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Duplicate posting from VetRehab yahoo list.

Would love some input on this case. The patient is a 2 year old, small framed, 50 lb, super fit intact male Golden retriever. Came up lame on rear leg after retrieving balls down hill in owners yard. Was sound the next day. The owner was spectating at an agility trial where I was vending, so asked if I would look at her dog. He was perhaps a little short strided on the left rear, but completely weight bearing. He was painful on stifle extension. I could get a cranial drawer, although not the usual dramatic sign. I just figured he was not relaxing due to the environment, and discussed CCL rupture. The next day she saw her primary vet who confirmed CCL rupture and recommended extracapsular repair. The owner is not too keen on surgery, so asked me to look at her dog again a few days later. Findings were the same as original exam. Just seems so odd to me that the dog is mostly sound, with only an occasional lame step.

The dog was then seen by a surgeon at a local referral hospital, who diagnosed caudal CL rupture. I had not ever seen this before, so had to do some reading. From the little info I can find, most occur from trauma, and are significantly lame. This dog had no trauma, and is barely lame.

I would most appreciate any experiences with Caudal tears. Thoughts on surgery vs rehab? What sort of exercise program for rehab? With how well this dog is walking, it seems to me that rehab without surgery should be a viable option.

Hey Jan!

So I have only seen a handful of these. One that comes to mind was a partial the progressed to full, and as a Newfoundland, the surgeon did not opt to do anything about it. She was not lame, but the owner noted a shortened stride as well.

I would speculate that there was likely a trauma that caused a partial tear at some point, which progressed to a full - as a guess.

What to do?
Hmm...
As a physio, I am trained to think, what are your goals in treatment (or surgery)? I would say to improve function and decrease pain.
This dog has good and some might say 'great' function as an agility dog... will surgery improve that? Improve already great function? Hmmm
Pain, yep, you can work on that. Pain and joint inflammation - rehab tackles that well.
Can a conservative program work to strengthen and reduce joint inflammation as the joint fibroses and tightens a bit? - SURE.
Can surgery in this case guarantee better function or no joint inflammation? No.

Back to my Newfoundland case. The surgeon she saw told the owner that there isn't really a great surgery for caudal cruciates - so if she was doing well, to just let her be. Unless something new and relatively non-invasive has come about, I'd say the same!

You and your rehab can likely 'tweek' the dog enough to improve things... and that's where I'd start!

Cheers,
Laurie

It is not uncommon for CdCLs to not be profoundly lame, so that is consistent with the diagnosis

David Lane
DVM, ACVSMR

I am begining to think that Caudal Cruciate Ruptures are not nearly as rare as reported. I have been practicing part time as a CCRT for 5 months and have had 3 caudal ligament ruptures sent my way- all confirmed with arthroscopy or arthrotomy. Two of these dogs are sporting performance dogs (upland bird dog and one flyball border collie.

I am looking for insight into rehabilitative management of these cases. Are there certain exercises you avoid? Are there others that are more beneficial? And what is the prognosis for return to sport for these dogs (particularly agility or flyball).

Any insight is appreciated.

- Kendra Carlson, DVM CCRT

Veterinary Surgery 39 (2010) 936–941
Caudal Cruciate Ligament Damage in Dogs with Cranial
Cruciate Ligament Rupture
Julia P. Sumner
Objective: To investigate the incidence of caudal cruciate ligament (CaCL)
damage in dogs with cranial cruciate ligament rupture (CCLR).
Study Design: Prospective clinical study.
Animals: Dogs (n=24) admitted for surgical stabilization of the stifle after CCLR
and 8 healthy dogs with intact cranial cruciate ligament (CCL) and CaCL studied as
controls.
Methods: Preoperative radiographs and stifle joint images (arthrotomy, 6;
arthroscopy, 18) were collected from dogs with CCLR. Severity of arthritis, synovitis,
CCL damage, and CaCL damage were assessed using numerical rating
scales. The CaCL was probed to determine whether minor fraying or a full thickness
defect in the ligament was present. Data collected from the study population
were compared with the control population of dogs.
Results: The CaCL was damaged in 21/24 (88%) of dogs with CCLR; 6/24 (25%)
had a full thickness defect in the CaCL. Severity of stifle synovitis and severity of
damage to the CaCL were positively correlated (Po.05).
Conclusions: The CaCL is damaged in a high percentage of dogs with CCLR. A
significant and positive correlation exists between the degree of synovitis present
and the extent of CaCL damage.
Clinical Relevance: In dogs with CCLR, cruciate ligament pathology typically
involves both the CCL and CaCL. As the severity of synovitis and the extent
of CaCL damage are related, this observation supports the hypothesis that
stifle synovitis may contribute to CCL and CaCL degeneration and subsequent
damage.

In dogs, the hamstrings act as CrCL stabilizers, whereas the gastrocs and quads increase stress on the CrCL. To my mind then, for a CdCL issue, I would work on increasing quad and gastroc strength to increase stability of the CdCL. I have no research to back that though.

I posted the abstract from a paper that looked at the incidence of concurrent CdCL and CrCL injury, although that is different from primary CdCL tears. Everything comes in 3's, so you won't see another case for long time (says the guy who isn't superstitious).

David Lane
DVM, ACVSMR

What is interesting is that we want to simplify things into - work hams or quads... and we choose biomechanical rationale for what we choose. (And I have been guilty of thinking this way, and even teaching it in the past.) Which is a good first step. But we also know that there is substantial quads strength lost after a cranial / anterior cruciate tear... which needs to be addressed for best possible functioning, even though, quads are are an antagonist to the CrCL.

So, I would tend to say - strengthen the whole of the leg. Don't forget glutes as well.

The same exercise principles would apply to patellar luxations, and even tarsal dysfunctions.

So, my thoughts are a well rounded strengthening regime.

Cheers,

Laurie

And return to sport / agility in particular... tough to say... I don't actually have any first hand experience to give insight! I do think that agility would be the toughest one to return to however!

Thank you both for your insight and experience. It is very helpful.