Sprain in a dog's front leg. Anterior cruciate ligament rupture in a dog. Review of treatment methods. Etiology of ACL rupture in dogs

The knee joint in dogs is a complex combined joint, i.e. movement occurs in several joints at once - in the tibia and kneecap, and between the connecting bones (femur and tibia) there are intra-articular menisci. The knee joint is supported on the sides by the collateral ligaments, and internally by the cruciate anterior and posterior intraarticular ligaments.

This set of ligaments provides smooth, uniform movement of the joint, limits excessive flexion of the joint, and prevents the joint from bending to the side.

Torn knee ligaments in dogs can occur in all breeds of dogs and at any age.

The most common rupture of the anterior (cranial) cruciate ligament in dogs.

Predisposing factors

Quite often, a rupture of the anterior cruciate ligament in dogs causes various types of injuries - falls, unsuccessful turns, slipping, jumping, as well as prolonged physical activity, especially after a long break.

Anterior cruciate ligament rupture is common in large and giant breed dogs. Such dogs are heavy and often have a loose constitution, which contributes to excessive stress on the joints during movements, and hence the occurrence of various types of injuries in them.

In older people, an ACL rupture may occur due to wear and tear of the ligaments themselves.

The risk group also includes animals with chronic diseases of the knee joint - arthritis, arthrosis, degenerative changes in the knee joint.

Predisposing factors are also the pathological structure of the knee joint, as well as heredity.

Symptoms of anterior cruciate ligament rupture in dogs

Anterior cruciate ligament rupture can be incomplete (tear) or complete and requires immediate treatment.

Symptoms may be more or less severe, depending on the degree of traumatic injury. But, as a rule, this is always lameness in the hind limb or complete exclusion of the paw when the dog moves (the paw simply hangs in a slightly bent position). With an incomplete rupture, the dog sometimes stops practically limping on the damaged limb; after some time, after the injury has occurred, and only slightly protects the limb, but later without treatment, the lameness will resume.

Diagnosis of anterior cruciate ligament rupture

Collecting an anamnesis and the clinical picture of the disease may cause a veterinarian-traumatologist to suspect a rupture of the ligaments of the knee joint in a dog. The main research method is an x-ray of the damaged joint in certain projections, and in order to perform an informative x-ray, sedation of the animal is often required.

When diagnosing this pathology, a veterinary traumatologist examines the knee joint for the presence of the so-called “anterior drawer” symptom. This is a pathological mobility of the joint in which the head of the tibia moves forward in relation to femur, but this symptom is not always present.

Treatment of anterior cruciate ligament rupture in dogs

In small breeds of dogs (up to 12 kg), it is sometimes possible to treat this pathology conservatively. The main method of treatment is restrictions on mobility (short walks on a leash, exclusion of jumping and playing with the animal). In some cases, such treatment gives a positive result and it is possible to cure the animal completely, without recurrent lameness. If lameness persists, surgery is required. U large breeds In dogs, surgical intervention is always required to treat a ruptured anterior cruciate ligament. IN in this case It is important not to delay surgical treatment, otherwise secondary osteoarthritis of the knee joint will occur, which will be incurable.

During the operation, a number of surgical techniques are used such as periarticular stabilization of the knee joint, TPLO, TTA.

In our clinic, we choose a technique depending on the specific situation, the severity of the injury and the condition of the dog’s knee joint. After examination and making this diagnosis, the veterinarian-traumatologist will choose the most appropriate surgical technique in this particular case.

After the operation, as a rule, the animal remains in the postoperative hospital of the clinic under the supervision of doctors until the condition stabilizes. Next, the pet is given to the owner, with detailed recommendations for care, treatment and a schedule for examining the animal. A special bandage is usually applied to the joint area for several days. Usually, period full recovery is 8 - 12 weeks. During this time, it is necessary to limit the animal’s mobility and strictly follow all recommendations prescribed by the veterinarian.

Anterior cruciate ligament rupture is a common problem in various breeds dogs leading to pelvic limb lameness due to pain and instability in the knee joint. In the future, this pathology will lead to the development of a chronic inflammatory process and osteoarthritis, as a result of which the dog will lose the ability to fully use its paw.

Anterior cruciate ligament rupture often occurs in large and medium-sized dog breeds: Rottweiler, Caucasian Shepherd, Canecorso, Labrador, Boxer and others. In our veterinary practice, it is also not uncommon to see ruptures of the anterior cruciate ligament in small breeds of dogs, such as Yorkshire terriers, miniature poodles, pugs and chihuahuas. In extremely rare cases, this pathology occurs in cats and, as a rule, has a traumatic origin.

The age of dogs can vary. This is due to the cause of this pathology, but most often dogs from 5 to 7 years old suffer from ACL rupture.

Rupture of the anterior cruciate ligament in dogs accounts for 60-70% of the total number of pathologies of the knee joint.

To better understand the cause of an ACL tear, the mechanism of the tear itself, and its consequences, you need to have a good understanding of the anatomy of the knee joint.

The knee joint includes the distal epiphysis of the femur, the patella, the proximal epiphyses of the tibia and fibula and respectively consists of the femur joint, the patella joint and the proximal intertibia joint.

The knee joint in a dog is a complex uniaxial joint, since movement in this joint is possible in the lateral sagittal plane.

The femoral joint is formed by the femur and the kneecap. The lateral and medial holders of the patella originate in the ligamentous tuberosities of the femoral condyles and end on the kneecaps. The straight ligament of the patella starts from the apex of the patella and ends at the crest of the tibia.

The femur joint is a complex joint. In addition to the femur and tibia, it includes the lateral and medial menisci, which are involved in smoothing the incongruent articular surfaces. The menisci have a semilunar shape and each of them is connected to the tibia - the cranial and caudal tibiomeniscal ligaments. The lateral meniscus also has a femoral meniscal ligament.

The lateral and medial sesamoid bones (vesalian bones) are located on the caudal side of the joint and are connected to the femoral condyles.

The proximal intertibia joint connects the head of the fibula to the lateral condyle of the tibia via the cranial and caudal ligaments of the fibular head.

The cruciate ligaments are located in the center of the joint and consist of intersecting bundles of collagen fibers.

The anterior cruciate ligament originates from the posterior portion of the lateral condyle of the femur and runs anteriorly in a ventromedial direction to the tibia and inserts in front of the intercondylar eminence of the tibia. The posterior cruciate ligament begins in the caudal ligamentous fossa of the intercondylar eminence and ends in the intercondylar fossa of the femur. The anterior cruciate ligament itself consists of longitudinally oriented collagen fibers, the purpose of which is to prevent displacement of the tibia in the cranial direction during flexion and extension of the knee joint, rotation of the tibia, and prevention of hyperextension of the knee joint.

