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Ah, the dreaded cruciate ligament rupture… It’s often a dog owner’s most expensive nightmare. Commonly referred to as an ACL injury in human sports medicine, we vet types are more likely to call this knee condition an RCCL (rupture of the cranial cruciate ligament) when we’re speaking in sciencese, or a “cruciate” for short.
This post is the second in a series discussing what vet medicine costs...and why.
What’s a cruciate?
A cruciate injury is a common problem in dogs of all ages and across all breeds, though middle aged, large breed dogs are the typical patients presenting for this problem. In some odd cases, our feline friends may be affected as well.
It can happen suddenly, when a dog makes a sudden turn, gives out a yelp, and ends up three-legging it home from the park. But it usually happens slowly after gradual tearing and deterioration of this thin strip of tissue connecting one bit of knee bone to another, as seen in this illustration:
Because this ligament is mechanically crucial to maintaining knee stability, its sudden rupture leads to the inability to bear weight on a now-wobbly joint. Pain is also a factor in all these cases, though it’s more evident in acute injury than with more gradual insult to the ligament. While the pain is not as severe or persistent as for a broken bone, for example (though some sufferers may beg to differ), pain relief and strict (cage) rest is the mainstay of its initial treatment.
A gradual or “chronic” series of tearings of this ligament is a more insidious manifestation of the disease. Many owners don’t even realize it’s happening, as the dog may never even limp. In these cases, the knee gets gradually more creaky as the joint, craving stability, finds arthritis a physiologic alternative to its unsteadiness.
A common secondary injury that often accompanies a torn cruciate is a tear of the meniscal cartilage. This secondary injury causes severe lameness, and is often the first time an owner notices severe limping, even in a dog who has had a chronic, progressively tearing cruciate.
Complex problems mean big money
Happily for our US dogs, owners are increasingly unwilling to let their dogs go through life with a bum knee—not without some kind of treatment. As a result, the vet industry is smiling, too. According to one JAVMA study published in 2005, $1.3 Billion was spent on this surgical repair and its affiliated costs in 2003. That’s Billion with a capital B!
Though I take issue with some of this study’s methodology, it’s clear that blown knees lead many owners to blow out their bank accounts, too. It’s an expensive problem.
As with many veterinary concerns I discuss, a variety of levels of care are available after such an injury. The procedures, medications and so-called “conservative” (non-surgical) management of the condition vary, as do the education, experience and proficiency levels of the surgeons performing procedures in these cases.
Like what you've read? Stay tuned. Tomorrow I’ll give you the skinny on the vast range in repair options and their equally schizophrenic expenses.
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The prognosis is almost always excellent though, so despite the pain and cost... I don't think the risk of this type of injury is greater than the reward to dogs and human alike for being active and competitive in dog sport. It's a question that's worth asking though, since it does appear to be a super common issue.
One of the vets in one of the groups went so far as to say that post op patients can actually be BETTER then healthy dogs given the unfortunate natural structure of that joint. I wish I knew the specifics on why the reshaping surgery is so successful, but perhaps the good Doctor knows what I'm talking about and can elaborate tomorrow.
Barbara/NH
The vet was encouraging us to act quickly but I needed a second opinion. So we put him on metacam and then saw another vet. After a few days on Metacam he was basically back to normal. The second surgeon didn’t agree with the 1st vet’s diagnosis. He couldn’t feel the movement and he didn’t think metacam would have such dramatic results on a cruciate tear. Our Boxer has now been on Metacam more than a month. I am getting ready to wean him off and see how it goes. I still struggle with the fact that we really didn’t do anything for him. But on the other hand maybe we avoided an unnecessary surgery.
I wonder how common it is to have problems making a clear diagnosis?
Did the total confinement thing for two weeks, carried him in and out of the house (stairs at both doors), gradually moved up to walking, etc. It took a couple of months but he was right back to normal after that, running and everything.
This was about 6 or 7 years ago now, I imagine there are new procedures today.