By: Dr. Paul Duncan
The case this month is about an adorable six-year-old Corgi named Mary Lily. She was brought in for one of the most common orthopedic problems seen in dogs, a tear of the cranial cruciate ligament (similar to ACL in humans). This typically happens as a result of increased forces applied to the knee during activity/play. Once the ligament is torn, marked limping of the affected leg occurs. Pain results from acute inflammation as well as abnormal motion in the joint during weight bearing movement. In addition to cranial cruciate ligament tear, meniscal damage may also occur, commonly referred to as a torn cartilage.
Cranial cruciate ligament tear is one of many causes of rear leg lameness. An examination and X-rays identify the cause. Upon examination, typically there is a swelling on the inside of the knee and there also may be an abnormal movement of the knee called cranial drawer, which is diagnostic for cranial cruciate damage. On x-rays there may be forward displacement of the patellar fat pad. The use of the digital X-rays we take at Animal Hospital of North Asheville allows better visualization of the fat pad as well as surrounding bone and soft tissue. The combination of these clinical findings aids in the diagnosis of a cruciate tear.
On July 29th Mary Lily was brought to Animal Hospital of North Asheville for an examination because she was limping on her right rear leg. Mary Lily had been examined previously in Florida for mild limping, probably a partial tear, but now the limping was more pronounced and did not seem to get better with anti-inflammatories.
Mary Lily was new to our hospital as her family lives part time in Florida and had not needed veterinary care for her in Asheville. Dr. Duncan diagnosed a tear of her anterior cruciate ligament. After discussing surgery and the typical 12 weeks of therapy and recovery after surgery, Mary Lily’s “mom and dad” decided that they would wait until returning to Florida before having surgery.
A few days later we received a call that they wanted to schedule surgery for Mary Lily because she appeared to be in more pain and they did not want her to suffer for the next 1-2 months that they would be in Asheville. Dr. Duncan performed surgery on Mary Lily on August 3rd and used a state-of-the-art bone anchoring system which allows for much better stabilization. The system uses FiberWire to increase the strength of the repair. The nursing staff utilized multi-parameter pain control because this is true orthopedic surgery. Pre-operative narcotics for relaxation and “to be ahead of the pain” were used to allow a lower level of anesthesia without sacrificing comfort. Local nerve blocks, epidurals and continuous rate infusion IV pain medication were used to assure that Mary lily was comfortable. Like all hospitalized patients, she was charted and pain scores were calculated so that pain medications could be adjusted as needed. All night staffing assured that Mary Lily had 24 hour monitoring. Mary Lily was hospitalized overnight so that our overnight technician could administer and adjust injectable pain medications throughout the night.
Mary Lily did beautifully after surgery. The first video shows her mobility one day after surgery. You can see that she is already placing the right rear leg on the ground and weight bearing on it. The second video shows her mobility at 2 weeks post-surgery. The x-rays show the bone anchor system that corrects the instability of the knee. Mary Lily’s “dad” called just recently and reported that they are back in Florida and she is doing great and almost finished with her 12 weeks of therapy. We are all so happy that we were able to help relieve Mary Lily’s pain and get her back to enjoying her active life in Florida and North Carolina.