Understanding cruciate disease in dogs

Vets in general practice are going to see dogs with cruciate disease on a regular basis. In some cases the diagnosis can be challenging and then there is the minefield of different techniques for managing cruciate disease.

The exact aetiology is not completely understood and is likely to be caused by many factors including genetics, breed, weight and sex although underlying all of this it is considered to be a degenerative process rather than an acute injury in the vast majority of cases.

The financial impact of cruciate disease was documented in 2003 and calculated to be in the region of $1 billion US dollars. It therefore remains one of the most significant orthopaedic problems facing surgeons.

Whilst cruciate disease can be treated medically or surgically there is a trend towards surgical management due to improved function with the hope of stabilising the stifle joint and thus restoring normal joint kinematics. Many techniques and variations have been described over the years.

The most commonly performed procedures tend to be tibial plateau levelling osteotomy (TPLO), tibial tuberosity advancement (TTA) along with various derivatives of this (e.g. MMP, TTA rapid etc.), cranial closing wedge osteotomy (CCWO) and extracapsular stabilisation (ECR). The aim with all of these is to restore normal stifle joint biomechanics. Ultimately none of these techniques actually achieve this and so the surgeon then has to decide on the most appropriate technique.

This raises the question, how do you choose between TPLO, TTA, closing wedge or extracapsular stabilisation when managing cruciate disease? How do you advise the client in the consultation as to the best option?

How can you be better prepared to discuss cruciate disease with your clients?

It is important to remain up-to-date with current trends and techniques. Given the accessibility of information on the internet and the high profile of some television programmes owners are often well informed before you even see them.

Why not come along for and join us for a day on cruciate disease? We will be taking an evidence based approach to outline the rationale for common techniques used in the management of cruciate disease in the dog and outline the current preferred technique.

Detailed discussion of techniques and procedures will enable you to discuss management with owners in more detail even if it is not you doing the surgery. The aim is to review the most common post-operative problems and complications and discuss these in detail.

Where does physiotherapy fit in?

In addition to clinical aspects of cruciate disease there will also be lectures on physiotherapy dovetailed into the day to address management of these cases from all aspects.

Understanding that post-operative rehab can begin immediately after surgery is important for recovery. The Veterinary Surgeon and Veterinary Physiotherapy must work together closely to assess the patients individual needs and goals and tailor a programme for each individual.

A variety of techniques such as range of movement, cryotherapy, heat therapy, massage, proprioception exercises, various electrotherapy modalities such as: ultrasound therapy, laser therapy and hydrotherapy can be utilised during recovery. The rationale behind each of these physiotherapy techniques will be discussed including how they fit into the rehabilitation programme with details on what is needed at each stage of recovery.

Maintaining an effective rehabilitation multimodal approach following a sequential and progressive approach your patients can be returned to good activity levels after surgery.