Preventing CCL Rupture: Eliminating the Warning Signs

In our last episodes we identified some early warning signs that increase the chance a dog will injure or rupture their cranial cruciate ligament. Now, we will talk about how to prevent that ligament tear by addressing those signs and symptoms early or even before they show up.

Monitoring for the presence or absence of effusion in the stifle allows us to create and implement a plan to keep our dogs’ knees as healthy as possible. Your clients can be a part of the team in identifying effusion early. When effusion is present, we know there is inflammation at the knee and we can reduce or eliminate it with

• PEMF - Pulsed Electromagnetic Field Therapy

• Laser – at the veterinarian or at home - learn more at Optimum Laser Therapy for veterinary professionals or get on the waiting list to learn more about Optimum Laser Therapy for Pet Parents.

In addition to looking for effusion, we assess for crepitus. When we find it, the first thing we want to add is some form of chondroprotectents. In the video we discuss the secret ingredient to know which supplements are more likely to have a positive effect. When that isn’t enough, or if the dog is at a risk for knee inflammation or CCL rupture, using a PSGAG injectable disease modifying agent is our next possible step. If you don’t remember the super sensitive test that Dr. Laurie designed, check out our Preventing CCL Rupture: What Are the Warning Signs Part 1 episode by clicking here.

Both effusion and crepitus can indicate some degree of current or previous inflammation. Eliminating inflammation in the stifle is key when treating a CCL injury. In the last Learn & Go, Dr. Laurie taught us how to easily assess if the patella is tracking straight? We know that if it is not, then every time the knee bends and extends, the patella glides against the trochlear groove, scraping the cartilage of the femur and patella, and causing damage and inflammation to the cartilage and joint as a whole. Do you want to know the secret fix when the patella is pulled to one side? Oscillations. Watch today’s video to learn how to use Dr. Laurie’s method to find and fix this issue with ease and to increase patient comfort.

In CCL tears, partial or complete, pain can be found not only on flexion and extension, but also weight bearing, especially with the increased peak vertical force seen in the knee as the dog moves faster. Pain indicating some fibers are disrupted can be identified by testing cranial tibial thrust or anterior drawer tests. We review hand position and testing methods.

We can reduce pain with ice, laser, PEMF, and/or manual therapy. Dr. Laurie shares an easy manual therapy technique that can be done at home to decrease pain and improve range of motion for most any stifle with pain or restriction in movement.

Long before there is pain or pathology, bad posture can be an early indicator of things to come, such as CCL tears. By identifying and addressing poor posture in our canine patients early, we can change the biomechanics that contribute to CCL tears.

Strengthening the muscles around the stifle helps to stabilize the joint. But, we are fighting the body’s normal response. When animals are injured, or as they age, myostatin levels increase. Myostatin is a protein that reduces muscle production, leading to muscle atrophy. Our canine patients are in a catch-22. Fortunately, we now have a way to affect the myostatin levels. Fortetropin is a natural substance that decreases myostatin, allowing the muscle to rebuild and stabilize the stifle. Dr. Laurie talks about one supplement with Fortetropin that has been researched in dogs post-TPLO surgery as well as a supplement that she takes for arthritis.

Taking supplements alone will not build muscle. Implementing a muscle building exercise routine is key in the prevention and rehabilitation of CCL tears. Equipment is available we can use to encourage strength building. The OctoBoard is an amazing tool, designed with the cruciate dog in mind. It is shaped in an octagon to allow the dog to have 3 legs on the board and the leg to be strengthened on the floor. All of the dog’s ability to maintain balance is dependent on the muscles of the limb on the floor. Without any sheer force or added compression, we can strengthen the muscles that help stabilize the stifle, and the other joints in the limb. Dr. Laurie demonstrates strength exercises on the Octoboard.

Another important tool in the quest to strengthen canine limbs is the cavalettis. These series of bars require the dogs to use both their flexor muscles as they pick their legs up over each bar and their extensor muscles as they shift weight to lift the other limb. In this way, we can strengthen the quadriceps and gastrocnemius muscles, the ones that specifically help stabilize the knee. Dr. Laurie talks about using the Cavaletti Jacks, an easy to use adjustable set of cavalettis that can be set at 2”, 4”, 6”’ 8” or 11” for any size dog at any size level of challenge.

The final exercise that Dr. Laurie describes is Rhythmic Stabilization. This, easy to do, easy to teach, exercise turns on all of the muscles of stabilization in all four limbs and the trunk. This can be done in dogs of all ages and is a great starting exercise for all dogs. By pushing on the dog and having the dog push back into you, many of the muscles fire. Depending on where you push, you can target the strengthening process.

Remember, look for effusion, crepitus, and pain. Address those with ice, PEMF, laser, chondroprotectants, and oscillations. Most importantly, be sure to strengthen the joint with directed specific exercises designed for the stifle.

We hope you enjoyed this series and will join us for each Learn & Go session.