Cranial Cruciate Ligament Tears and Ruptures
Zahira came to see us for pain management for an anterior cruciate ligament tear in her left rear knee. She tore her ligament about a month before her initial exam. She was on a non-steroidal anti-inflammatory medication for pain. It was not giving her the relief she needed. She continued to refuse to place weight on her leg. Her owner was hoping that the effects of acupuncture would help with controlling her pain, and ultimately avoid surgery on the knee.
What is the cranial cruciate ligament?
The knee is a complicated joint. It involves two major bones, the femur and the tibia, the patella (knee cap), cartilage called menisci that act as cushions between the bones, and a multitude of ligaments that stabilize all the bones and muscles of the joint. The two major ligaments within the inside of the knee are called cruciate ligaments because they cross over each other, forming an “x.” The cranial cruciate stabilizes the movement of the tibia. It prevents the tibia from moving too far forward when the knee bends.
What happens after the cranial cruciate tears or ruptures?
The damage to the cruciate involves partial tears or strains to complete rupture of the cruciate ligament. When the patient flexes the knee, and places weight on the leg, mild to severe pain occurs, depending on the degree of damage within the knee. The patient compensates by shifting more weight to the other limb. The result is more strain on the opposite leg and muscle atrophy in the initially damaged leg. The cartilage and menisci degenerate, and osteoarthritis develops within the joint, resulting in increasing levels of pain, further shifting weight to the other limb, more muscle atrophy, and compensatory strain in the back and lumbar muscles.
In most patients, damage to these ligaments is due to a combination of dog’s activities, their body conformation (breed), and their weight. Although all breeds are susceptible, the Labrador retriever, Golden Retriever, Rottweiler, Akita, St. Bernards, and American Staffordshire Terriers are high on the list. In the small breeds, the excessive strain placed on the ligaments from medial patellar luxation cause tears and ruptures to the cranial cruciate ligament.
What are the treatment options?
The ideal treatment involves pain management and surgical repair. However, for the majority of clients, the cost of the procedure prevents them from going forward. For these patients, pain management is crucial to maintain movement, prevent muscle atrophy, and compensatory strain on the back and opposite limb. Pain control can include steroids, non-steroidal anti-inflammatory medications, opiates, acupuncture, rehabilitation exercises, laser therapy, and various dietary supplements to maintain the health of the ligaments and cartilage within the joints.
None of these “repair” the torn ligament, they only help the patient heal and manage the chronic pain that occurs from the continued instability of the knee joint. The cartilage and bony changes, osteoarthritis, will continue, but the patient will remain comfortable and maintain a good quality of life.
Kidney Qi Bony Bi Syndrome
How did Zahira respond to the acupuncture treatments?
Zahira began the standard initial protocol of six weekly treatments. We initiated treatment on BOTH rear legs. Body conformation plays a huge role in the disease process. It is rare that only one knee is affected. At the second treatment, the owner reported Zahira was placing more weight on her leg. At the end of the sixth treatment, we increased the duration between treatments to every ten days, then every fourteen days, then to every three weeks and finally a treatment session every four weeks to five weeks. Zahira’s sessions began September of 2014 and continued to December of 2015. Zahira maintained muscle mass in both her rear legs.
We did not see her during the year of 2016. In 2017, Zahira started limping on the right hind leg. She responded quickly to the treatments. At her fourth session, she was no longer favoring the right leg. We continued once a month for four months. Unfortunately, Zahira passed away unexpectantly in Sept of 2017.
What other recommendations?
I did not alter the western pain medications. She was already on cartilage support, Cosequin. I prescribed two Chinese herbal formulas — Tendon and Ligament (Jing Tang) to help with inflammation, pain, and the healing process of the tendons and ligaments and Benefit Hips and Knees Formula (kan Essentials) to support the hips and knee joints.