Client Education

	Bonnie has a ruptured cranial cruciate ligament.  This ligament is responsible for 
preventing her leg from twisting in relation to her thigh and it prevents her knee from 
extending too far.  Since it has ruptured, her leg is able to move separately from her thigh.  
This is called a cranial drawer sign and it is indicative of this type of injury.  Since the 
joint fluid has a significant number of red blood cells in it, Bonnie's injury was most 
likely the result of trauma and not a degenerative change in the joint.  We saw nothing 
that would indicate a bacterial infection in the joint either.  The radiographs we took of 
her knee look pretty normal.  It indicated some joint effusion, or increased fluid 
production, and a change in the width of the joint.  The bones around her knee looked 
normal.  With a cranial cruciate rupture, these bones can develop arthritis since her knee 
is not able to function properly and there is extra stress on her bones.  To prevent severe 
arthritis from developing, Bonnie needs to have surgery to repair her knee.  
	The surgery uses some tissue around her knee as a replacement for the ruptured 
ligament.  This surgery provides good results in patients 80-95% of the time.  She should 
have normal joint function if everything heals properly.  There are some complications, 
however.  The replacement ligament could be destroyed by Bonnie's immune system.  
Also, a meniscal injury could be found during the surgery that would have to be repaired 
as well.  The meniscus provides support for the knee and helps to absorb the stress when 
she walks.  It is common for it to be damaged at the same time the ligament ruptured.  If 
we do see that it is damaged, we will just go ahead and fix it during the ligament repair.  
A meniscal injury, however, could increase the probably of Bonnie developing arthritis in 
the future.  
	After the surgery, Bonnie needs to be confined to a crate for two weeks and 
during this time she will have a sling on her left leg to prevent her from moving her knee.  
If she moves her knee too early, then the replacement ligament might fail before it has 
time to heal.  Also, immediately after surgery, we will put ice packs on her knee to reduce 
the swelling.  After these first two weeks, you should help Bonnie do some physical 
therapy exercises.  These include passive knee movement, swimming, and short leash 
walks.  These exercises will help to maintain her muscle tone and promote a healthy 
environment in her joint as it heals.  After the first two weeks after surgery, I would like 
for you to bring Bonnie in so I can check on her progress and show you how to do the 
physical therapy exercises.  Also, Bonnie will be receiving pain medication while she is 
in the hospital and I will be sending Rimadyl home with her.  You should follow the 
instructions on the label and notify me if you feel that she is in pain so I can adjust her 
dose or change her medication.
	Bonnie's knee injury probably occurred because she took a wrong step while she 
was playing or exercising.  Bonnie is overweight and this provided extra weight on her 
knee that increased the chance that it would rupture.  Her weight makes it more likely 
that she will have other joint problems in the future, such as arthritis, since her joints and 
bones have extra stress on them.  We should work on a weight loss program for Bonnie to 
prevent this from happening.  She will be healthier and you will find that she will have a 
lot more energy.  As a start, you should change her diet to Hill's Science Diet Adult 
Canine Light.  She should receive about four cups a day; this will provide all the calories 
she needs.  Once she has recovered fully from the surgery, we can discuss an exercise 
program as well.  
	If you have any questions about Bonnie's injury or the surgery, please let me 
know.