The treatment for this disease can be surgical or non-surgical. Non-surgical management consists of exercise restriction, anti-inflammatory medications, physical therapy and weight loss. These therapies can be effective in very small animals such as cats and dogs weighing less than 15 pounds, although these animals will develop some arthritis, they may regain almost normal function.
Most veterinarians will recommend surgery for treatment of a ruptured cranial cruciate ligament. The many surgical procedures that are available for treatment can be organized into three basic categories: intracapsular stabilization, extracapsular stabilization, and a patented procedure called the Tibial Plateau Leveling Osteotomy® (TPLO).
Intracapsular ligament replacement involves either transplanting tissue from other parts of the dog's body, such as the patellar ligament or fascia lata, into the knee joint. Other options for ligament replacement include a synthetic graft made from materials such as Gore-Tex® or ligament from a tissue bank. The goal of intracapsular ligament replacement is to position the replacement ligament in an anatomically correct configuration.
Extracapsular stabilization stabilizes the knee joint, using materials such as fascia lata, which is a strong fibrous sheet of tissue surrounding the muscles in the outside of the leg, monofilament nylon or other suture material, or stainless steel wire. Fibular head transposition is an extracapsular technique that allows another ligament in the knee joint, the lateral collateral ligament, to replace the function of the cranial cruciate ligament. These techniques are not performed inside the joint; rather, they function to counteract the instability in the joint by acting in a manner similar to an intact cranial cruciate ligament.
Tibial Plateau Leveling Osteotomy® (TPLO) is a technique that utilizes a different approach to treating cranial cruciate ligament injury. Rather than trying to oppose the forces acting on the cranial cruciate ligament in the normal knee joint, a TPLO® eliminates these forces -- and thus the need for a cranial cruciate ligament -- by changing the anatomy of the knee joint. This procedure requires that a bone cut be made in the tibia, which is then stabilized with a specialized bone plate. Only veterinarians that have been trained and licensed by the developer of the technique are permitted to perform this surgery. In general, dogs weighing less than 40 pounds are too small for this procedure.
There are advantages and disadvantages to each of these techniques. The results of these procedures are generally very good; however, some surgeries are more promising than others for complete return to function. There also can be substantial differences in cost and recovery time. A veterinarian can detail these surgical options and further explain the various procedures. Although cruciate ligament surgery can be very demanding, many veterinarians have a great deal of experience and success with these procedures.
Rehabilitation regimens vary, but most veterinarians recommend range-of-motion exercises, gradual return of activity, swimming, weight reduction, and pain medication.
