Canine Cranial Cruciate Ligament Rupture

犬髌骨十字韧带断裂

Introduction

Rupture of the cranial cruciate ligament (CCL) is a common problem and is the most common cause of a rear leg lameness in dogs. The cranial cruciate ligament in dogs is comparable to the anterior cruciate ligament (ACL) that is commonly injured in human athletes. Injury to this ligament in people is typically associated with some type of extreme trauma. In dogs, however, the ligament most typically ruptures during normal activities without any abnormal stress on the knee.

介绍

犬髌骨前十字韧带断裂（CCL）是一个常见问题，是狗后腿跛行的最常见原因。 犬的前十字韧带与人类运动员常受伤的前十字韧带（ACL）相似。 人体韧带损伤通常与某种极端创伤有关。 然而，在犬中，韧带通常在正常活动期间断裂而髌骨上没有任何异常应力。

Anatomy

The knee is located on the back leg between the femur and the tibia. There are four ligaments present in the knee of dogs. These include the cranial and caudal cruciate ligaments and the medial and lateral collateral ligaments. Each ligament has a different function in stabilizing the knee joint of dogs. Ligaments are strong tissues that connect two bones. The cranial cruciate ligament is by far the most commonly damaged of all the knee structures. It is composed of two separate bands that function differently at various knee angles. Approximately 25 to 30% of dogs with cruciate ruptures will have tearing of only one band, which is referred to as a partial cruciate rupture. Most dogs however will have a complete tear involving the entire ligament.

解剖学

髌骨位于股骨和胫骨之间的后肢上。 犬的膝盖有四条韧带。 这些包括前十字交叉韧带以及内侧和外侧副韧带。 每条韧带在稳定犬的膝关节方面有不同的功能。 韧带是连接两个骨骼的结缔组织。 迄今为止，十字韧带损伤是所有髌骨结构中最常见的损伤。 它由两个独立的韧带组成，在不同的膝盖角度上的功能不同 ，大约25％至30％的具有十字形断裂的狗只会撕裂一条带，这被称为部分十字形断裂。 然而，大多数狗会有一个完整的撕裂涉及整个韧带。

The canine cranial cruciate ligament is thought to rupture because of continual stresses placed on the ligament during walking and running. This continual stress is primarily a result of the shape of the top of the tibia. The weight bearing portion of the top of the tibia is angled or sloped. During weight bearing movement, the pressure between the femur and tibia at this location causes the tibia to shift forward, producing repeated stress on the cranial cruciate ligament. This is believed to play a major role in rupture of the ligament in dogs.

由于在行走和跑步期间对韧带施加持续的压力，犬前十字韧带被认为是容易受伤的。 这种持续的压力主要是胫骨顶部形状的结果。 胫骨顶部的负重部分是倾斜的或前倾的。 在负重运动期间，股骨和胫骨之间的压力导致胫骨向前移动，从而对头十字韧带产生反复的应力。 这被认为在犬韧带断裂中起主要作用。

Two other important structures in the dog knee are the medial and lateral menisci. These are C- shaped pieces of cartilage located inside the joint between the femur and tibia that help to stabilize the knee. The medial meniscus is commonly damaged in association with rupture of the cranial cruciate ligament in dogs. Meniscal tearing is painful and if a torn meniscus is identified at surgery it will be at least partially removed.

犬髌骨中的另外两个重要结构是内侧和外侧半月板。 这些C形软骨位于股骨和胫骨之间的关节内部，有助于稳定膝关节。 内侧半月板通常与狗的十字韧带断裂相关而同时受损。 半月板撕裂是痛苦的，如果手术中发现撕裂的半月板，它将至少部分被切除。

What animals are most commonly affected?

Medium to large breed dogs (e.g. retriever breed size) between the ages of 6 and 10 years are most frequently affected. However, dogs as young as 1 to 2 years old and of any size including toy and giant breeds can rupture their cranial cruciate ligament. Cats also can occasionally develop limping because of a ruptured cranial cruciate ligament.

哪些动物最常受到影响？

6至10岁之间的中型至大型犬（例如猎犬犬种）最常受到影响。 然而，年龄在1至2岁之间且包括玩具和巨型品种在内的任何尺寸的狗都可能会出现。 猫偶尔也会发生损伤造成跛行。

What are the common signs of a cranial cruciate ligament rupture?

Dogs will typically develop a sudden onset of non-weight bearing or toe-touching lameness. This will usually improve to some degree with a few weeks of rest.  However, the lameness will typically recur with return to normal activity. Occasionally, an animal’s owner will identify an abnormal incident that caused the lameness such as falling off a deck or stepping in a hole. Most often however no incident is identified and animals become lame while performing every day activities such as running and playing.