Accordingly, when it ruptures, the dog experiences instability in the knee joint and with each step the lower leg moves in the cranial direction and normal movement of the limb becomes impossible. Instability in the knee joint very often leads to damage to the medial meniscus, which further aggravates the course of the disease and prognosis.

Etiology of ACL rupture in dogs

There are several causes of anterior cruciate ligament rupture, but the most common is degenerative changes in the ligament itself. Due to various predisposing factors, the cruciate ligament becomes thinner, its nutrition is disrupted, the ligament becomes inelastic and any unsuccessful movement of the dog leads to its rupture.

With degenerative changes in the anterior cruciate ligament, its rupture, as a rule, occurs gradually, and clinical signs increase over time. That is, first the dog’s cruciate ligament is torn, and the dog begins to limp, then with a slight jump or playing with other dogs, it completely ruptures with clear clinical manifestations. As stated above, rupture of the anterior cruciate ligament due to degenerative changes in the ligament itself is the most common cause of rupture in dogs aged 5 to 7 years.

In dogs at a younger age, degenerative changes in the anterior cruciate ligament and its rupture can occur as a result of congenital deformities of the knee joint itself or other pathologies of the pelvic limb, for example, dysplasia hip joint or luxating patella in small breed dogs. As a result of improper load on the ligament, it undergoes changes and ruptures.

Rupture of the anterior cruciate ligament due to injury to the knee joint practically does not occur in veterinary practice, and if it does occur, it is usually due to severe sprain of the knee joint, for example, during a car injury.

Another cause of anterior cruciate ligament rupture is immune-mediated or infectious inflammatory arthropathy.

Predisposing factors for anterior cruciate ligament rupture may also include excessive slope of the tibial plateau or excessive caudal slope of the superior articular surface of the tibia and stenosis of the intercondylar recess of the femur.

Excessive tilting of the tibial plateau places excessive stress on the cruciate ligament and can cause changes and rupture.

The theory of insufficient intercondylar recess has its origins in humane medicine. In humans, anterior cruciate ligament rupture can occur as a result of impingement of the medial surface of the lateral femoral condyle with the cranial cruciate ligament. In dogs, this theory has reason to exist, since when studying knee joints, scientists in 1994 noted that all studied joints with torn anterior cruciate ligaments had less pronounced intercondylar grooves compared to healthy joints.

Clinical signs of ACL rupture in dogs

The most common clinical sign of anterior cruciate ligament rupture is pain when moving the knee joint. With a partial rupture, the pain syndrome may not be very pronounced and the dog will limp slightly on the affected leg. With a complete rupture, the pain syndrome is more pronounced, the dog experiences severe lameness of the supporting type, or the dog generally loses the ability to use the affected paw and keeps it in a bent state.

When the anterior cruciate ligament ruptures, swelling of the knee joint and increased local temperature may occur. This may be due to infection in the knee joint or secondary inflammation due to instability after rupture.

The presence of instability in the knee joint, this clinical sign is usually assessed by a veterinarian using tests that are performed on the knee joint. In a complete rupture that has occurred recently, the instability is usually much more pronounced and can be easily assessed by a veterinarian. Also, instability in the knee joint is well diagnosed in small breeds of dogs and can even be noticed by the dog owners themselves. In large breed dogs, instability after approximately 3-4 weeks may be less pronounced due to the presence of chronic inflammation and peri-articular fibrosis, making diagnosis more difficult. With a partial rupture of the anterior cruciate ligament, instability in the knee joint will not be observed, but pain and lameness will be clinically observed. Swelling of the knee joint is rare.

A clicking sound may also be heard when the knee joint flexes. This clinical sign is observed when the medial meniscus is damaged, when the torn part of the meniscus can bend between the articular surfaces of the medial femoral condyle and the tibial plateau and create a characteristic sound when the knee joint is flexed. This is not uncommon in large dogs. Damage to the medial meniscus can worsen over time, when the meniscus is rubbed against the articular surfaces and becomes even more unusable. If the medial meniscus is damaged, then over time arthritic changes will be observed in such a joint, since the meniscus performs very important shock-absorbing functions in the knee joint.

Usually, with a complete rupture of the anterior cruciate ligament, at first the clinical signs will be very pronounced, but over time they begin to subside, and the dog may begin to move on the affected limb and, accordingly, this is not very good for the meniscus. Prescribing painkillers accordingly is also not permissible in order to avoid movement in an unstable joint.

As for long-term clinical signs, this is atrophy of the thigh muscles, arthrosis of the knee joint, which is not uncommon for dogs with a rupture of the anterior cruciate ligament.

Atrophy of the thigh muscles develops if the dog does not give proper weight to the affected leg, and it can walk on both legs, but try to transfer its body weight to the healthy hind limb. Atrophy can be easily seen by comparing a healthy paw and a diseased one; a paw with a ligament rupture will appear thinner, the muscles will feel flabby and lack normal tone.

It is more difficult to determine atrophy when the anterior cruciate ligaments are torn in both legs, simply due to the impossibility of comparison, but an experienced specialist should be able to cope with this.

With arthrosis of the knee joint with rupture of the anterior cruciate ligament, when palpating and flexing the knee joint, crepitus may be felt in the joint itself, the knee joint will be increased in size, especially on the medial side, and contracture may be observed.

Diagnosis of anterior cruciate ligament rupture in dogs

A torn anterior cruciate can be diagnosed using special tests performed by a veterinarian at an appointment and special diagnostic studies.

When examining a sore joint, two special tests must be performed to diagnose anterior cruciate ligament rupture:

Sometimes it makes sense to carry out both tests under anesthesia, especially if you suspect that the rupture occurred a long time ago and there is already arthrosis in the knee joint. When diagnosing old ACL tears, tests may not be very informative and displacements during tests may be insignificant due to the presence of peri-articular fibrosis, so minimal displacement can only be noticed in a relaxed joint, so such patients are given a sedative.

If the anterior cruciate ligament is torn, these tests will be negative.

X-ray examination for anterior cruciate ligament rupture is not specific and is sufficient informative research, since the diagnosis is mostly made on the basis of a clinical examination of the joint. X-ray diagnostics can be useful for detecting consequences after rupture of the anterior cruciate ligament, in particular the presence of deforming osteoarthritis. During X-ray diagnostics, the following changes will be noticeable: osteophytes will be present in the area of ​​the patella, on the medial side of the knee joint and in the area of ​​the sesamoid bones. The articular surfaces of the knee joint may also have defects; there may be loose fragments of cartilage and bone structures in the joint cavity.

Computed tomography of the knee joint in case of rupture of the anterior cruciate ligament, as well as radiographic examination, is not sufficiently informative for this pathology. With CT, we can clearly evaluate the bone structures of the joint, their changes or the presence of osteophytes. Soft tissue structures such as the lateral and medial menisci and the cruciate ligament are difficult to assess.

Special attention should be paid to this diagnostic study, like knee arthroscopy.

