DECREASING POST SURGICAL ARTHRITIS AND REDUCING FURTHER CCL DAMAGE

It is estimated that of dogs that experience a CCL tear, 30-50% of them will go on to tear their other CCL. Numerous measures can be taken to decrease this tendency.

1. Don’t Delay: if lameness is noted, or you suspect that your pet is painful seek professional attention as soon as possible. The longer a CCL tear goes untreated, the more arthritis will develop and more strain will be putting on the other hind leg, predisposing it further to a CCL tear.


2. Ensure an appropriate diagnosis has been made. Since CCL tears can be difficult to diagnose at times, it is not uncommon for a torn CCL to be mistaken for hip dysplasia/arthritis. If this occurs, the torn CCL will go untreated. To minimize the likelihood of a misdiagnosis, ensure that your veterinarian performs a thorough exam on your pets’ stifles (knees) during the examination and that radiographs are taken of the knees as well as hips. See CCL Diagnosis Tips to minimize the likelihood of a misdiagnosis.


3. If possible, ensure that the best surgical technique is performed. If a pet is small and less active, an extra capsular repair will typically provide excellent results, however, as a dogs’ activity level and size increase the success rate achieved with an extra capsular repair decreases. This increases risk of severe arthritis developing and also increases the need for future pain killers as well as the likelihood of the other CCL tearing due to the added strain put on it. It is generally accepted that larger more active dogs fair far better with the TTA and TPLO procedures. The TTA and TPLO certainly cost more in the short term, however, typically patients do far better and in the long run it may be far les expensive due to their excellent success rate, which decreases the likelihood of future problems. If surgery has been performed and the patient continues with lameness it is imperative that a re-evaluation, by the surgeon, be performed. The most common reasons for a poor response to surgery are due to inappropriate surgical technique, breakdown of the surgical repair, a meniscal tear (very common), or arthritis (very uncommon). Unless arthritis is very dramatic, we have found that it typically does not play a very significant role in lameness after surgery. If is far more common to find a meniscal tear that was missed at the time of surgery or that occurred post-operatively. Some meniscal tears can be very difficult to identify and it is not uncommon for a surgeon to see this complication occur in around 5% of their CCL repair cases. Until the damaged meniscus is removed, and it should definitely be removed, lameness will continue, with a progression of pain and arthritis.


4. Ideal Body Weight: while most people can appreciate that being overweight places excess strain on joints, many are unaware that recent studies have indicated that excessive body fat also releases hormones that result in inflammation throughout the body. This inflammation will result in progression of arthritis and a significantly greater risk of tearing a second CCL. Excessive weight and obesity can dramatically decrease a pets’ quality of life due to pain and therefore, significantly decrease life expectancy. Over feeding your pet is truly “killing them with kindness”. These pets should be maintained on the lean side of normal.


5. Avoid extremely high impact activities such as Frisbees and ball throwing.


6. Pain medications, typically anti-inflammatories, are extremely useful in the treatment of arthritis. If a pet is uncomfortable the painful limb will suffer loss of muscle, strength and flexibility from disuse. A resulting vicious cycle of further discomfort and disuse will occur. Discomfort in one limb often results in compensatory mechanisms in the back and other limbs thereby resulting in additional injuries. Regular low impact activity (walking, swimming) on a daily basis is very beneficial.


7. Chondroprotectants: (Injectable) regulated and tested by the FDA, Health Canada, such as Cartrophen, Adequan) have been clinically proven to: increase joint fluid production (lubrication in the joint); stimulate production of new cartilage; decrease joint inflammation; decrease pain.

These treatments are considered to be extremely effective, easy to administer (given under the skin, typically between the shoulder blades on a weekly basis for up to four weeks and then topped up with one injection every 2 to 3 months), and very safe. No recognized negative side effects beyond allergic reactions which are considered extremely rare.


8. Supplements / Nutraceuticals: Omega 3 fatty acids have been shown to be HIGHLY EFFECTIVE at decreasing joint inflammation (joint inflammation results in pain, progression of arthritis and damage to joint structures, including the CCLs). It is imperative that Omega 3s be derived from fish sources (not flaxseed) and be administered between 20 and 40 mg/pound daily. Glucosamine/Chondroitin: While anecdotal reports indicate that these products may be beneficial, human as well as animal studies have not supported these claims. These products are NOT regulated by the FDA or Health Canada and many manufacturers’ labels claims have been proven to be fraudulent. If interested in these utilizing these supplements please only purchase from a reputable company.


9. Therapeutic exercises to maintain and strengthen muscles, tendons, and ligaments, and increase or maintain joint flexibility are beneficial. Warming up before and cooling down after intensive exercising is also important.


10. Laser Therapy: laser therapy treatment is a drug free option used to decrease inflammation and pain. It has been proven effective in treating pets with arthritis and chronic pain. It is non-invasive, pain free and leaves your pet feeling more comfortable. Laser therapy can decrease lameness, thereby helping decrease the progression of muscle loss and arthritis.

As always, the team at Upper Canada Animal Hospital are available to answer any questions or concerns you may have. Talk to us, or call your regular veterinarian. We are always here to help.