前十字韧带断裂的常见症状是什么？

狗通常会突然发生不敢负重或损伤的后肢形成跛行。 休息几周后，这种症状会有所改善。 但是，患肢通常会随着恢复正常活动而复发。 偶尔，动物的主人会发现一个异常事件导致跛足，如从高处掉下来或踩到一个洞里。 然而，大多数情况下，没有明显的事件，动物在跑步和玩耍等日常活动时突然跛行。

How is a cranial cruciate ligament rupture diagnosed?

Nearly all dogs with tearing or damage to their cruciate ligament will have swelling or inflammation in the joint that is felt on the front part of their knee. Your veterinarian will most likely be able to feel this swelling. A definitive diagnosis of a complete cranial cruciate ligament rupture is based on palpable laxity or looseness of the affected knee. This laxity can be felt without sedation in some dogs but others will need to be sedated in order to identify the instability. This looseness is called cranial drawer instability. The diagnosis of a partial cruciate ligament rupture is more difficult. Dogs with partial ligament tears will usually have swelling of their knee and pain when their knee is completely extended. A definitive diagnosis however is inevitably made during exploratory surgery of the knee.

如何诊断前十字韧带断裂？

几乎所有撕裂或损坏十字韧带的狗都会在膝关节前部感觉到关节肿胀或发炎。 兽医很可能会感觉到肿胀。 一个完整的前十字韧带断裂的明确诊断是基于受影响的膝关节可触及的松弛或松动。 这种松弛可以在一些狗没有镇静的情况下感觉到，但其他人需要镇静以识别不稳定性。 这种松动被称为前抽屉不稳定。 部分十字韧带断裂的诊断更困难。 当膝盖完全伸展时，局部韧带撕裂的狗通常会有膝盖肿胀和疼痛。 然而，在膝盖探查手术期间不可避免地会做出明确的诊断。

Dogs with longstanding complete or partial cruciate tears will commonly develop thickening on the inside of their knee, which is known as a medial buttress. They will also have arthritis visible on radiographs taken by your veterinarian. Radiographs are taken to make sure no other problems exist in the knee such as infection or cancer and to show how much arthritis is present. Occasionally, fluid will need to be collected from the joint if any question exists about the possibility of a joint infection, cancer or other knee conditions.

长期完全或部分十字形韧带损伤的狗通常会在其膝盖内侧发生增厚，这被称为内侧支撑。 他们也会在拍摄的X光片上看到关节炎。 采取X光检查以确保膝盖中不存在其他问题，例如感染或癌症，并显示存在是否关节炎。 偶尔，如果存在关于关节感染，癌症或其他膝盖病症的可能性的问题，则需要从关节收集液体，进一步检查诊断。

Are there any other possible causes of my pet’s limping?

Yes, but other causes are very uncommon. Generally the diagnosis is extremely straightforward. Other possible causes of rear leg limping include joint cancer, joint infection, trauma and auto-immune diseases. Some indication of one of these diseases will almost always be seen on a complete physical examination or radiographs of the affected knee. If anything about your dog’s limping does not “add up”, other tests such as blood work or joint fluid analysis will be recommended. This is fortunately not necessary in most dogs.

有没有其他可能的原因导致宠物的跛行？

是的，但其他原因是非常罕见的。 一般来说，诊断非常简单。 后腿跛行的其他可能原因包括骨关节癌变，关节感染，外伤和自身免疫性疾病。 这些疾病可以通过相应的检查而确诊。 如果你的狗的跛行有其他表现，进行其他测试，如血液检查或关节液分析将被推荐。 幸运的是，大多数狗都没有必要这样做。

Will my dog rupture the cruciate ligament on his/her other leg?

Approximately 40-50 % of dogs with one cranial cruciate ligament rupture will rupture the ligament on the other rear leg within two years of the first rupture.

我的狗会使他/她的另一条腿上的十字韧带断裂吗？

大约有40-50％的一侧前髌骨十字韧带断裂的狗会在第一次破裂后的两年内，另一个后腿上的韧带也会造成损伤。

What are my treatment options?

Surgery is the treatment of choice for dogs with a cranial cruciate ligament rupture. Approximately 90% of dogs will return to near normal function within a few months of surgery. Several surgical options exist.

我有什么治疗选择？

手术是治疗十字韧带断裂的选择。 大约90％的狗在术后几个月内会恢复到接近正常的功能。 存在几种手术选择。

Some surgical procedures attempt to recreate the function of the cranial cruciate ligament with a prosthetic ligament, and are typically called a Lateral Suture. The prosthetic ligament runs in the same direction as the cranial cruciate ligament and therefore provides the same approximate function as the ligament. The biggest risk with this type of repair is that the prosthetic ligament can break or stretch causing recurrence of the instability and lameness.

