Clean Run - October 2010 - 72

off the affected limb when standing, and stiffness upon rising. In dogs with concurrent meniscal injury, an audible click may be noted when walking or flexing the stifle. Partial CCL tears typically present with a complaint of a mild weight-bearing lameness following heavy exercise, or “stiffness” following prolonged periods of rest. Owners often report that their dog tends to “warm out of it” as the day progresses. The lameness usually resolves with restricted activity but returns following another event of heavy exercise. As the CCL continues to tear and the stifle becomes increasingly unstable, the lameness becomes more severe and persistent. Dogs with both limbs affected may shift weight back and forth between the hind limbs when standing, shift weight forward to the forelimbs, have difficulty or be slow to sit and rise, and may be exercise intolerant. In some cases, the dog may be unable or unwilling to bear weight in either hind limb. This presentation can delay accurate diagnosis, as it may be confused with a neurological condition or solely attributed to concurrent hip dysplasia.

Diagnosis
Diagnosis of CCL rupture is straightforward when the patient presents with the classical history, lameness, radiographic appearance, and physical examination findings. See Figure 3. However, some dogs with chronic cranial cruciate disease or partial CCL tears do not have significant palpable stifle instability. This is often the case in performance dogs. In these cases, additional diagnostic tests, such as arthrocentesis, magnetic imaging (MRI), and/ or arthroscopy may be recommended. Arthrocentesis involves using a sterile needle and syringe to collect joint fluid. Analysis of the cellular makeup of the joint fluid can help distinguish between a CCL tear, an underlying infection, tick-borne disease, or an immunemediated joint disease. MRI allows for detailed imaging of soft-tissue structures within the stifle and can detect even subtle pathology of the cruciates and menisci. Arthroscopy is a minimally invasive technique that allows for a live magnified high-resolution assessment of the structures within the stifle joint. Should an injury be confirmed, stabilization may be performed at that time, under one anesthetic event. See Figure 4. In the second part of this article we will present current concepts and techniques for the treatment of canine cruciate disease. D

Figure 3: Lateral X-ray of a stifle with a complete cranial cruciate ligament. While the ligament cannot be seen on X-rays, classic secondary changes include water on the knee (blue arrow) and osteoarthritis (yellow arrows). Courtesy of Dr. Peter J. Lotsikas

Figure 4: Arthroscopic picture of a complete cranial cruciate ligament tear. Courtesy of Dr. Jimi Cook.

Dr. Peter Lotsikas is a Diplomate of the American College of Veterinary Surgeons. He graduated with a BS degree in Biology from Virginia Tech and a DVM degree from the Virginia-Maryland Regional College of Veterinary Medicine. He then completed a general small animal internship at Kansas State University, followed by a surgical internship at Dallas Veterinary Surgical Center. Dr. Lotsikas received his formal surgical residency training at Iowa State University. He now practices at the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction, Maryland. Additional information about Dr. Lotsikas is available at www.VOSM.com Dr.Faith Lotsikas earned her veterinary degree from the Virginia Maryland Regional College of Veterinary Medicine.She has always had a strong interest in whole pet wellness.For that reason,she became a certified canine rehabilitation therapist through the Canine Rehabilitation Institute.She now practices with her husband at the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction,Maryland.She is also an amateur veterinary medical illustrator.Additional information about Dr.Lotsikas is available at www.VOSM.com Lisa Fair has been a veterinary orthopedic technician for 13 years. She is certified in canine massage therapy and has completed all coursework for certification as a canine rehabilitation therapist. She served as Manager of Surgical Services for VOSM until recently. She is now the Director of Marketing and Customer Service for DogLeggs (www. dogleggs.com), manufacturers of external orthopedic coaptation devices and coverage solutions for small animals.

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Clean Run - October 2010

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