Arthroscopic examination of the knee joint is extremely important in cases of partial rupture of the anterior cruciate ligament. This method makes a diagnosis in the absence of a positive response to the drawer test or calf compression test. Also, arthroscopic minimally invasive surgery of the knee joint is actively used in our clinic. Using it, we can assess the condition of the menisci, carry out manipulations for partial or total removal of the meniscus, remove fragments of the anterior cruciate ligament - minimally invasive!; that is, with the least surgical trauma, and then apply a technique to stabilize the knee joint.

MRI of the knee joint is a diagnostic area that is this moment is beginning to be considered as a highly informative study of the knee joint in veterinary medicine. An MRI of the knee can show damage to the meniscus, partial or complete tear of the anterior cruciate ligament, and other joint structures. Unfortunately, due to the high cost of equipment, not every clinic can afford to conduct such a study.

Treatment of cruciate ligament rupture in dogs

The choice of treatment method for a ruptured anterior cruciate ligament depends on various factors, such as the dog’s body weight, the angle of the tibial plateau, how long the disease has been, etc., but in any case everything should be aimed at eliminating pain and improving the dog’s quality of life.

There are two methods of treating a torn ACL:

Therapeutic treatment

Therapeutic treatment for anterior cruciate ligament rupture means:

Limiting the dog's mobility is walking with the animal on a leash or keeping the dog in a small enclosure where active movements are not possible. Accordingly, you should avoid active games with a dog, various jumps and so on. Restriction of mobility should be carried out for one month, in some cases for a longer period.

Non-steroidal anti-inflammatory drugs. Drugs in this group are prescribed to eliminate pain and inflammation in the knee joint.

These NSAIDs are represented very widely on the veterinary market, but in our practice we most often use only a small range of drugs from this group.

For small breeds of dogs we use the following medications:

• Loxicom (0.5 mg meloxicam in 1 ml) suspension.
  For dogs weighing up to 5 kg. The drug is prescribed on the first day of administration, 0.4 ml per 1 kg of body weight, then 0.2 ml per 1 kg of body weight of the animal, strictly after feeding. Course up to 10 days. The drug can be used for animals from 6 weeks of age.
• Previcox 57mg (firocoxib) tablets.
  For dogs weighing over 3 kg. The drug is prescribed in a dosage of 5 mg per 1 kg of body weight, strictly after feeding the dog. The drug can be used from 10 weeks of age and if the dog weighs more than 3 kg.

For dogs of larger breeds, we most often use drugs such as:

• Previcox 227 mg (firocoxib) tablets.
  The drug is prescribed in a dosage of 5 mg per 1 kg of body weight, strictly after feeding the dog. Also, the dosage calculation table is given above.
• Rimadyl 20,50,100 mg (carprofen) tablets.
  The drug is prescribed in a dosage of 4 mg per 1 kg of body weight, strictly after meals. The drug is not prescribed to dogs under 12 weeks of age.

It should be remembered that all nonsteroidal anti-inflammatory drugs can cause irritation of the mucous membrane of the stomach and intestines, leading to the development of erosions and ulcers, but when used correctly, this is extremely rare. NSAIDs are also used with caution in dogs with liver or kidney disease, as they may have hepatotoxicity and nephrotoxicity. Therefore, before using the drug, it is recommended to carry out biochemical analysis blood to avoid subsequent problems.

Separately, the use of knee pads for dogs is not used as an independent therapeutic treatment. In complex therapy, for example, with insufficient limitation of mobility, this method can be useful as additional support for the knee joint when the dog moves. Most often due to anatomical structure On the dog's limbs, the knee pad slips off the paw or the dog itself tries to remove it, which makes this method ineffective.

In itself, the therapeutic approach to rupture of the anterior cruciate ligament is not the gold standard in the treatment of this pathology and often leads to the development of deforming osteoarthritis of the knee joint, which over time makes movement in the affected paw impossible. Therefore, in our clinic this type of treatment is offered to patients who have contraindications to general anesthesia or when surgical treatment is not possible at the request of the owners.

Surgical treatment of cruciate ligament rupture in dogs

Surgical treatment for anterior cruciate ligament rupture is the most reliable method that gives the best result. Let's consider several methods of surgical treatment for rupture of the anterior cruciate ligament:

Intracapsular methods.

The goal of the intracapsular technique is to restore stability to the knee joint by replacing the ligament with a graft. In the supra-apical method of surgery, the graft consists of a straight patellar ligament, a patella wedge, a patellar tendon and fascia lata. It is placed along the course of the original cruciate ligament in the knee joint, in its normal anatomical position. Over time, the graft should take root in the knee joint, its blood circulation should be restored and over time it will resemble a healthy cruciate ligament.

All intracapsular stabilization methods have their own positive sides: Complete replacement of the anterior cruciate ligament. In biomechanical terms, this method has its noticeable advantages.

On the other hand, there are also negative points: after replacing a ligament, a significant load is immediately placed on it and it may not take root and rupture. Also, if a dog has a deformity of the knee joint, as a result of which degenerative changes in the cruciate ligament have occurred and it has torn, then there is no point in replacing the ligament. There are also operational technical difficulties in replacing it.

Extracapsular methods (FTS or lateral suture, muscle transposition).

Extracapsular techniques rely on stabilizing the knee joint with sutures or using soft tissue to support the knee joint.

Fabello-tibial suture or lateral suture.

Stabilizes the knee joint due to the formation of fibrous tissue around the implant (suture). The lateral suture is placed on the lateral side of the knee joint through a double hole in the area of ​​the tibial tuberosity. The other end of the thread is passed through the lateral fabella with a needle. Next, both ends of the thread are passed through the clip, the thread is pulled tight and the clip is clamped.

This method is good for dogs no more than 12-15 kg. The ability to support the affected limb after surgery occurs on days 7-14, and by the 12th week the lameness disappears.

Transposition of muscles.

Stabilization of the knee joint is achieved by transferring the distal end of the biceps femoris muscle and the distal end of the sartorius muscle to the crest of the tibia. As a result, the knee joint remains stable when moving, and no cranial displacement of the tibia is observed.

This method is suitable for dogs of any weight and is quite inexpensive. The ability to support the affected limb is restored after 4-6 weeks. Complete lameness can take up to 4-5 months.

U this method There are disadvantages in the long term, such as secondary damage to the medial meniscus and the development of osteoarthritis.

Also, this method requires limiting the dog’s mobility for up to 4 weeks, which is not always possible, otherwise, separation of the displaced muscles may occur.

Around joint methods (Osteotomies: TPLO, TTA, TTO). These methods are based on changing the anatomical structures of the joint for restoration.

TPLO tibial plateau leveling osteotomy is a surgical method based on reducing the angle of the tibia, where the forces of movement during extension provide dynamic stabilization of the joint.

