Guest Post: Rupture of the Cranial Cruciate Ligament

Our new guest blogger, Dr. Philip Williams, gives us a clear picture of what a cranial cruciate ligament rupture looks like in a dog. Dr. Williams has his own practice, Companion Animal Hospital, based in Solon, OH.

One of the more common causes of lameness affecting the rear legs in dogs is the partial or complete tear of the cranial cruciate ligament. The cranial cruciate ligament is a dense fibrous band of tissue located in the knee, which is necessary to maintain stability and hence, normal function of the knee. This ligament can tear due to trauma (in people, this is a common football injury), and it may also rupture secondary to degeneration associated with aging.

This injury can occur in any breed and age of dog, but is most commonly seen in active, large breed dogs. It is an uncommon injury in cats, although if seen in cats, they are often overweight.

Dogs with ruptured cranial cruciate ligaments will often present in three different ways. A sudden onset is associated with playing/running hard, acutely becoming lame to the point of non-weight bearing in the affected limb. These animals may progressively get better over the next 3-6 weeks, but will often reinjure the leg at a later time. If not diagnosed at the time of the initial injury, this pattern of getting better and becoming sore again will tend to repeat itself, becoming a chronic intermittent lameness. In those animals that partially tear the ligament, the lameness may be mild and seem to resolve with rest. Only until the ligament completely ruptures does it become obvious what was causing the lameness. It is important to note that up to 40% of those dogs that tear a ligament in one leg will rupture the ligament in the other leg within 18 months.

Charlie a 9 year old neutered male Labrador cross presented for lameness with a duration of 2 days in his right hind leg. He had been running around outside when he injured his leg. He could put weight on the injured leg, but preferred to not if possible. We initially tried 2 weeks of anti-inflammatory therapy.

Normal versus ruptured cruciate ligamentTo the left, the image on the left shows a normal knee, and the image on the right shows a ruptured cranial cruciate ligament, and instability in the knee.

In order to diagnose a tear of the cranial cruciate ligament, a physical exam must be performed. Dogs will often sit with the injured leg not completely under themselves; swelling of the knee and thickening around the joint can sometimes be detected.

The veterinarian will check for instability of the joint, which is best done under sedation, in order to relax the animal and attenuate pain with the procedure. The sedation also allows for X-rays to be taken of the knee to rule out any other causes for the lameness, evaluate the joint for arthritic changes, and look for subtle changes that can be associated with a ruptured cranial cruciate ligament. Arthritis will develop in the injured knee over time no matter what type of treatment is selected.

After 2 weeks of the anti-inflammatory therapy with little effect, we did x-rays and checked the knee for instability. There was no arthritis yet in the knee, but Charlie had a completely torn his cranial cruciate ligament.

Conservative treatment for a ruptured cranial cruciate ligament includes rest, anti-inflammatory therapy, acupuncture, and physical therapy. This approach may work well in dogs weighing 20 pounds and under; however, in bigger dogs reoccurrence of the lameness is almost inevitable with an unlikely return to pre-injury activity, without a surgery to stabilize the knee.

Surgical stabilization can benefit any sized dog, and is usually what is required to return the animal to optimum function. There are a number of surgical techniques used to stabilize the knee (lateral suture, TPLO, TTA), and they all seem to work well in dogs weighing 80 pounds and under, while dogs that weigh over 80 pounds will probably benefit the most from more aggressive and expensive procedures (TPLO, TTA), that involve cutting bone and placing metal plates and screws.

Post-surgical care is extremely important, including: anti-inflammatory therapy, physical therapy, and acupuncture treatment, which help restore the joints back to normal function. Because arthritis will occur, it is highly recommended for joint supplements to be given that contain Glucosamine, chondroitin sulfate, and MSM for the remainder of your pet's life.

Lateral suture technique cruciate ligament repairCharlie weighs 70 pounds and the owners decided to have the lateral suture procedure done. After the surgery he was on anti-inflammatory therapy for another 2 weeks, and was limited to leash walks, no running allowed, for 3 months. It took him about 2 weeks to start putting weight on his leg, and within 1 month he was using the leg normally. About 8 months later he ruptured the cranial cruciate ligament in the left leg, which we repaired in a similar fashion as is doing well now on both surgically repaired legs.

The picture to the right demonstrates the lateral suture technique to stabilize the knee, similar to what was used to repair Charlie’s knee.

Both figures were taken from: Small Animal Surgery, Third Edition, Ed., TW Fossum, Pub., Mosby Elsevier.

