The Treatment of CrCL Tears in Dogs
Management of the CrCL tear in dogs can be medical or surgical. In fact, we believe all dogs – at least for a short period of time – require early medical management to reduce knee swelling including activity restrictions, local cold therapy to the affected knee and anti-inflammatory medications. Other approaches – including additional pain medications, joint supplements even physical therapy may frequently be tried during this early phase to improve comfort.
Ultimately, Decisions About Treatment Including Continued Longer Term Medical Management Versus Surgical Management Revolve Around Three Major Concerns
- What is the activity level of your dog?
- How do you describe your pet-centric lifestyle in terms of activity? In other words, where do you go and what do you do with your dog? And finally,
- What are your athletic goals and outcome expectations for your dog?
Simply put, the higher the activity level of your dog, the more active your lifestyle and with higher athletic outcomes expectations, we consider surgery. Ok, then what?
There are two major categories of operations we consider and divide them into dynamic and static procedures. Each general approach is very different.
As a group, the dynamic procedures consist of more invasive techniques whereby the geometry of the joint is affected to create an immediate change in weight bearing knee mechanics. Each is a functional “workaround” solution to the deficient CrCL. There are five dynamic techniques including the plateau leveling procedures – Tibial Plateau Leveling Osteotomy (TPLO), CORA-based Leveling Osteotomy (CBLO), and the Cranial Closing Wedge Osteotomy (CCWO) – as well as Tibial Tuberosity Advancement (TTA) and the Triple Tibial Osteotomy (TTO).
Static techniques provide early support for the CrCL-deficient knee by tightening or constraining the joint to mimic CrCL function. There are several dozen procedures in this category and all typically require some sort of heavy suture(s) placed outside of the capsule of the joint and acts like and internal brace for several months during which time the joint capsule will thicken or scar. These procedures vary widely based on the numbers of suture(s) used, the material and size of the sutures and how these sutures may be tethered or anchored to bone (tunnels, buttons, anchors, etc.)
A nice example – based on joint geometry, position and orientation of the osteotomy – of a TPLO stabilized with an Arthrex Vet Systems locking bone plate and screws.
This is an example of a technically sound TTA and utilizes the orginal Kyon cage and fork design implants. Some clinical success has been reported with TTA management of CrCL tearsbut make no mistake… TTA is an invasive, bone-cutting operation that requires the use of metallic orthopedic implants.
Treatment
Do your research. Then decide.
We’ll help you understand exactly what is going on with your pet. If you’d like to do your own research, read on. Learn about your dog’s anatomy and how we identify exactly what is wrong and all options for treatment.
We strive for full transparency and to provide all of the information you need to make an educated decision. Note: this information gets pretty technical. Have a question? Let us know. Click here.