This method of treatment for rupture of the anterior cruciate ligament is one of the most reliable surgical techniques. Suitable for dogs of all weight categories with a tibial plateau angle greater than 15 degrees. The goal of TPLO is to dynamically stabilize the knee joint. The cranial displacement of the tibia in case of rupture of the anterior cruciate ligament is caused by the angle of inclination of the tibial plateau by the compression traction that occurs when the body weight is transferred to the injured limb, directed parallel to the longitudinal axis of the tibia. If the plateau angle is 5-6.5°, then there will be no displacement of the tibia in the cranial direction and the joint will be stable. Osteotomy is performed using an oscillating saw and a blade of a specially selected radius. Then, after changing the angle, the plateau is fixed relative to the tibia with a special plate for the TPLO (“clover leaf”) technique.

After this technique, dogs with a rupture of the anterior cruciate ligament have a fairly early ability to support the affected paw. After 5-7 days, dogs actively use their paws. IN postoperative care Strict restriction of mobility is not required; the use of antibiotics, non-steroidal anti-inflammatory drugs and suture treatment are recommended. If the menisci are damaged with this technique, arthrosis of the knee joint develops much more slowly. Like any other technique, this method has its complications, such as infection of the implant (2%), avulsion of the tibial tuberosity (4.3%), secondary damage to the meniscus (3%).

TTA advancement of the tibial tuberosity (Tibial tuberosity advancement) - the surgical method is based on the advancement of the tibial tuberosity, where, during extension, additional dynamic traction is created, directing the tibial plateau to its natural position.

The essence of this technique is that if an angle of 90 degrees is achieved between the direct patellar ligament and the tibial plateau, then the cranial displacement of the tibia will not be observed, and accordingly the knee joint will be stable.

The technique is suitable for dogs of different weight categories, as well as with a tibial plateau angle of less than 15 degrees. In the postoperative period, the use of antibiotics, non-steroidal anti-inflammatory drugs and suture treatment is recommended. The advantage of the method is also the early ability to support, the disadvantage is the development of postoperative seromas (33%) and separation of the tibial tuberosity (15%). TTA is not often used in our clinic due to the high cost aspects of the implants, as well as the higher degree of postoperative complications compared to TPLO.

TTO (Triple Tibial Osteotomy).

The essence of this method also consists in changing the anatomy of the tibial plateau, namely, changing the angle of the plateau and extending the tuberosity using osteotomy. This technique is performed on dogs whose plateau angle is less than 15 degrees. There are also a number of disadvantages, such as the traumatic nature of the operation, separation of the tibial tuberosity and severe postoperative limitation of mobility.

Prognosis for ACL rupture in dogs

The prognosis for recovery directly depends on the time of treatment after rupture of the anterior cruciate ligament.

A secondary problem after anterior cruciate ligament rupture is damage to the medial meniscus. If the dog has been walking with a tear for a long time, the meniscus injury may worsen and most often undergo surgery. posterior horn The medial meniscus is removed partially or completely. Removal of the meniscus, chronic inflammation of the knee joint, etc., leads to the development of arthrosis of the knee joint, which in the future will lead to the inability to fully use the paw.

Also with long-term pain syndrome atrophy of the thigh muscles occurs in the dog’s knee joint, which aggravates the rehabilitation period after surgery.

In conclusion of this article, I would like to note the main recommendation for animal owners - timely seeking help from a veterinary specialist.

Clinical case No. 1

The owners of an Alabai dog named Yuzbash contacted the State Educational Center "Pride" with complaints about lameness of the pelvic limb in their pet.

As a result of an orthopedic examination and x-ray examination, a diagnosis was made of a torn anterior cruciate ligament. This problem was solved using surgical treatment using the TPLO (Tibial plateau leveling osteotomy) technique. This is a modern technique that allows you to achieve quick and effective results. This technique involves changing the angle of the tibial plateau, at which the anterior cruciate ligament loses its functional significance.

5 days have passed since the operation, and Yuzbash can already use his paw. Rehabilitation after such an operation does not require a lot of time and expense for the owners.

Clinical case No. 2

A poodle dog named Dorphy was admitted to the Pride veterinary center because she began limping on her left pelvic limb. Over time, the lameness only worsened.

Veterinary orthopedic surgeon E.S. Maslova A series of examinations (clinical examination of the animal and x-ray examination) and tests (drawer syndrome) were carried out, which made it possible to diagnose a rupture of the anterior cruciate ligament. It was decided to surgically treat the problem using the fabellotibial suture (lateral suture). This technique is performed to stabilize the knee joint when the anterior cruciate ligament is torn in small breed dogs. The technique is considered non-traumatic and dogs recover very quickly after surgery. Dorfi, having passed all preoperative examinations, was allowed to undergo surgery. The dog tolerated the anesthesia, the operation itself and the recovery period well.

Veterinary surgeon, specialist in traumatology, orthopedics and neurology Maslova E.S.
Veterinary anesthesiologist K.V. Litvinovskaya

Clinical case No. 3

A dog named Kuzya (11 years old) was admitted to the State Educational Center “Pride” to the veterinarian orthopedic surgeon E.S. Maslova. with the fact that the day before at the dacha he stopped stepping on his right pelvic limb. At the appointment, using special tests and radiographic examination, medial dislocations of the patellas on both sides and a rupture of the anterior cruciate ligament on the right were diagnosed.

The causes of anterior cruciate ligament (ACL) rupture vary. In older dogs, ACL rupture occurs for two reasons: degenerative changes in the ligament and inflammatory processes in the joint. This pathology is extremely rarely traumatic in nature, and is always treated surgically.

Since Kuzi has a small body weight, they decided to fix his knee joint using a lateral or fabellotibial suture. This technique involves applying a suture made from a special polymer thread (there are special kits for lateral sutures), which prevent instability of the knee joint. The method is also relatively inexpensive and produces good results, but only for small breeds of dogs. After a preoperative examination by doctor Maslova E.S. Kuza underwent this operation successfully.

Veterinary surgeon, specialist in traumatology, orthopedics and neurology Maslova E.S.
Veterinary anesthesiologist Smirnova O.V.

Clinical case No. 4

A Chihuahua named Lelya (9 years old) was admitted to the Pride State Medical Center to see a veterinarian orthopedic surgeon E.S. Maslova. with lameness on the right pelvic limb. Using special tests and radiographic examination, medial patellar dislocation and right anterior cruciate ligament rupture were diagnosed. This pathology is very common in small breeds of dogs and can only be treated surgically.

Since Lelya is a miniature girl, they decided to fix her knee joint using a lateral (fabellotibial) suture. This technique involves applying a suture made of a special polymer thread, which prevents instability of the knee joint. The method is also relatively inexpensive, non-traumatic and gives good results, but only in small breeds of dogs. After a preoperative examination (blood tests and ultrasound of the heart) by orthopedic surgeon Lele, this operation was successfully performed. And after recovering from anesthesia in the hospital, she went home.

