Dr. Walt's happy tails: November 2003

The Doctor is In @ drwalt@petcareinsurance.com

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Dear Dr. Walt: Our 3-year-old, female Italian mastiff inured her leg as a puppy when she fell on the ice. Rest and the use of Metacam (an anti-inflammatory medication) have helped her tremendously but this same leg seems prone to re-injury. We recently took her back to the vet, wanting to know exactly where the problem was as she was limping more often. By watching her walk, the vet told us that it wasn't her hip (which we previously thought) but rather her cruciate ligament. We were told a bit about the options: Metacam or surgery. She is now at the point where she can walk on her leg with a limp but if she wants to walk quicker, she goes on three legs. What we would like to know is if you can give us some infomation about the surgery (different options) and what the costs would be?

From what you describe, it sounds like your pet has injured or ruptured her anterior cruciate ligament (ACL). This ligament, in conjunction with the posterior cruciate ligament, provides internal stability to the knee joint and together with external support from the joint capsule and the collateral ligaments, ensures proper knee function. Damage to and rupture of the ACL is a relatively common orthopedic problem in the dog, although rare in the cat. The cause may be traumatic or secondary to an underlying joint problem, obesity, or other metabolic diseases (i.e., endocrine diseases, immune diseases, etc.). If an obvious trauma was not the cause, having your veterinarian perform a variety of diagnostic tests to investigate the root cause and its treatment is often helpful in providing for better healing following repair and to avoid a similar fate to the same ligament in the other knee. Although rest, Metacam, and time may allow for the other supporting structures of the knee (principally the joint capsule) to develop scar tissue and provide compensatory support, this is not a given. For most dogs suffering from this problem (especially large-breed dogs), surgery is the only realistic option available to try and return joint function to normal and avoid early onset arthritis in the affected joint. This approach would also allow your pet to get back to a more active lifestyle quicker.

Perhaps a good start would be to have your pet re-evaluated by your veterinarian. This would include both a physical manipulation of the knee joint involved, as well as radiographs (x-rays). If you haven't done so as of yet, investigating for a potential underlying cause is important (as outlined above). The good news is that since this is a relatively common orthopedic problem in the dog, many well-defined, tried and true surgical procedures exist to treat it - from ligament reconstruction to joint modification (tibial plateau leveling osteotomy). If it would make you more comfortable, ask your veterinarian for a referral to a veterinary surgical specialist. These are veterinarians who have had extensive post-graduate training and are exceptionally skilled at providing orthopedic diagnoses, prognosis, and suggested treatment options. Providing you with a specific cost is difficult as these will vary depending on where you reside, the type of procedure you have done, and the level of expertise you choose to perform the procedure. It is best to discuss both your options and the attendant costs with your veterinarian.