for the dog and encourages weight bearing, despite the tendon still being ruptured and not directly repaired

how can massage help post-surgery?

Post operative massage therapy should be introduced 2-3 weeks after surgery and also it would be good to have the vets check and sign off the scar. Post operative massage therapy will help:

  • To prevent oedemas, inflammation and muscle wastage in the leg as it heals

  • To improve the supply of nutrients to the muscles

  • To stimulate the lymphatic system

  • To mimic exercise by moving nutrient rich blood and lymph around the body while flushing metabolic waste and toxins from the body (including flushing anaesthetic) 

  • Make the dog more comfortable during healing

  • To improve mobility 

  • To increase endorphins in the body to aid with pain reduction

  • To speed up the recovery process

  • To loosen tense muscles and muscles that have become stuck from inactivity

  • To increase weight bearing on the limb or limbs

  • Reduce muscle splinting 

  • To reduce changes in the mood and behaviour or the animal

  • To reduce trigger points

  • To reduce myofascial pain, seen as twitching along the back, tight skin, or a ‘tickly’ spot in the middle of the back.

  • With the break down of the restrictive scar tissue and adhesions

how can massage help with cruciate ligament damage?

Helps with post surgery rehabilitation after TPLO/TTA (Tibial Plateau Leveling Osteotomy/Tibial Tuberosity Advancement)

  • Helps with combating lymphoedema (swelling)

  • Can help with pain management resulting from the condition

  • Helps with reducing areas of overcompensation on the unaffected leg. Muscles such as the quadriceps will be affected by the damage. This is very important as the overcompensation on the other leg will put pressure on the ligament and could cause the same damage in the previously healthy leg.

  • Helps reduce back, neck and shoulder pain due to the dog having to adjust its gait

  • Reduces inflammation

  • Promotes mobility

  • Significantly improves comfort levels

Contraindications (reasons to not massage or to alter the massage) to be aware of - if your dog is showing any signs of the following then please let me know and then we can discuss a treatment schedule to work around or outside of the particular issue.

Specific to :

  • Inflammation

  • The extent of the damage

  • Recent surgery

  • A recent contusion to the area

  • Open wounds

  • Muscle ruptures

  • Sprains and strains

  • Broken bones

  • Arthritis

  • Infections in the area

  • Swelling

General contraindications:

  • High blood pressure

  • Diabetes

  • Cardio-vascular conditions

  • Bruises

  • Pregnancy

  • Epilepsy

  • The severity of the condition

  • The level of inflammation in the area (heat therapy should be avoided if inflammation present)

  • Skin irritations such as eczema