Veterinary surgeon, specialist in traumatology, orthopedics and neurology Maslova E.S.
Veterinary anesthesiologist K.V. Litvinovskaya

Clinical case No. 5

Labrador Uta was admitted to an orthopedic veterinarian E.S. Maslova. with the problem of pain in the left pelvic limb. After examination and a series of orthopedic tests, accompanied by x-ray diagnostics, the dog was diagnosed with crepitus in the knee joint and “drawer” syndrome. The doctor diagnosed him with a torn anterior cruciate ligament. This is a fairly common pathology among dogs. To solve the problem, surgical treatment using the TPLO technique is used. The most modern method that allows an animal to quickly begin to use its paw without the presence of a cruciate ligament. Uta was successfully operated on and went home after waking up under the supervision of his anesthesiologist and doctors in the inpatient department.

Veterinary surgeon specialist in traumatology, orthopedics and neurology Maslova E.S.
Veterinary anesthesiologist K.V. Litvinovskaya

The knee joint is one of the most complex parts of the body in its structure and anatomy. Femur ( lower section) connects to the tibia and fibula (upper sections) through the anterior and posterior cruciate ligaments. These ligaments do not allow the joint to “walk” freely, i.e. restrict his movement.

The anterior ligament controls forward movement, and the posterior ligament, accordingly, regulates backward movement. In the cavity of the knee joint there are menisci that protect the bones from friction against each other and provide better articulation of the bones.

Causes

If in humans the most common cause of cruciate ligament rupture is mechanical damage, then in dogs there are several of them:

• Breed predisposition. It occurs in dogs of large and giant breeds, and a predisposition has also been noted in dogs of the Labrador, Rottweiler and Staffordshire Terrier breeds.
• Excess weight. Excess weight of a dog puts increased pressure on the limbs, and accordingly all components work “for wear and tear”. The slightest careless movement can lead to rupture.
• Knee deformity. Incorrect alignment of the components of the knee joint can cause abnormal tension in the ligaments and, as a result, their rupture.
• Patella luxation. The process is similar to deformation. As a result of a dislocation, excessive tension occurs and the ligaments tear.
• Excessive exercise. Jumping too hard, sudden movements on unheated muscles and joints, heavy load on exhausted organs, etc. – all this can cause joint damage and ligament rupture.
• Ligament degeneration in older dogs. With age, the strength of the ligaments decreases, and it becomes easier to tear them. Most often, ligament rupture occurs in dogs of both large and small breeds at the age of 5-7 years.
• Inflammation of the knee joint. Due to inflammation of the joint, pus entering the ligaments can lead to their melting, which can cause a rupture.

Symptoms

Depending on the characteristics of the disease, symptoms appear.

• A ligament tear or complete rupture.
• The instantaneous nature of the rupture or the stage-by-stage nature of the process.
• Preservation of the integrity of the meniscus or its destruction.
• The presence or absence of an inflammatory process.

When a ligament ruptures, the animal experiences sudden lameness, it does not use the damaged paw to move and keeps it suspended. Externally, swelling may be observed in the knee area. After about a week, the animal begins to use its paw again, but does not rely entirely on it, but only on its fingers. When moving, a characteristic clicking or crackling sound is usually heard.

Most characteristic feature rupture of the cruciate ligament is the so-called “drawer syndrome”, when the femur and tibia bones “walk” freely, not fixed by ligaments. Also, malnutrition may gradually occur (i.e., a decrease in muscle mass) thigh muscles.

Diagnostics

• Palpation, detection of “drawer syndrome”.
• X-rays, which reveal anomalous location bones of the knee joint, secondary changes in the joint.
• MRI (magnetic resonance imaging).
• Arthroscopy (surgical procedure performed to identify pathologies and internal damage associated with the joints).

In most cases, to diagnose the disease, a set of procedures is carried out at once, because each of them individually is not able to fully identify the degree and nature of the disease. It should be taken into account that in this case, diseases, i.e. ligament rupture, the most effective method is arthroscopy, during which not only injuries are identified, but also therapeutic manipulations are carried out.

Treatment

When selecting treatment methods, the following are taken into account:

• Age of the dog.
• The animal's activity level.
• Severity of the disease.
• Duration of damage.

Young dogs of small breeds (up to 10 kg) can use a conservative treatment method - rigid fixation of the injured limb and maximum reduction of physical activity (short walks, tracking the animal’s body weight). In such a situation, optimal restoration of mobility occurs in approximately 85% of cases, and lameness disappears. If lameness does not go away, surgical intervention becomes necessary.

To avoid the development of arthrosis of the knee joint and other complications, surgical treatment is recommended for all breeds of dogs. During it, the knee joint is opened, the integrity of the menisci is checked, parts of the damaged cruciate ligaments and, if necessary, destroyed menisci are removed. Then fixation occurs. For better effect the joint capsule (the connective tissue that envelops the joint itself) can be sutured “overlapping”. Additional fixation is divided into extra-articular and intra-articular.

In extra-articular fixation, an implant is implanted into the knee. It also overlaps the joint, providing additional fixation. A triple osteotomy of the tibia can be performed - one of the most modern and effective methods. The advantage of this operation is that after it you do not need to wear a fixing bandage.

The intra-articular fixation method is the replacement of a damaged ligament with a prosthesis or autograft.

Immediately after surgery, the dog must undergo a course of antibiotic therapy. She needs to ensure minimal physical activity and complete fixation of the damaged limb, for which bandages are used (for example, a Robert-Johnson bandage). If the dog is experiencing severe pain, the doctor may additionally prescribe various anti-inflammatory drugs and analgesics.

In general, a torn cruciate ligament is treatable. The success of treatment depends on when the dog’s owners turned to the veterinarian, since prolonged injury to the knee leads to the emergence of new diseases and permanent lameness.

An overview of treatment methods for anterior cruciate ligament (ACL) rupture is presented. Both conservative treatment and extra- and intra-articular techniques are possible. Various surgical techniques have been described. There is no consensus among veterinarians regarding techniques for repairing a torn ACL in dogs.

Introduction

Surgical repair of a torn anterior cruciate ligament (ACL) in dogs has been described in detail in veterinary publications. However, there is still much controversy regarding the treatment of ACL tears in dogs. The fundamental rationale for surgery is to restore stability to the knee joint and prevent further damage after surgical debridement. The huge variety of techniques described in the literature suggests that none of them has proven to be completely effective. The outcome may vary and appears to be relatively independent of technique. More than a hundred techniques have been described so far. Surgical techniques can be roughly divided into three main categories: extracapsular, intracapsular, and tibial articular angulation techniques.

The basic principle of extracapsular techniques is to enhance tissue support lateral to the joint using craniocaudal sutures. Another method of extra-articular stabilization of a knee joint with a damaged cruciate ligament is transposition of the fibular head.

