Knee injuries are very common in bully breed dogs such as Pit Bulls, American Bulldogs, Boxers and Mastiffs because of the confirmation of their legs.Also known as Cranial Cruciate Ligament (CCL) rupture, it most frequently happens in the rear legs of dogs and will initially present at lameness of the leg after exercise or immediately after injury. The lameness can be intermittent, but will return after long periods of walking/running or other activities. In addition to lameness, here are a few other symptoms to look out for if you suspect your dog has a stifle injury.

Canine Cruicate (Knee) Injury Symptoms:

1. Decreased range of motion.
2. Hind leg extended when sitting – this is known as the sit sign.
3. Crepitus – crackling noise of bones rubbing against each other.
4. Pain – when stifle (knee) joint is touched.
5. Unwilling or resistant to exercise.
6. Restricted mobility or extension.
7. Stiffness after exercise.
8. Swelling of joint.
9. Thick, firm feel to knee are, may be hot to touch.
10. Weight shifted to one side of body when standing.
11. Exhibits toe-touching while standing.

When faced with this type of injury an owner has a couple of different options depending on the severity and onset of the symptoms. During your first visit to the vet they will want to take x-rays of the legs to rule out hip dysplasia or other issues. The x-ray will also give the doctor a good idea of whether or not there is ligament damage, but because soft tissues do not show up on xray it is not a certain diagnosis, and the dog’s symptoms need to also be taken into account if relying on x-ray imaging alone.

The veterinarian will also perform a test on your dog called the clinical drawer sign. During the drawer sign test the doctor will physically manipulate the canine’s knee by holding the femur in place while attempting to move the tibia forward. Your dog may need to be put to sleep using anesthesia to properly do this test depending on the amount of pain your pet is in, and their willingness to have the test performed. Any forward movement of the tibia is known as a positive drawer sign and indicates that the dog has partial tears or a complete rupture of the cruciate ligament – the only way to tell for sure is with ultrasound or surgery.

There are a few other conditions with similar symptoms to cruciate ligament tears including:

1. Acute arthritis – related to lyme disease or immune disorders
2. Stifle (knee) joint sprain
3. Meniscus (cartilage within the knee) injury
   
4. Hip dysplasia
5. Patellar (knee cap) fracture or luxation
6. Myelopathies – diseases of the nervous system

If it can be confirmed that your dog has a cranial cruciate ligament rupture or tear you have a number of options both surgical and non-surgical. The most popular non-invasive and non-surgical method for ligament injury is known as conservative management. Treatment using conservative management, also known as CM, involves the use of anti-inflammatory medications, weight loss (less stress on the joint) and a one to two month period of rest.

There are a number of surgical options for healthy dogs and each owners should consult with their health care provider to find out which one is the best fit for their dog.

Surgical repair techniques for cranial cruciate ligament repairs:

1. Traditional Repair or Extracapsular Imbrication Technique – A leader line is woven in a figure-eight pattern through the joint beginning at the outer aspect of the femur to the tibial crest. The heavy suture will eventually be replaced by scar tissue providing support for the joint.
2. Tibial Plateau Leveling Osteotomy or TPLO – The head of the tibia is surgically altered and plated to create a new joint angle and prevent the femur from sliding off of the tibia. This procedure is an invasive on and involves cutting and plating of bone; it is associated with a higher rate of complications than the other surgical options.
3. Tibial Tuberosity Advancement or TTA – This is very similar to TPLO, yet considered to be less invasive, and involves stabilization of the stifle joint by cutting the bone and changing the angles of the knee.
4. Fibular Head Transposition – The head of the fibula is rotated and the lateral collateral ligament is moved in such a way that it mimics the cruciate ligament. The new positioning of the fibula is held in place using pins and wires. This procedure is not done very often and you may have a hard time finding a veterinarian that will actually perform it.

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