Dr. Anna Dunton-Gallagher
OFF THE LEASH
Your dog runs to fetch a stick on one of our many icy days, but slides right past it! He then makes a quick correction with a tiny cry, grabs the stick and comes running back. But his run looks a little different. You realize as you walk home that he is hardly putting any weight on one of his back legs. When you come to see me the next day, you find out that he tore his ACL (anterior cruciate ligament, also known as a CCL or cranial cruciate ligament in dogs.) This is one of our most common injuries this time of year, but just one of the many orthopedic injuries that we see. I will be discussing a few common orthopedic issues and their corrections. Orthopedic surgery can seem like a scary prospect in our pets, but it is necessary for a comfortable life in many situations.
Anterior (cranial) cruciate ligament tear
This is common mostly in dogs, and is essentially the same injury as in people. Sudden turning, stopping, or sideways force can rupture this ligament. We see a lot of them during icy times of the winter, and then again during high ball/frisbee activity times. Flying off a deck to catch squirrels is another common scenario. Two ligaments form an X in the knee and help stabilize the joint. The ligament acts to secure the knee position and maintain the proper alignment of two bones to each other in the leg.
There are different ways to repair this injury surgically. Both return the knee to stability, but in slightly different ways. Size of the dog, needed activity level after surgery and budget are all considerations when deciding which surgery to choose. There is also a meniscus in this area. A meniscus is a soft tissue disc that is essentially a shock-absorbing cushion. While a torn ACL provides instability which can lead to pain, the main painful part of this injury is a meniscal tear.
ACLs can also be partially torn. This means that they can sometimes heal themselves with scar tissue and help the knee regain stability. However, these are very prone to re-injury. The most definitive and effective way to repair an ACL is with surgery. Your veterinarian can discuss alternatives with you if surgical repair is not an option.
Luxating patellas occur when an animal’s knee conformation is slightly off from ideal. The groove that their kneecap (or patella) sits in is not deep enough to hold it in place. Occasionally the tendon that holds the kneecap can also be a little bit too loose. With either cause, the kneecap “pops” in and out when the animal walks. This causes discomfort, and we usually see the animal skip for a few steps with their leg up then return to walking normally. This is very common in many small-breed dogs (poodles, yorkies, pomeranians, pugs) and larger dogs with very straight legs (like akitas).
Not all grades of luxating patellas require repair. Many dogs can live with this condition. However, the more severe grades should be repaired. Every time the knee-cap slips out of place it causes abnormal wear on the surface of the knee. These pets are much more prone to arthritis as they age, since they have abnormal strain on the knee.
Surgical repair for luxating patellas involves deepening the groove that the patella sits in. This makes it more difficult for it to move out of place. The main goal of this correction is to eliminate the pain when the kneecap slips out, and lessen the arthritis that results.
Bone chip removal
This is most common in elbows of dogs, but is occasionally seen elsewhere. In many breeds of dogs (especially retriever breeds) as the elbow fuses from puppy to adult stage, some small pieces of bone don’t fuse. These chips then move around the joint causing pain, bone irritation and arthritis. The earlier these are addressed the better, but like a small stone in your shoe, removal at any point is helpful.
Limb amputation is another fairly common procedure. While it at first seems like a very drastic step, amputation can be a good treatment option in certain cases. Pets that have bone or cartilage cancer have a lot of pain in the affected bone. Amputation of the limb eliminates this pain and gives them a longer survival time. Amputation is also a cheaper alternative than some other orthopedic surgeries, so especially in cats can be a salvage procedure. Amputation as a salvage surgery (last option before putting the pet to sleep) works better the lighter a pet is, but even in big dogs with bone cancer provides relief. Many animals do wonderfully on three legs. Most don’t slow down at all, and are happy to have the painful limb removed.
FHO (femoral head ostectomy)
This is a surgery that actually removes the head of the femur, which is the “ball” part of the hip joint. This is often done in young dogs with painful and malformed hips. It is not a good option for older dogs with osteoarthritis, but instead for younger dogs that have poor hip conformation from an injury or genetics. Instead of a bone-bone joint, this is replaced with a muscle. While it may seem odd at first, shoulder blades are only attached to bodies with muscle, and they are very strong! This surgery allows an immediate pain relief, and most pets return to function in a few months with hardly any restrictions.
There are many other types of orthopedic surgery: to repair fractures, hip dysplasia and injuries. We all know that if there is a way to get injured, there is a pet who has done it! If your pet needs an orthopedic procedure and you are uncomfortable about it, make sure you speak with your veterinarian or the surgeon about the specifics. Orthopedic surgery is as routine in animals as in humans these days. Repairing painful or unstable joints will help your pet live a more comfortable life.