一些外科手术试图通过假体韧带重建前十字韧带的功能，并且通常称为横向缝合。 假肢韧带的运行方向与十字形十字韧带相同，因此可提供与韧带相同的近似功能。 这种类型的修复最大的风险是假体韧带可能破裂或拉伸，导致不稳定和跛行复发

The most popular type of surgery involves changing the shape of the top of the tibia to change the biomechanics of the knee – so that the cranial cruciate ligament is no longer needed for stabilization. These surgeries are called tibial osteotomies, and are typically recommended for any dog weighing more than 15-20 pounds. The two most commonly performed tibial osteotomies are the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity advancement (TTA). The cranial cruciate ligament is not replaced with these procedures, so there is no concern for tearing the ligament again in the future.

最常见的手术类型包括改变胫骨顶部的形状以改变膝关节的生物力学 - 因此不再需要十字韧带进行稳定。 这些手术称为胫骨截骨术，通常建议任何体重超过15-20磅的狗。 两种最常用的胫骨截骨术是胫骨平台矫正截骨（TPLO）和胫骨粗隆前移（TTA）。 十字韧带不会被这些程序所取代，所以不用担心将来再次撕裂韧带。

Are there any potential complications associated with surgery?

With any surgical procedure there is the potential for complications. Potential complications associated with any cruciate surgical procedure include problems with general anesthesia, incisional infection 5% of surgical sites), implant breakage (much more common with Lateral Suture technique), and failure to improve function (less than 10% of animals). Research has shown that a better outcome occurs more predictably with the tibial osteotomy procedures (TPLO, TTA) than with the Lateral Suture stabilization. Finally, less than 10% of dogs will have a significant complication.

手术是否有任何潜在的并发症？

任何外科手术都存在并发症的可能性。 与任何十字形外科手术相关的潜在并发症包括全身麻醉，切口感染占手术部位的5％），植入物破损（更常见于横向缝合技术）以及未能改善功能（少于10％的动物）。 研究表明，使用胫骨截骨手术（TPLO，TTA）比使用横向缝线稳定更好地预测出更好的结果。 最后，只有不到10％的狗会有明显的并发症。

How will I take care of my dog following surgery?

Activity restriction: Your dog will need to have its activity controlled for 8 to 12 weeks following surgery. For the entire 8 to 12 weeks of recovery, your dog should avoid slippery surfaces (e.g. slick concrete, hardwood floors, tile, etc.) and long flights of stairs. He or she should be confined to a single room without access to jump on furniture when not on a leash. Your pet should not be allowed to play with other animals or people and should be on a short (i.e. less than 6 foot) leash and under your complete control at all times when outside for bathroom purposes.

手术后如何照顾？

活动限制：狗在手术后需要控制其活动时间为8至12周。 对于整个8至12周的恢复期，狗应该避免表面光滑（例如光滑的混凝土，硬木地板，瓷砖等）和长途楼梯。 如果没有皮带，他或她应该被限制在一间单独的房间里，不能在家具上跳起来。 您的宠物不应该被允许与其他动物或人玩耍，并且应该在外部活动时，缩短牵引带的长度，始终在主人的控制范围之内

Two situations pose a potential problem following surgery. One is continuous walking on the operated limb. This repeated stress increases the chances of a complication associated with healing of the incision and the deeper tissues (i.e. joint and bone) and predisposes the implants (i.e. bone plate and screws) to fail. The other is a sudden burst of energy causing extreme stress on the surgical site. This is the worst of all possible scenarios. It is therefore essential that your dog is on a leash under your complete control at all times while outside during the 8 to 12 weeks following surgery. If your dog has had a tibial osteotomy procedure (TPLO, TTA) he or she will only be able to return to normal activity after radiographs have confirmed bone healing. Healing is almost always complete by the end of 12 weeks.

两种情况在手术后造成潜在的问题。 一个是在手术肢体上连续行走。 这种重复的压力增加了与切口和较深组织（即关节和骨）愈合相关的并发症的机会，并使植入物（即骨板和螺钉）易于失效。 另一种是突然爆发的能量，对手术部位造成极大的压力。 这是所有可能情况中最糟糕的情况。 因此，在外科手术后的8至12周内，您的狗在任何时候都必须完全控制，因此这是至关重要的。 如果您的狗进行了胫骨截骨手术（TPLO，TTA），他或她只有在X光片证实骨骼愈合后才能恢复正常活动。 愈合几乎总是在12周结束时完成。

Care of the incision: During the first 2 weeks after surgery, special attention needs to be paid to the surgical incision. You should watch for any type of cloudy or foul smelling drainage, opening of the incision, or excessive swelling. Swelling associated with the incision should progressively decrease over 2 weeks. To minimize swelling, the incision can be cold packed for 24 hours following returning home. The incision should then be hot packed 3 to 4 times daily for 5 more days. A protective Elizabethan (i.e. lampshade) collar will need to be worn by your dog at all times to prevent licking and checking of the incision until the time of suture removal.