Related Posts:
October is Orthopedic Month at Embrace Pet Insurance
Claim Example: Old English Bulldogge with multiple medical conditions
Guest Post: Pixie the Chihuahua Mix - a remarkable story of love and dedication
The Lowdown on Dog and Cat Orthopedics
Guest Post: Rupture of the Cranial Cruciate Ligament

Dr Philip WilliamsDr. Phil Williams obtained his DVM from the University of California, Davis. He worked as a large animal veterinarian in both Fresno, CA, and Greeley, CO for five years and then returned to school to pursue a PhD in Neuroscience, where he researched alterations in brain physiology relating to epilepsy at the Colorado State University College of Veterinary Medicine, where he also received advanced training in Anatomic Pathology.

Dr. Williams was a research associate in the Case Western Reserve University School of Medicine department of Neuroscience, and has been practicing small animal medicine at Companion Animal Clinic in Solon OH. He enjoys gardening and relaxing with his wife Jessica, stepson Gabriel, daughter Meadow, dog Moet, and cat Blackie.

The Lowdown on Dog and Cat Orthopedics

Today, Dr. Mahaney covers bones, ligaments, and inflammation and what you can do to keep up your pet's orthopedic health.  Over to Dr. Mahaney...

The musculoskeletal system is one of the body’s best assets and greatest enemies.  Without our muscles, bones, ligaments, tendons, and other connective tissue, our pets would take the form a jelly-like blob barely capable of movement.

Despite the amazing ambulatory capabilities provided by the musculoskeletal tract, its components also serve as the origin of potentially debilitating injuries and life threatening illness.

Cruciate 2Let’s start with a review of the musculoskeletal tract’s components.  The canine and feline skeleton provides the structure which supports internal and external organs.  The skeleton is made of numerous bones formed from a matrix of mineralized calcium, phosphorous, and other substances.  The bones are held together by the integration of joints, intervertebral discs, and ligaments.  Muscles connect to bones via tendons.  Collectively, the above components work with organ systems (nervous, cardiovascular, endocrine, digestive, etc) to sustain life.

As the musculoskeletal tract is such a vital part of the body’s functional capacity, there are also many places where breakdown can occur.  We have to look at our pets holistically and realize that they are merely a composite of finely tuned parts.  If arthritis (joint inflammation) develops, other organ systems will suffer in a compensatory fashion.

Arthritis is one of the most common orthopedic diseases I treat in veterinary practice.  It can happen to juvenile, adult, or senior animals and can significantly affect quality of life. Arthritis occurs for a variety of reasons, including:

  • Congenital and developmental joint malformation- hip and elbow dysplasia, etc
  • Trauma- jumping, falling, overexertion, etc
  • Chronic stress from carrying excess weight
  • Infectious organisms- bacterial, fungal, other
  • Immune system disease- immune mediate arthropathies (like Rheumatoid arthritis in humans)
  • Cancer
  • And so on...

When a joint becomes inflamed, the immune system is called into action to reduce inflammation.  If the underlying cause of inflammation is removed and adequate time is given for the body to heal, the joint may not have sustained any permanent damage.  Other times, more severe damage occurs or inflammation is inadequately controlled, which starts the painful process of degenerative joint disease (DJD).  DJD is a permanent remodeling of joint surfaces which limits range of motion, mobility, and overall quality of life.

As a pet owner, you can reduce the likelihood your pet will suffer the painful effects of arthritis and DJD by taking preventive measures early in life.

Maintain a lean body condition

A slimmer pet carries less weight and therefore incurs less day to day joint trauma.  When feeding your pet, follow manufacturers feeding guidelines, use a metric measuring cup, and minimize snacks to stay under recommended daily caloric requirements.

Partake in daily pet appropriate exercise

Maji 1yr old happy labradorSchedule time on a daily basis to engage in metabolically stimulating activity with your pet.

When starting out, choose simple workouts like briskly walking around your neighborhood, then increase the intensity and duration as Fido’s fitness progresses.

Cats can exercise in the safety of your home by chasing a laser pointer or feather toy.  Feeding from an elevated surface or placing food inside a feline-friendly toy provides both physical and behavioral stimulation.

Consistent activity benefits both you and pets.  The PPET (People Pets Exercising Together) Study showed that owners who regularly exercised with their dog were better able to stick with their workout plan than dog-less participants.

Immediately address lameness with your veterinarian

Should your pet show any inability to use a limb (there are four) properly, immediately address the problem with your veterinarian.  Radiographs (xrays) may be needed to determine if the joints and bones are normal or abnormal.  The piece of mind that comes from finding no evidence of fracture, joint abnormality, or other significant concerns is well worth the expense.