Various materials have been studied for intracapsular replacement of damaged ACL. The first prosthesis in history was a strip formed from fascia lata.

The use of other autografts has also been described: skin, 6 tendons of the peroneus longus muscle or extensor digitorum longus, a fragment of the bone of the patella connected to the direct ligament of the patella. On the other hand, you can also use synthetic dentures. One study described the use of nylon implants, as well as Teflon and Terylene. Recently, materials that induce collagen formation, such as carbon fiber and polyester, have received much interest. Techniques for changing the angle of the articular surface of the tibia involve orthopedic reconstruction of the proximal part of the tibia to neutralize its cranial displacement when supporting the limb.

Therapy

ACL rupture in a dog was first mentioned in a Carlin publication in 1926. This gave rise to a cascade of research and publications about possible causes and treatments. The first truly extensive scientific study was published in 1952.

Conservative treatment

According to Paatsama and Arnoczky, conservative treatment in dogs only wastes time. The authors recommend immediate surgical stabilization. However, results from other researchers indicate that non-surgical treatment of dogs weighing less than 15 kg is successful in 90% of cases. In dogs of greater weight, the effectiveness is lower; only in 1 out of 3 cases an acceptable clinical result is obtained. It is possible that these surprisingly good results with conservative treatment in small dogs are due to less demand and less stress on an unstable joint. Most of these animals are older and therefore less active. Conservative treatment of such patients should be considered as an acceptable alternative to surgical stabilization, according to at least, at the initial stage. For generalized joint diseases, such as rheumatoid arthritis or systemic lupus erythematosus, surgical treatment is completely contraindicated.

Conservative treatment consists of restricting activity (short walks on a leash) for 3 to 6 weeks, controlling weight, and using pain medications during periods of discomfort. For pain due to arthritis, a short course of anti-inflammatory drugs may be prescribed.

Surgical correction

Instability leads to progressive degenerative changes in the affected knee joint, appearing soon after injury. For this reason, conservative treatment is often just a waste of time. The need for surgical treatment for ACL rupture depends on functional as well as objective criteria.

With severe instability, especially in large or service dogs, and also if the process lasts (more than 6 - 8 weeks), surgical treatment is strongly recommended. There is no consensus on the possibility of regeneration and healing of the ACL with a partial rupture. It is not yet clear whether such ligaments need to be replaced and whether further ruptures can be avoided. Several studies have shown that lameness and pain with manipulation of the affected knee are also observed with partial ACL tears, even when instability is minimal or undetected. Thus, in such cases, surgical intervention is required. Meniscal pathology, which in all cases requires surgical treatment, often accompanies ACL rupture or develops as a consequence of it. Symptoms usually appear when the medial meniscus is damaged.

Meniscus surgery is performed after arthrotomy before ACL reconstruction. Most meniscal injuries can be treated by partial resection, removing only the damaged portion (Figure 1A). If possible, the meniscus should be removed partially rather than completely, as this will cause less degenerative changes in the joint. Other surgeons prefer complete meniscus resection due to lower risk of iatrogenic damage articular cartilage or caudal cruciate ligament with a scalpel blade (Fig. 1B).

Recently, a meniscal release technique has been developed to prevent meniscal injury in knees with a torn cruciate ligament if the meniscus is intact at the time of arthrotomy. The caudal horn of the medial meniscus is released using a sagittal incision just medial to the lateral insertion of the intercondylar tubercle (Fig. 2A) or an incision caudal to the medial collateral ligament (Fig. 2B). The release of the meniscus is carried out with the aim of displacing it away from the crushing effect of the medial condyle of the femur during cranial movement of the tibia.

The first surgical treatment for ACL rupture in dogs was introduced in 1952 and was based on replacing the ligament with an autograft. Many years later, a new surgical concept was developed to correct craniocaudal instability of the joint without any attempt to replace the torn ACL. Several comparative studies have shown effectiveness different techniques stabilization. In 1976, Knecht published a comparative review surgical methods treatment. Subsequently, several modifications were developed. According to Arnoczky, no single technique has proven superior for all patient populations.

Rice. 1. The principle of meniscectomy in a dog with a damaged medial meniscus.
A. Partial meniscectomy. The torn meniscus fragment is captured with a curved hemostatic clamp, and the remaining peripheral parts are cut off.
B. Complete meniscectomy. Section of the ligament and the place of attachment to the capsule CaCL - caudal cruciate ligament, CCL - anterior cruciate ligament, LM - lateral meniscus, MM - medial meniscus, TT - tibial tuberosity.

Rice. 2. The principle of meniscus release in a dog with an intact medial meniscus.
A. Incision just medial to the lateral insertion of the caudal horn of the medial meniscus
B. Incision caudal to the medial collateral ligament.

Extra-articular techniques- in small dogs and cats, extra-articular stabilization of knee joints with incompetent cruciate ligaments allows obtaining satisfactory results. Even in larger dogs, overlapping lateral suturing techniques are used to close the joint capsule.

Despite the existence various techniques extra-articular stabilization, the main principle of joint stabilization is to strengthen and thicken the soft tissue around it by applying sutures oriented craniocaudalally. In general, these techniques are easy to implement. From a biomechanical point of view, such extra-articular techniques are far from ideal. In this case, the tibia also loses its ability to rotate normally relative to the femur, which can lead to abnormal loading. Complications such as ruptures of soft tissue or suture material have been described.

One of the first techniques described involves placing several Lambert sutures of chrome-plated catgut on the lateral aspect of the joint capsule. Pearson and others improved this technique by using three-layer sutures. At the same time, De Angelis and Lau described a single mattress suture using polydeck material from the lateral aspect of the fabella to the lateral third of the direct patellar ligament, or through a bone tunnel in the tibial crest (lateral fabellotibial loop). In a modified version of this technique, an additional suture is placed on the medial side. To restore normal biomechanics of the knee joint in dogs weighing less than 15 kg, the synthetic material can be replaced with a strip of extra-articular fascia lata. Olmstead's paper describes 5 years of experience using stainless steel wire for lateral tissue support in dogs of varying weights. Several years ago, a curved clamp system made of nylon material was developed that eliminates the need to tie large knots when creating a loop. However, regardless of the material used, any lateral sutures between the fabella and the tibia may tear or loosen after surgery. However, it is believed that due to short-term stabilization, fibrosis of the periarticular tissues develops, providing long-term stabilization of the joint. In practice, lateral joint stabilization is still considered the preferred method of rehabilitation for small dogs.

Another technique that provides lateral and medial support was developed by Hohn and Newton in 1975. It involves a medial arthrotomy, incision of the caudal belly of the sartorius muscle and cephalad transposition to the rectus patella ligament. From the lateral side, 2 mattress sutures are applied to the capsule. The biceps muscle and its fascia lata are then placed over the patellar ligament and secured with sutures.

