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ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES
One of the most common causes of hind leg lameness in a large breed dog are injuries related to the knee (stifle) joint.
Typical History
So, here are the two most common histories we Veterinarians hear regarding large breed dogs with accutely sore hind legs . . .
Typical History
So, here are the two most common histories we Veterinarians hear regarding large breed dogs with accutely sore hind legs . . .
1. "Hershey"
"Hershey", a three-year old female chocolate Lab spends most of her time curled up on the couch waiting for the kids to get home from school. After all, where there are kids, there is sure to be food, and food is "Hershey"'s favorite thing. After a snack, the kids take her out to the yard where "Hershey", who can't believe her luck, comes face to face with her second favorite thing - THE squirrel! The chase is on . . . until "Hershey" (who seems to be gaining) yelps in pain, stops in mid-flight, and comes limping back to the house.
2. "Thor"
"Thor", a six-year old Rottweiler who had previously been diagnosed with arthritis in his knees, comes in to discuss his worsening hind leg lameness. Recently, "Thor" started limping on his hind leg after going for walks and seems much stiffer the next morning. Last week, he jumped out of the car at the park and limped so badly that his owner packed him up and took him home. One week later, he is no better . . .
What do they have in common? In all likelihood, both of these cases are examples of a ruptured, torn, or stretched anterior (or cranial) cruciate ligament (ACL).
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The knee is a very complicated joint involving an assortment of ligaments that connect the femur (thigh bone) to the tibia (shin bone). Additionally, there is the patella (kneecap), it's ligaments, the menisci, and the fabellae. |
How Do We Diagnose ACL Tears?
1. History: often an overweight large breed dog with some variation of the previously described histories.
2. Physical examination: palpation of the knee, assessing for swelling, pain, medial butress (arthritis) and the "drawer test". This test is best performed with the dog sedated. It is a test of forward movement of the tibia in relation to the femur. This movement can only occur if the ACL is torn.
3. Radiographs: we usually take advantage of the sedation required to perform the drawer test and take radiographs (X-rays) at the same time. Radiographs do not diagnose ACL tears - they screen for arthritis and tell us if any additional concerns are present. We often recommend hip radiographs so we have lots of information about the major joints in the hind end.
Treatment
In almost every case, surgery is recommended. The goal of surgery is to stabilize the knee, and there are several techniques which accomplish this goal. Some of the surgical techniques require special equipment and are offered at Veterinary Referral Hospitals. While there are pros and cons to each technique, no one procedure has been proven superior to the others. It comes down to considerations like the weight of the dog, pre-existing conditions the dog may have, financial and travel constraints, and the experience of your surgeon.
Surgical Technique
Dr. Malone has been performing ACL surgeries since her graduation in 1996. We perform an extracapsular repair that involves full assessment of the knee joint, removal of the frayed and torn ligament, assessment and removal, if necessary, of the meniscus, and removal of any disruptive bone spurs. The joint capsule is tightened upon closure and two large gauge sutures are passed around the knee. The sutures are run behind the knee, anchored by the fabella and pass through two holes drilled in the front of the tibia. The sutures are independently tightened and knotted to prevent the "drawer" motion and essentially take the place of the torn ACL.
1. History: often an overweight large breed dog with some variation of the previously described histories.
2. Physical examination: palpation of the knee, assessing for swelling, pain, medial butress (arthritis) and the "drawer test". This test is best performed with the dog sedated. It is a test of forward movement of the tibia in relation to the femur. This movement can only occur if the ACL is torn.
3. Radiographs: we usually take advantage of the sedation required to perform the drawer test and take radiographs (X-rays) at the same time. Radiographs do not diagnose ACL tears - they screen for arthritis and tell us if any additional concerns are present. We often recommend hip radiographs so we have lots of information about the major joints in the hind end.
Treatment
In almost every case, surgery is recommended. The goal of surgery is to stabilize the knee, and there are several techniques which accomplish this goal. Some of the surgical techniques require special equipment and are offered at Veterinary Referral Hospitals. While there are pros and cons to each technique, no one procedure has been proven superior to the others. It comes down to considerations like the weight of the dog, pre-existing conditions the dog may have, financial and travel constraints, and the experience of your surgeon.
Surgical Technique
Dr. Malone has been performing ACL surgeries since her graduation in 1996. We perform an extracapsular repair that involves full assessment of the knee joint, removal of the frayed and torn ligament, assessment and removal, if necessary, of the meniscus, and removal of any disruptive bone spurs. The joint capsule is tightened upon closure and two large gauge sutures are passed around the knee. The sutures are run behind the knee, anchored by the fabella and pass through two holes drilled in the front of the tibia. The sutures are independently tightened and knotted to prevent the "drawer" motion and essentially take the place of the torn ACL.
Recovery
Your dog will spend one night following surgery with us in the hospital. This will enable us to provide effective pain management and ongoing intervenus fluid support. Your dog will have a large incision over the affected knee and the skin will be closed with staples. We do not typically bandage these legs after surgery. Your dog may go home with antibiotics and a variety of pain management options like an opiod patch and pills such as NSAIDS and analgesics. A recheck exam in 10 days, at the time of staple removal, is scheduled.