切口的护理：在手术后的最初2周内，需要特别注意手术切口。 与切口相关的肿胀应该在2周内逐渐减少。 为了尽量减少肿胀，回家后切口可以冷敷24小时。 然后应该每天热敷3到4次，连续5天。 狗的任何时候都需要佩戴保护性伊丽莎白罩，以防止舔和检查切口，直到拆除缝线。

Recheck examinations: Recheck examinations are generally scheduled for 2 weeks following surgery for suture removal and 8-10 weeks for final examination. If your dog has had a tibial osteotomy (TPLO, TTA), he or she will have radiographs taken at the final recheck visit.

复查：一般安排在拆除缝线的手术后2周以及8-10周。 如果您的狗有胫骨截骨术（TPLO，TTA），他或她将在最后的复查访问时拍摄X光片

Medications: We will provide you with instructions about medications to be taken following surgery. Generally some type of pain medication will be administered for 10-14 days following surgery.

药物：我们会为您提供手术后服用药物的说明。 通常一些类型的止痛药将在手术后10-14天施用

Should I do physical therapy on my dog following surgery?

We recommend physical therapy in the post-operative period starting 4 to 5 days after surgery. The most simple form of physical therapy involves moving the operated knee through a full range of motion repeatedly for 10 to 15 minute sessions 3 to 4 times each day. This should continue for approximately 4 to 6 weeks following surgery. If you have any other questions about physical therapy please consult with one of our surgeons or request a consult with Canine Rehabilitation of Nashville

. 我应该在手术后对我的狗做物理治疗吗？

我们建议手术后4至5天开始手术后的物理治疗。 最简单的物理疗法包括将所操作的膝盖反复进行全方位的运动，每次10至15分钟，每天3至4次。 这应该在手术后持续大约4至6周。 如果您对物理治疗有任何其他疑问，请咨询我们的外科医生或向康涅狄格州纳什维尔的康复咨询部门咨询

Summary

·         Cranial cruciate ligament rupture (CCLR) in dogs is similar to anterior cruciate ligament (ACL) rupture in people.

·         Approximately 30% of dogs with cruciate ruptures will have partial tears of the cranial cruciate ligaments.

·         Approximately 50% of the dogs with cruciate ruptures will tear the cranial cruciate ligament on their other leg within 2 years of the first tear.

·         Dogs with CCLR most often go to the veterinarian because of a sudden onset of non-weight bearing or toe-touching lameness on a rear limb.

·         Most of the time an owner will not see a reason for the sudden lameness.

·         A definitive diagnosis is made when your veterinarian feels abnormal looseness in the affected knee.

·         Surgery is recommended for all dogs with cranial cruciate ligament ruptures (CCLR)

·         The two most common surgeries are tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA). These procedures are tibial osteotomies that involve changing the shape of the tibia rather than replacing the ligament.

·         Greater than 90% of dogs improve with surgery.

·         Potential surgical complications include:

·         problems with anesthesia

·         infection of the incision

·         implant breakage

·         failure to improve

·         Activity restriction is required for 8-12 weeks following surgery.

·          

概要

•狗的前十字韧带断裂（CCLR）与人前十字韧带（ACL）断裂相似。

•大约30％有十字韧带断裂的狗会有十字韧带部分撕裂。

•大约50％有十字韧带断裂的狗在第一次撕裂后2年内会撕裂另一条腿上的十字韧带。

•CCLR犬最常去兽医，因为后肢突然发生无负重或脚趾跛行。

•大多数时候，主人不会看到突然跛脚的原因。

•兽医在受损膝盖中感觉到异常松弛时，会做出明确诊断。

•建议对所有患有十字韧带断裂（CCLR）的犬进行手术

•最常见的两种手术是胫骨平台矫形截骨术（TPLO）和胫骨粗隆前移（TTA）。这些程序是胫骨截骨术，涉及改变胫骨的形状而不是替换韧带。

•超过90％的犬只通过手术获得改善。

•潜在的手术并发症包括：

•麻醉问题

•切口感染

•种植体破损

•未能改善

•手术后8-12周需要限制活动。