Dog Cruciate Ligament Injury
Cruciate Ligament Injuries are one of the most common injuries in dogs effecting the hind limbs. The ligament has an important job of stabilising the knee. It is a painful condition and needs to be treated in a timely manner
Unfortunately a CCL injury inevitably leads to arthritis whether the dog has surgery or not. It's important to have a rehabilitation plan in place and have frequent vet checks to ensure a management plan is put in place for the long term
So what is the Cranial cruciate Ligament?
The cranial cruciate ligament (CCL) is an important ligament found inside the stifle (knee) that stabilises the knee, and facilitates proper movement and weight bearing
In humans it's often called the 'footballers injury', the anterior cruciate ligament (ACL) is often ruptured in sports persons when twisting or turning quickly
In dogs, the CCL is often effected by a disease process over time that frays the fibrous tissue. Some breeds are effected more than others
What is the cause of Cruciate Injury In Dogs?
Causes of a CCL injury include;
The main cause of a CCL rupture (or partial rupture) is degenerative changes within the knee joint that weakens the ligament over time. The following points can also contribute to the rupture as well as wear and tear;
Trauma - a sudden forceful trauma to the knee like turning for a ball, slipping or running on the beach
Age - Older dogs become more susceptible to the disease as their ligaments, muscles and joint tissues deteriorate over time
Breed predisposition & genetics - Certain breeds are more likely to suffer with CCL disease. Labradors, Rottweilers, WHWTs, Golden Retreivers, Staffordshire Bull Terriers and more. This is due to their anatomy and genetics
Obesity - Increased stress on the joint due to excess body weight is a common contributor to the condition
What are the signs my dog has CCL Disease?
Lameness (limping) is the most common sign of CCL injury in dogs. This may appear suddenly during or after exercise in some dogs, or it may be progressive and intermittent in others. It can sometimes be confused for arthritis or 'typical age related lameness'
In some dogs that affected in both knees at the same time, they can often find it difficult to rise from a laying position at all and have a very strange walking pattern (Gait)
- Reluctance to exercise or move around
- Hind leg extended when sitting
- Pain and/or swelling in Stifle (Knee)
- Stiffness/lameness after exercise
- Muscle atrophy over time
How are cranial Cruciate Ligament Injuries Diagnosed ?
It is important to have a diagnosis by a veterinary surgeon. The vet can diagnose by a one or a selection of the following options;
Examination - The vet will look at the gait (walking pattern) of your dog and assess the movement and weight bearing. There is a manipulation test, often done under sedation, that can be performed to evaluate the stability of the knee. This is called the cranial drawer test. A positive cranial draw suggests a CCL rupture of some degree
X-rays - although x-rays can mainly assess bones, the vet can look for other indications of disease which suggests a CCL rupture. It is also a good tool to look at the degree of arthritis in the joint
Athroscopy - this involves a tiny camera being inserted into the joint. It is minimally invasive and gives a good visualisation of the joint anatomy and severity of the condition including cartilage tears
CT/MRI scan - advanced imaging can be used the diagnose the condition and health of the surrounding joint
How is a Cruciate Injury Treated?
The ligament itself is not replaced in dogs. The most common surgical options for CCL ruptures in dogs are;
TPLO (Tibial Plateau Leveling Osteotomy) - this procedure alters the angle of the tibia where it meets the femur. Changing the angles in the knee reduce the need for the CCL to function. Screws and plates are used to hold the tibia in it's new position
TTA (Tibial Tuberosity Advancement) - this procedure moves the section of the tibia where the patellar tendon attaches. It is repositioned and secured with a special metal implant. This again changes the geometry of the joint, reducing the need for the CCL
Lateral suture - this technique uses a strong synthetic suture to stabilise the joint around the bones. This avoids cutting through bone or using metal implants. This suture mimics the function of the damaged ligament
Hydrotherapy can be started from 4-6 weeks post op to encourage controlled weight bearing and improve muscle mass. Dogs that have physical rehabilitation after a CCL injury have a better outcome and often a quicker recovery
Surgery may not be an option for a number of reasons; age, complicating conditions, obesity, cost etc. CCL rupture can be treated conservatively with rest and rehabilitation.
In these circumstances the body will try to lay down scar tissue around the joint to help stabilise it. Rest and controlled exercise including hydrotherapy and physiotherapy are an effective way of treating the non surgical CCL. At Operation K9 we have protocols for all types of CCL injuries at all stages of healing