Now for the tough part. We recommend six weeks of very strict exercise control. Basically, think about every scenario that may set your dog off and create excitement, and strive to avoid them all. If your dog lays in front of your window waiting for the neighbor's dog to walk by, which happens several times a day, that's likely going to result in some excitement behaviors in the form of barking, running, hopping, rearing . . . all of the things we do not want the dog to do while recovering from surgery! What normally happens with your dog when someone rings the doorbell or the kids come home from school? Even though a dog is in the house, this does not mean they are safe or cannot injure themselves. Ideally, your dog should be kept in a comfortable crate or placed in a small room without furniture whenever you are not home, and even sometimes when you are home. You must use a short leash to take the dog outside (don't forget that squirrel who's to blame for you being in this situation in the first place!) and you should only be out for the short walks required for the purposes of . . . well, you know . . . "Doggy Business". There should be no climbing up onto or off of furniture, no running, no jumping, no playing, and basically no fun at all. And to top it all off, we will recommend you feed less, even if your dog isn't specifically overweight as he will be much less active and therefore require less food than normal. Obesity is a major risk factor and contributes to the fact that a large percentage of these dogs will sustain a similar injury to their other knee. During this time, owners can perform a variety of physical therapy techniques like warm and cold compresses, passive range of motion exercises, and hydrotherapy to hasten their dogs recovery and ease symptoms of discomfort.
After six weeks, a slow return to normal activity is achieved by gradually lengthened leash walks, walking daily and increasing by 10 minute increments each week. After six weeks of this type of exercise, achieving a total walk time of 60 minutes (holy cow, we're all going to get in shape!), your dog should be ready to resume normal activities.
Use common sense when introducing new activities and remember that a lot of these dogs have arthritis in their knee (at a minimum) and this may limit what they can or should do. Follow your Veterinarian's advice regarding weight loss and management. It is incredibly important and can benefit your dog in a number of ways.
As always, consult your Veterinarian for specific recommendations.
Your dog will spend one night following surgery with us in the hospital. This will enable us to provide effective pain management and ongoing intervenus fluid support. Your dog will have a large incision over the affected knee and the skin will be closed with staples. We do not typically bandage these legs after surgery. Your dog may go home with antibiotics and a variety of pain management options like an opiod patch and pills such as NSAIDS and analgesics. A recheck exam in 10 days, at the time of staple removal, is scheduled.
Now for the tough part. We recommend six weeks of very strict exercise control. Basically, think about every scenario that may set your dog off and create excitement, and strive to avoid them all. If your dog lays in front of your window waiting for the neighbor's dog to walk by, which happens several times a day, that's likely going to result in some excitement behaviors in the form of barking, running, hopping, rearing . . . all of the things we do not want the dog to do while recovering from surgery! What normally happens with your dog when someone rings the doorbell or the kids come home from school? Even though a dog is in the house, this does not mean they are safe or cannot injure themselves. Ideally, your dog should be kept in a comfortable crate or placed in a small room without furniture whenever you are not home, and even sometimes when you are home. You must use a short leash to take the dog outside (don't forget that squirrel who's to blame for you being in this situation in the first place!) and you should only be out for the short walks required for the purposes of . . . well, you know . . . "Doggy Business". There should be no climbing up onto or off of furniture, no running, no jumping, no playing, and basically no fun at all. And to top it all off, we will recommend you feed less, even if your dog isn't specifically overweight as he will be much less active and therefore require less food than normal. Obesity is a major risk factor and contributes to the fact that a large percentage of these dogs will sustain a similar injury to their other knee. During this time, owners can perform a variety of physical therapy techniques like warm and cold compresses, passive range of motion exercises, and hydrotherapy to hasten their dogs recovery and ease symptoms of discomfort.
After six weeks, a slow return to normal activity is achieved by gradually lengthened leash walks, walking daily and increasing by 10 minute increments each week. After six weeks of this type of exercise, achieving a total walk time of 60 minutes (holy cow, we're all going to get in shape!), your dog should be ready to resume normal activities.
Use common sense when introducing new activities and remember that a lot of these dogs have arthritis in their knee (at a minimum) and this may limit what they can or should do. Follow your Veterinarian's advice regarding weight loss and management. It is incredibly important and can benefit your dog in a number of ways.
As always, consult your Veterinarian for specific recommendations.
****** INTERESTING CASES ******
UROLITHS IN DOGS (also called "bladder stones")
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There are a number of different types of uroliths including calcium oxalate, struvite, ammonium phosphate, and urate, each with a distinct set of parameters that allow them to develop in the urinary bladder. The above pictures are of a 9 year old spayed female Shih Tzu and the struvite stones that were removed from her bladder. To learn more about uroliths, please click on the attached article.
UROLITHS IN DOGS
UROLITHS IN DOGS
GASTRIC DILATION AND VOLVULUS (GDV) OR "BLOAT"
Knowing the signs of bloat may save your dog's life. This is a typical radiograph of a dog with GDV. To learn more about this life-threatening condition, please click on the following link to an article describing what to watch for in your dog.
THE BLOATED DOG
NASAL MITES
We had a young dog presented to us for a one month history of increased, wet nasal sounds, sneezing, and no significant discharge. Our major rule-outs were allergies, foreign body like a grass awn, fungal infection, or a tumour. We performed an examination and flushed the nasal passages with no significant improvement. We also tried a course of anti-histamines and antibiotics, but they did not cure the problem.
The dog came back in for radiographs, endoscopy, and a repeat nasal flush. The radiographs did not reveal any obvious problems, but the endoscopy was very rewarding. Click on the video link below to see the nasal mites - yes, bugs! - we found in the dog's nasal passage.
The dog came back in for radiographs, endoscopy, and a repeat nasal flush. The radiographs did not reveal any obvious problems, but the endoscopy was very rewarding. Click on the video link below to see the nasal mites - yes, bugs! - we found in the dog's nasal passage.
Nasal mites are small white bugs that are found basically world-wide. They are very contagious among dogs. The clinical signs include sneezing and nasal discharge. The primary way to diagnose them is with an endoscope. Treatment is available.