Cranial Cruciate Ligament (CCL) Rupture
Cranial Cruciate Ligament (CCL) rupture is one of the most common veterinary orthopedic injuries in dogs and causes intense pain, swelling and lameness in one or both hind legs.
With an acute (sudden) rupture of the cranial cruciate ligament many dogs will not place weight on the leg at all, sometimes leading owners to believe the leg has been broken or fractured. The cranial cruciate ligament is inside the knee, analogous to the ACL (anterior cruciate ligament) in humans, that prevents abnormal rotation and forward and backward motion of the bones of the knee relative to each other. In humans, these ligament tears are almost always traumatic – they occur when a soccer player twists a knee, a skier takes a bad fall, or a football player gets tackled.
In dogs, CCL injuries are usually not associated with significant trauma. In humans, the top of the shin bone is essentially flat, so we only put strain on our cruciate ligament if we pivot our knee excessively or suffer a blow to the top of our shin.
In dogs, however, the top of their shin bone is angled an average of 25 degrees. This means that any time a dog is standing, walking, or putting weight on their leg, gravity wants the bottom of the thigh bone to slide backwards down that slope, like a car parked on a steep hill. This constant strain on the dog’s cruciate ligament predisposes them to a more chronic, gradual fraying of the fibers of the ligament that can lead to a complete tear over time.
Because of this difference in bone structure and the resulting difference in why dogs tear their CCLs, the options for treating CCL injury in dogs are different than in humans. Surgery is almost always recommended to stop the abnormal motion in the knee which leads to bone-on-bone grinding, the development of arthritis, and pain. There are multiple procedures available, and many different factors that go into determining which type of surgery is the best option for any individual pet. These can include your dog’s size, weight, activity level, bone structure, gait pattern, if they have any other orthopedic problems, and if they have any other general health problems for instance.
Symptoms of CCL injury in veterinary medicine include:
gradual waxing and waning lameness which may improve pain medications and rest
non-weight bearing (with acute ruptures) that may gradually improve over time
swelling at the knee joint that often is unnoticed by owners but may be visible to your veterinarian
instability of the knee when tested by your veterinarian while your dog is sedated
a tendency to sit down with the affected knee laying straight and not bent in a flexed position
loss of muscle mass around the hip and thigh of that leg.
Your veterinarian should perform a thorough orthopedic examination, including checking the stability of the knee. There may or may not be abnormal back and forth movement but there will likely be pain evident to your veterinarian. X-rays help confirm the diagnosis and are used to look for other problems or injuries in the patient that should be considered when planning the next step.
Currently the most common repairs are:
TTA (tibial tuberosity advancement)
Extracapsular stabilization including tightrope, bone anchors, lateral suture technique, and others
Veterinary patients with cruciate injuries will do much better with physical rehabilitation therapy.
Cathy Davis, DVM, CCRT improves post-op recovery from many veterinary orthopedic surgeries including cruciate ligament repair such as TPLO, TTA, tightrope, and extra-capsular repairs. Her special training as a veterinarian, certified in physical rehabilitation makes her an expert who works with patients and ability for pain management, arthritis management, and many other conditions.
To learn more about canine rehabilitation therapy, click here.
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