Later, a simple extra-articular technique appeared, introduced by Meutstege. He recommends overlapping the lateral fascia with absorbable suture material after debridement of the affected joint.

In the latter extra-articular technique, the fibular head is secured in a more cephalad position using a tension wire or cortical screw. This technique changes the orientation and tension of the lateral collateral ligament to stabilize a knee with cruciate ligament failure.

Intra-articular techniques- theoretically, such techniques are preferable to extra-articular ones, since they allow a more accurate replacement of a torn ACL. Even in cases of fresh rupture and excellent reduction, the ACL never regains its original strength. It is possible to restore normal ligament function in any position of the knee joint only if there is a fresh fracture with avulsion of the ACL and anatomical restoration.

Extensive research has been conducted to investigate the properties of the ideal replacement material as well as the correct anatomical position. The prosthesis should imitate the natural ligament, preventing cephalad displacement of the tibia and excessive extension of the knee joint. Incorrect graft orientation can lead to material wear and eventual failure.66 In 1952, a modification of Hey Groves' medical technique was described as a treatment for dogs with cruciate ligament failure. In this case, a strip of fascia lata is formed to recreate the ligament. It is pulled through the joint through a hole drilled in the lateral femoral condyle towards the intercondylar groove and through a tunnel formed from the ACL insertion to a point medial to the tibial crest. This strip is stretched and sutured to the straight ligament of the kneecap. Since the first publication, minor changes in the technique have been described. Singleton's work describes graft fixation to the proximal and distal ends of bone tunnels using orthopedic screws. The technique was significantly modified by Rudy. In this case, osteophytes are removed, the meniscus is excised, regardless of its damage, and an orthopedic wire is installed, which serves for internal fixation, from the lateral fabella to the tibial tuberosity.

Gibbens, instead of a fascial graft, used chemically treated skin, which was pulled through bone tunnels oriented in the same way as described in Paatsama's original work. In addition, with concomitant dislocation of the kneecap, the latter is excised. Other experiments have been carried out using untreated skin (Leighton) to form bone tunnels more cephalad without opening the joint (Foster et al).

In the technique with external fixation of the implant (“over-the-top”), the flap includes the medial third of the patella ligament, the craniomedial part of the patella, and the fascia lata. The free loop is pulled proximally through the intercondylar groove and sutured to the soft tissue over the lateral femoral condyle. To better simulate the anatomical attachment, the graft can be placed under the intermeniscal ligament first. Another possibility is the use of a lateral strip, as described by Denny and Barr, which can be passed through the oblique tunnel in the tibia, starting at the original ACL insertion.

In addition, there are other methods of tendon transposition: peroneus longus tendon, flexor digitorum longus tendon, and extensor digitorum longus tendon. Experimental studies have been conducted on cruciate ligament reconstruction using fresh and freeze-dried patellar tendon and fascia lata allografts. The use of lyophilized specimens was well tolerated, whereas fresh allografts may cause a foreign body reaction. The effectiveness of implantation of frozen bone and ACL allografts has not yet been confirmed by clinical data.

Alternative methods for stabilizing the knee in ACL failure are still in the experimental phase. The possibility of using various synthetic materials as replacements for a torn ACL is of great interest to both medical and veterinary orthopedists. Despite positive results preliminary studies, synthetic prostheses are still not very common in veterinary medicine. Materials for reconstruction should be equal in strength to normal ligament or, preferably, superior to it. Of course, it is necessary that the prosthesis is biologically inert and implantation causes only a minimal tissue reaction. The synthetic implant may need to be removed at any time after surgery.

Another disadvantage is the relatively high cost of implants. There are still no data confirming the possibility of reconstruction with a double-bundle graft in clinical practice.

Several synthetic replacement materials have been investigated. In 1960, Johnson began using braided nylon. In the same year, a publication was published describing the use of Teflon tubes. Since then, many materials have been described, although a significant number of them were used without prior research. In addition to Teflon meshes, supramid, terylene and dacron were used for implantation.

A special prosthesis made from polydeck material was developed for dogs. Opinions are mixed regarding the fragmentation of carbon fiber replacements. According to some researchers, as the synthetic mesh weakens, a new ligament gradually forms, while others argue that the only result is a constant inflammatory response. In addition, the polyester acts as a supporting frame. It can be used in the form of a bundle of fibers or a tape.

More recently, an intra-articular technique for replacing a torn ACL under arthroscopic guidance was described and is becoming increasingly popular in veterinary medicine.

Techniques involving changing the angle of the articular surface of the tibia- the main goal of classical extra- and intra-articular techniques is to eliminate the “drawer” symptom. In 1984, a new concept emerged based on the results of a study of wedge-shaped osteotomy of the cranial part of the tibia. To stabilize the joint, orthopedic reconstruction is necessary to enhance the action of the knee flexors on the hip. Another stabilization technique is needed to control internal rotation of the femur. Osteotomy with changing the angle of the articular surface of the tibia using a curved osteotome and a special plate for fixation was developed in 1993. The modified technique uses a wedge-shaped osteotomy at the level of the articular surface of the tibia and fixation with screws. The purpose of osteotomy with a change in the angle of the articular surface of the tibia is to eliminate the cranial displacement of the tibia during limb support and movement. The “drawer” symptom persists with passive manipulation.

The principle of the operation is to rotate the articular surface of the tibia to the desired level so that the force acting when supporting the limb is directed only to compression. However, recently published work states that this procedure results in caudal displacement of the tibia, making joint stability dependent on the integrity of the caudal cruciate ligament. To avoid excessive load and damage to the caudal horn of the medial meniscus, the latter is additionally released by crossing the lateral portion of the attachment of the caudal horn.

In medicine, the importance of rehabilitation programs is generally recognized. Training the antagonist muscles (hamstrings) appears to play a large role in stabilizing the non-ACL knee. To date, little attention has been paid to postoperative rehabilitation in dogs and its impact on outcome.

Prognosis after treatment

Conservative treatment produces satisfactory clinical results in approximately 85% of dogs weighing less than 15 kg, but only in 19% of larger patients.

All animals develop osteoarthritis (OA). It also increases the risk of future medial meniscal injuries.

The likelihood of successful surgical treatment depends on many factors, such as the experience of the surgeon and the population being studied. The result is also influenced by the surgeon's subjectivity when assessing clinical and radiographic results.

A correlation between postoperative joint stability and progression of osteophyte formation has not been shown. It is obvious that OA worsens in the postoperative period. To date, there is no method that can stop its development. On the other hand, the clinical outcome does not appear to depend on the degree of OA changes seen on imaging.

The percentage of patients with concomitant meniscus injury appears to be related to the length of time the untreated cruciate ligament injury has been present. This phenomenon is not related to the age or gender of the dogs. A strong attachment of the medial meniscus carries the risk of compression between the moving articular surfaces of an unstable knee joint. Concomitant damage to the medial meniscus negatively affects the final prognosis. It accelerates the progression of changes associated with OA, both before and after surgery.

