Signs of a cranial cruciate ligament (CCL) injury in dogs include limping, struggling to get up off the floor, and reluctance to climb stairs. Today, our Jacksonville vets discuss the causes of CCL injuries and the surgeries used to treat them.
What is the CCL?
Our knees have a thin piece of connective tissue called the anterior cruciate ligament (ACL) that does the essential job of attaching our lower leg bone (tibia) to our upper leg bone (femur) and helping our knee function efficiently. Your dog also has connective tissue joining their tibia and femur however, in dogs this tissue is called the cranial cruciate ligament or CCL.
Although the dog's CCL and the person's ACL function somewhat differently, pet owners and vets will often refer to the dog's cranial cruciate ligament as the dog's ACL, CCL or 'cruciate' interchangeably.
How did my dog's CCL get injured?
ACL injuries in people generally occur suddenly, while performing a particular movement. On the other hand, CCL injuries in dogs typically come on gradually and become progressively worse with activity. For many dogs there is no defining moment when their CCL injury suddenly occurred, instead, it is more likely that through continued exercise, symptoms that began as mild gradually became more pronounced and painful for your dog.
Are there different kinds of CCL injuries?
CCL injuries fall into two general categories, chronic and acute, although the symptoms of these are pretty much the same except for the speed at which symptoms appear.
Chronic CCL Damage
When it comes to CCL tears in dogs, many cases are chronic onset ruptures caused by degeneration and aging. CCL injuries are commonly seen in dogs in middle age, around five to seven years old.
Acute CCL Injuries
Acute onset ruptures are most commonly seen in pups four years or younger. These tears are caused by injuries a dog will sustain just running around living their daily lives.
What are the symptoms of a CCL rupture?
If your dog has a CCL injury you will likely notice one or more of the following symptoms:
- Crackling noise of bones rubbing against each other
- Decreased range of motion
- Poor hind leg extension
- Pain when the joint is touched
- Lack of motivation to exercise
- Irritability
- Restricted mobility
- Stiffness after exercising
- Swelling/Inflammation
- Thick/firm feel of the joint
- Weight shifted to one side of the body while standing
- "Pop" sound when walking
If you notice any of the listed symptoms above, contact your vet and schedule an examination for your pup. If your dog suddenly develops a severe limp, contact your nearest animal emergency hospital for guidance.
What causes the pain of a CCL injury?
When a dog's CCL has been injured, the tibia slides forward in relation to the femur. This forward sliding movement is known as a 'positive drawer sign' or 'tibial thrust' and results in knee instability which can lead to osteoarthritis or damage to the cartilage and surrounding bones.
How are CCL Injuries treated in dogs?
If your dog is showing signs of a CCL injury it's important to see a vet to have the condition diagnosed so that treatment can begin before symptoms become more severe. Many dogs with a single CCL injury will often go on to injure the other leg soon afterward.
Non-Surgical Treatment
In dogs under 30 pounds, there is a possibility of recovery that doesn't require surgery through ample rest, anti-inflammatories, and physical rehabilitation. This is dependent upon the size of your pet, their overall health, and the severity of your dog’s CCL injury.
Your veterinary surgeon will advise you on the best course of action for your dog.
Treatment Via Surgery
CCL surgery is the most common surgery performed in dogs and is estimated to make up about 85% of all orthopedic surgeries performed every year on dogs. Given that this is such a common injury, several procedures have been developed over the years to repair the ligament. Each technique has its pros and cons, so it is important to discuss the options with your veterinarian to determine which procedure would be best for your dog's situation. Below are the most common methods of repairing the injury.
Arthroscopy
Arthroscopy is the least invasive means of visualizing the structures of the stifle, the cranial, and caudal cruciate ligaments. The technique offers enhanced visualization and magnification of the joint structures. The technology developed for this procedure allows for minimal surgical incisions for partial CCL and meniscus tears. This method may not be an option for completely torn ligaments.
Lateral Suture or Extracapsular
Often recommended for small to medium-sized dogs, this surgery stabilizes the stifle (knee) through the use of sutures placed on the outside of the joint. This is one of the most frequently performed surgeries for this type of injury and is usually performed on dogs that weigh under 50 pounds.
TTA (Tibial Tuberosity Advancement)
TTA is a method of surgery that corrects the need for the CCL by cutting the top of the tibia, moving it forward, and stabilizing it in its new position using a plate. Therefore, the goal with TTA is to replace the ligament entirely, rather than repair it.
TPLO (Tibial Plateau Leveling Osteotomy)
TPLO surgery is becoming increasingly popular and is typically the best option for larger dog breeds. The procedure entails cutting and leveling the tibial plateau. From there, the surgeon stabilizes the tibial plateau using a plate and screws. This surgery also eliminates the need for the ligament.
What should I expect after my dog's CCL surgery?
Regardless of which operation is performed to repair the ligament, it is the care your dog receives after surgery that will determine how successful the operation is.
The first 12 weeks following surgery are a crucial time for recovery and rehabilitation. Limited exercise and encouraging your pup to begin using their leg are keys to a successful recovery.
At 2 weeks postoperatively, you can gradually increase the length of your dog’s leashed walks. By the 8th week, your dog should be able to take two 20-minute walks each day and perform some of their basic daily living activities.
After 8-10 weeks post-operatively, your vet will take x-rays to assess how the bone is healing. Your dog will be able to gradually be able to resume normal activities at around 12 - 16 weeks. We at Pet Doctors of America recommend a rehabilitation program to optimize your dog’s recovery. Whatever rehabilitation facility you attend should have experience in post-op recovery from orthopedic injuries such as the TPLO.
Some dogs have also experienced positive results via acupuncture treatments and laser therapy.
How long will it take for my dog to recover from CCL surgery?
When it comes to CCL surgery, recovery is never a quick process, although some dogs recover more quickly than others.
Many dogs can walk as soon as 24 hours after CCL surgery, but a full recovery and a return to normal activities will take a minimum of 12 - 16 weeks, and it's important not to rush the process.
Diligently follow your vet's instructions for post-op care and carefully monitor your dog's healing progress. It is vital not to rush exercise following CCL surgery. Returning to regular activities too quickly could lead to re-injury. Never force your dog to do exercises if they resist. Speak to your vet if you are concerned that your dog's recovery is taking longer than expected.
Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet's condition, please make an appointment with your vet.