Cranial Cruciate Ligament Rupture

If your dog goes lame in one of his hind legs, he may have torn or ruptured his cranial cruciate ligament, or CCL.

What is the cranial cruciate ligament (CCL)?

The cranial cruciate ligament is one of the several ligaments in the stifle (knee) that connect the femur (thigh bone) to the tibia (shin bone).

The CCL has 3 main functions:

  • Prevent hyperextension of the knee.
  • Prevent internal rotation of the tibia.
  • Prevent cranial displacement of the tibia in relation to the femur.

Why does the CCL rupture?

Pets tend to experience CCL disease over time. The weakened ligament may partially or completely rupture through activities such as running or jumping. Unfortunately, the condition leading to CCLR is often present in both knees, and about 30- 50% of dogs will rupture both CCLs within 1 to 2 years of each other. CCL rupture is one of the most common orthopaedic disease seen dogs, and CCL repair is the most common orthopaedic surgery performed by veterinary surgeons.

As a pet owner, what symptoms will I see if my dog ruptures a CCL?

There are three potential scenarios that can occur with CCLR: acute rupture, chronic rupture, and partial tears.

  • Acute rupture –  Your dog will likely be in pain. The lameness will likely improve over few weeks, however, a sudden worsening may be seen if the medial meniscus (a fibrous pad attached to the top of the tibia that acts as a cushion inside the joint) becomes damaged, and your dog will not return to normal function without some evidence of lameness.
  • Chronic CCLR –  Over time, the body tries to stabilise the stifle by surrounding the joint with scar tissue. This will look like a swollen knee and range of motion of the joint may be compromised.
  • Partial CCLR –  Your dog may appear lame with exercise, but improves with rest. However, the ligament will continue to weaken and the joint will become increasingly unstable.  The ligament will likely rupture completely and lameness will not improve with rest.

Treatment for CCL Injuries in a Dog

If left untreated, the lack of a healthy CCL will cause the bones to rub against one another, leading to the development of bone spurs, pain, arthritis, and a decreased range of motion. These problems are more likely to occur in medium-sized to large dogs.

Non-surgical treatment for CCL injuries is typically only used for dogs weighing less than 30 pounds. This includes rest and anti-inflammatory medications for six weeks to two months, followed by a program of exercise and, if obesity is present, weight loss. Without surgery, the knee joint will be subject to degenerative changes.

CCL surgery for dogs includes a number of different techniques that aim to provide stability to the joint. Your veterinarian may also have a preference based on experience and training in orthopaedic surgery. There’s no single right answer, so don’t hesitate to discuss all the options.

There are many options when it comes to surgical repair. They include the TightRope (TR) stabilising procedure; a lateral suture (LS) procedure; a tibial plateau levelling osteotomy (TPLO); and a tibial tuberosity advancement (TTA) procedure. The TPLO and the TTA involve cutting the bone to rebuild the knee, while the TR and LS are less invasive implants that use synthetic materials to bind the femur and tibia. Each procedure has pros and cons.

Prevention

You can take the following steps to help prevent or reduce the risks of CCL disease in your dog:

  • Overweight dogs are at an increased risk for developing CCL injuries. Make sure they are on a diet that doesn’t contribute to unnecessary weight gain.
  • Keep your dog active. Dogs need daily exercise for good muscle tone and joint health.
  • Keep your dog safe. Do not let your dog jump from tall heights or risk unnecessary injury.

Call your local Village Vet practice to discuss ways that you can adopt to reduce the risk of CCL.