Feed a diet rich in nutrients having anti-oxidant and anti-inflammatory properties

Nature has created many beneficial food sources capable of aiding the prevention and management of disease.  Most whole foods are rich in bioavailable nutrients that combat the process of oxidation and inflammation, both of which cause potentially irreversible tissue damage.

Take preventive measures early in life

Provide joint supplementation at an early life stage.  If your dog or cat is predisposed to arthritis due to known or suspected joint malformations, carrying excess body weight, or has suffered orthopedic trauma, an oral joint (gluocsamine, chondroitin, other) and omega fatty acid supplement (fish oil, other) can safely promote joint health and reduce inflammation.

Taking care of your pet’s joints, discs, bones, ligaments, and tendons can increase the likelihood your pet will lead a comfortable and healthy existence.  As quality of life is the most important thing we can provide for our pets, take a proactive approach to maintain or improve your pet’s musculoskeletal system on a daily basis.

Related Posts:
October is Orthopedic Month at Embrace Pet Insurance
Claim Example: Old English Bulldogge with multiple medical conditions
Guest Post: Pixie the Chihuahua Mix - a remarkable story of love and dedication
The Lowdown on Dog and Cat Orthopedics
Guest Post: Rupture of the Cranial Cruciate Ligament
Other posts by Dr Patrick Mahaney

Dr Patrick Mahaney Dr. Mahaney is a veterinarian from the University of Pennsylvania and a Certified Veterinary Acupuncturist, having been inspired by his own chronic pain from Intervertebral Disc Disease to provide accupuncture to his veterinary clients. In addition to Dr Mahaney's house call integrative veterinary medicine business, California Pet Acupuncture and Wellness, he sees patients on an in-clinic basis at Veterinary Cancer Group in Culver City, CA.

Dr Mahaney writes a veterinary column (Patrick's Blog) for and contributes to a variety of media, including Perez Hilton's, Fido Friendly, Veterinary Practice News, Healthy Pets and People with Dr Patrick on, and MSNBC Sunday with Alex Witt and Career Day. His first book, The Uncomfortable Vet, will be available in 2012 through Havenhurst Books.

Guest Post: Pixie the Chihuahua Mix - a remarkable story of love and dedication

Wow! You just have to watch this video. Dr Riggs wanted to share a really positive story for Orthopedic Month at Embrace and this one tops them all. You'll have a smile and a tear after reading and watching.

Dr. Rex Riggs is the owner of Best Friends Veterinary Hospital in Powell, Ohio. He is a veterinarian, and an Advisory Board member of Embrace Pet Insurance.

>We tend to live in a hurried, instant gratification world anymore. We want the brand new shiny “whatever”, whether it be a car, a house, some jewelry or……whatever. If given the choice of working to get something or just be given that something, guess what; most of us will pick the easy way.

I am in my middle age years now (ouch that hurt saying that!), and I tend to notice such things. It also goes for our pets. There are literally millions of free pets looking for homes in the United States’ rescue shelters and foster homes. Great animals of all pedigrees and ages. It is estimated 3 million of these potential companions are put to sleep each year, simply because no one wants them.

Some have special needs and do need more TLC. It does take time and work to rehabilitate these animals. But you know what…. it is worth it.

The following video exemplifies how love, time and dedication can make a difference and bring joy and life back to an animal and bring fullfillness and happiness to a new owner. This is the story of Pixie Stardust, a little Chihuahua/Yorkie mix, which was given up to Noah’s Bark Pet Rescue in Los Angeles, because she could not walk. She was a pitiful sight. A small, scrawny puppy with deformed legs that could not even support her feather-like weight.

Enter Carolyn Paxton, owner of Chi WOW WOW, a hip clothing line for small dogs. Carolyn is an avid animal lover with a soft spot for Chihuahuas. Pixie's video shows just what love, persistence and a little technology can make in our lives.

I hope this makes us all think of helping these sheltered animals with a home. Their only crime was being born without an owner.

Related Posts:
October is Orthopedic Month at Embrace Pet Insurance
Claim Example: Old English Bulldogge with multiple medical conditions
Guest Post: Pixie the Chihuahua Mix - a remarkable story of love and dedication
The Lowdown on Dog and Cat Orthopedics
Guest Post: Rupture of the Cranial Cruciate Ligament
Other posts by Dr Riggs

image from Dr. Rex Riggs grew up in Wadsworth, Ohio, near Akron. Dr Riggs is co-owner of Best Friends Veterinary Hospital in Powell, Ohio. He is also on the board of the North Central Region of Canine Companions of Independence, a board member of The Ohio State College of Veterinary Medicine Alumni Society and Small Animal Practitioner Advancement Board at The Ohio State College of Veterinary Medicine. Dr. Riggs lives in Lewis Center, OH with his wife Nancy, their dogs Maggie, and two cats Franklin and Speeder. Outside of work, Dr. Riggs is an avid golfer and enjoys travel and photography.