There is no consensus regarding the success of treating chronic cases of severe OA.

Other authors have suggested that pre-existing degenerative joint disease before surgery negatively affects the final results. Older dogs have a worse prognosis; Perhaps in such cases it is better to choose conservative treatment with anti-inflammatory and analgesic drugs. In some cases, the opposite ACL ruptures due to chronic overuse. About a third of patients with cruciate ligament injury experience injury on the opposite side within a few months. This relatively high incidence of bilateral damage further supports a degenerative etiology.

Conclusion

The large number of techniques and materials for making prostheses suggests that the ideal method for treating ACL rupture has not yet been invented. All surgical techniques provide only temporary stabilization. Fibrosis of the periarticular tissues is responsible for the final stabilization of the knee joint, regardless of the technique used. To date, there have been no significant achievements in the field of preventing the progression of degenerative joint changes after surgery, but the clinical result does not seem to depend on the severity of joint changes.

Cruciate ligament disorders remain a mystery; We can expect many more reports and publications on this topic to appear in the future. Since there is no perfect technique, the choice of treatment depends largely on the surgeon's preference.

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A torn ACL (anterior cruciate ligament) is common reason Hind leg lameness in dogs. It is caused by a stretch or tear of the anterior cruciate ligament inside the knee joint. Lameness comes in two forms: chronic (long-term) mild lameness or acute (sudden) acute lameness, where the dog is unable to put weight on the injured leg. Fortunately, with treatment and rest, your dog can return to full health.

Steps

Part 1

1. Give your dog a couple of weeks to rest. A dog with a torn ACL will redistribute his weight to his three remaining paws, putting extra strain on them. For this reason, she becomes less mobile and needs rest.

   • The first two weeks should be strict rest in order to calm the initial inflammation in the joint. Keep your dog from jumping on furniture or cars, and off stairs. She should not be walked at all, and only take her outside to the toilet on a leash to prevent her from chasing anything.

2. Install a ramp and grating on the stairs to restrict movement. Rest is one way to care for a dog with a torn ACL. To prevent her from climbing the stairs, install a child safety net at the bottom. Also, don't let your dog jump in and out of the car. For large dogs that are difficult to lift, install a collapsible ramp so the dog can get up and down on his own.

   • Rearrange if necessary. If your dog's room is upstairs, make temporary adjustments to ensure he is comfortable in his new confined environment.

3. 2 weeks later, take your dog for a five-minute walk twice a day. The principle is not to overload healthy paws and allow time for the affected paw to heal. The dog must be on a leash, because... running will cause strain in the joints and may interfere with healing.

   • During rest, fibrous tissue will join the ends of the torn ligament and this scar will eventually stabilize the joint. Some surgical procedures, such as the di Angelis suture, provide temporary support until a scar, the fibrous connective tissue that ultimately leads to healing, forms.

4. Give your puppy an NSAID, such as Metacam. A torn ACL is a painful condition and moderate pain relief during treatment will be beneficial for your pet. NSAIDs (nonsteroidal anti-inflammatory drugs) are safe (when taken correctly), provide good pain relief, and are suitable for long-term use. Veterinarians commonly prescribe meloxicam (Metacam), carprofen (Rimadyl), and robenacoxib (Onsior).

   • Maintenance dose of Metacama – 0.05 mg/kg, 1 time per day, with or after food. Preoral suspension contains 1.5 mg/ml; a typical 30kg Labrador will need 1ml per day.
   • NSAIDs are prescription drugs that reduce inflammation and dull pain by inhibiting COX-2 enzymes that spread inflammation within the joint. Also, they have virtually no effect on the functioning of COX-1, enzymes that promote blood flow in the stomach and kidneys. Thanks to this, the possibility of serious side effects associated with the digestive tract is reduced, and they are safer compared to aspirin and paracetamol.

5. Carefully consider whether to give your dog aspirin. A dog that is healthy and well hydrated can be given aspirin if other painkillers are not available - especially if your veterinarian has approved it. Recommended dose: 10 mg/kg twice daily, during or after meals. Aspirin usually comes in 300mg tablets, so a 30kg Labrador will need to be given one tablet twice a day.

   • Aspirin (acetylsalicylic acid) provides mild to moderate pain relief, but long-term use tablets may cause side effects, such as stomach ulcers. This occurs because aspirin restricts blood flow to the stomach, rectum and kidneys. You can minimize side effects by taking aspirin with or after food.
   • You should not give aspirin to a dog on steroids or on NSAID medication. The interaction of these drugs increases the risk of ulcers and can be fatal.

6. Be even more careful when using paracetamol as a pain reliever. It is preferable to follow your veterinarian's prescription, but if other medications are not available, you can give your dog paracetamol with food, at the correct dose.

   • Recommended dose: 10 mg/kg, twice daily, with or after food. Most tablets contain 500mg of the substance, so a 30kg Labrador will need 3/5 of a tablet twice a day. If in doubt, it is better to give a lower dose, and for small dogs use a pediatric suspension.
   • Paracetamol (Acetaminophen) provides mild to moderate pain relief. Overdose can damage the liver by overloading it with toxic metabolites of N-acetyl-p-aminobenzoquinonimine. Care must be taken not to exceed the dose, otherwise liver failure may occur.

   Part 2

   Changing your dog's daily routine

   1. Consider the need for a diet. ACL rupture could be caused by overweight and, as a result, additional tension in the ligaments. Also, a dog with a torn cruciate ligament is at risk of tearing the ligament in the other leg due to the fact that he is distributing his weight on three paws instead of four. Thus, losing weight will have a beneficial effect on mobility and reduce stress on the joints.

      • Diet is an integral part of caring for an overweight animal. Ask your veterinarian about what is right for your pet, because... different dogs Different diets are suitable. When discussing the amount of food, also ask what you should feed your puppy. Your veterinarian may prescribe a special diet for the duration of treatment.

   2. Take your dog swimming. Swimming is a great exercise that doesn't put any weight on your paws and keeps your pup's muscles toned. Also, swimming stimulates brain activity as an unusual activity. If your dog is recovering after initial stage Strict rest and walks with eyeliner, two or three water treatments a week will help her tone her muscles and make her joints more elastic.

      • You should also ask your veterinarian about this. You don't want your dog to overexert himself and undo the progress he's made. Your veterinarian will tell you if the ACL has healed enough to recommend swimming as a treatment option.

   3. Don't let your dog walk on linoleum or laminate flooring. When grooming your dog, make sure that it only moves on surfaces with good traction. Slippery floors are more dangerous for dogs with limited mobility. You don't want your three-legged dog to slip and cause another sprain or tear.

      • If necessary, cover linoleum or laminate flooring with non-slip carpeting. Do not use towels or blankets - they will simply slide across the floor, exacerbating the consequences of slipping.