Happy Fifth Birthday to Embrace Pet Insurance!

IMG_1081 Happy Birthday to Embrace! This day five years ago, we sold our first policy to me and my cat Lily.

I distinctly remember when we got the go-ahead from our underwriters at the time, Lloyd's of London, and since I was out of the office on that day, I phoned in to purchase our first policy.

We'd been training our first 2 Embracers, Chris and Lea, on the phones by having people (including my mom) randomly call in to pretend to buy a policy so I didn't tell Lea, who happened to answer the phone this time around, that this was a "live" purchase until the end of the call. It was a giddy feeling for all of us when I told her to put through my real credit card info and really buy the policy.

A lot has changed since we sold that first policy but we remember our humble start fondly. We now have 24 Embracers, plus we're about to hire another 2. We broke even in June of this year and have insured thousands of cats and dogs and paid out millions in claim reimbursement. It feels really good to get to where we are now.

Here are some photos of the last 5 years at Embrace - do you have any fond memories of Embrace over the years you'd like to share? 


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  • Embrace Pet Insurance staff Jan 4 2007
  • Another use for Dell Server boxes - hidey hole!
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  • Embrace Pet Insurance dogs at work day
  • Chris H on the phone
  • Conference
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  • Tenisha and Lea
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Claim Example: Old English Bulldogge with multiple medical conditions

Given that it's Orthopedic Month at Embrace, I wanted to show you the claims over the last couple of years for a Olde English Bulldogge called Kobe. Kobe was born in March 2006 and lives near Los Angeles, CA. Little did anyone know when Kobe was born how expensive he'd be later in life.

First, let's go over Kobe's policy. Kobe's coverage costs $58.14 a month in his third policy term (prior years cost $49.28 and $53.83 consecutively) and he has a $200 annual deductible, 80% reimbursement percentage, $5,000 annual maximum plus the drug coverage selected.

The main contributors to Kobe's relatively high premiums are:

  • Kobe is an expensive breed to insure (as you can see by the claims below),
  • he lives in an expensive area (veterinary costs around LA are much higher than many parts of the country) and
  • he's now 6 years old

So on to Kobe's claims - see the table below.

I'm sure when Kobe arrived into his family's life, they certainly did not expect to be paying veterinary bills for 7 different medical conditions over the last two years. Probably, their only regret is that they did not get a $10,000 annual maximum instead of $5,000 but then his premium would have been higher.

Vet Visit Claim Status Diagnosis Claim Amount Paid
10/18/2009 Deduct gastroenteritis from eating chicken wings $72.20 $0.00
11/7/2009 Paid Dietary Indiscretion $1,623.20 $1,196.32
1/9/2010 Paid Skin Fold Dermatitis $99.68 $79.74
2/21/2010 Paid Allergies, Reverse Sneeze, & ADR $792.00 $575.84
7/9/2010 Paid Acute Vomiting; DDX Infectious, Inflammatory $401.30 $321.04
7/20/2010 Paid Conjunctivitis $152.17 $121.74
9/5/2010 Paid Left Pelvic Limb Lameness, No Known Trauma $60.00 $48.00
9/7/2010 Paid Bilaterally hip subluxation with DJD $410.25 $313.80
9/11/2010 Paid Bilateral DJD in hips $429.95 $343.96
11/4/2010 Deduct Conjunctivitis, Marginal Tear Production, Corneal Ulcer $168.00 $0.00
10/13/2010 Paid Pyoderma, Otitis, Balanoposthitis/Urethritis $209.36 $132.29
11/22/2010 Paid Corneal Ulcer OS- Healed, Conjunctivitis OU, Pyoderma $212.17 $169.74
1/4/2011 Paid Lumbosacral Stenosis, Hip Dysplasia $2,244.15 $1,795.32
1/11/2011 Paid Hip Dysplasia- Bilateral $3,382.70 $2,680.56
1/27/2011 Paid Post Op Physical Therapy after bilateral FHO's $665.00 $247.69
      $10,922.13 $8,026.04

Does this look familiar to you?

Related Posts:
October is Orthopedic Month at Embrace Pet Insurance
Claim Example: Old English Bulldogge with multiple medical conditions
Guest Post: Pixie the Chihuahua Mix - a remarkable story of love and dedication
The Lowdown on Dog and Cat Orthopedics
Guest Post: Rupture of the Cranial Cruciate Ligament

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