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Cranial Cruciate Ligament (CCL) Rupture in Dogs

Your dog's knees are designed in a way that they are always load-bearing. This means that injuries can occur quite easily. Here, our Novato vets talk about cranial cruciate ligament (CCL) in dogs, how CCL ruptures occur and how surgery can help address the issue and improve their quality of life.

Your Dog's Cranial Cruciate Ligament (CCL)

The cranial cruciate ligament is one of two ligaments dogs have in their knees. It's a band of connective tissue that helps connect the femur and tibia (the bones located above and under the knee) allowing the knee to function. This is also the ligament that is most prone to getting injured.

Cranial Cruciate Ligament (CCL) Ruptures in Dogs

A partial or complete rupture of the cranial cruciate ligament in dogs (or ACL injuries as they are sometimes called) can happen without warning and can cause your dog a great deal of discomfort. CCL tears occur due to an acute trauma stemming from a sudden movement such as a jump or change of direction, regular daily use should not contribute to a torn CCL. In dogs, CCL injuries tend to come on gradually, becoming progressively worse until a tear occurs.

What causes the pain your dog feels during a CCL rupture?

When your pup is suffering from a torn CCL, the pain arises from the knee's instability and a motion called 'tibial thrust'.

Tibial thrust is a sliding motion caused by the transmission of weight up your dog's shin bone (tibia) and across the knee, causing the tibia to 'thrust' forward about the dog's thigh bone (femur). This forward thrust movement happens because the top of the tibia is sloped, and your pup's injured CCL is unable to prevent the unwanted movement from occurring.

Continued activity on a mildly injured leg will cause the injury to worsen and symptoms to become more pronounced. Dogs suffering from a single torn CCL will typically begin favoring the non-injured leg, which commonly leads to the injury of a second knee. Approximately 60% of dogs with a single CCL injury will go on to injure the other knee soon afterward.

Signs of Cranial Cruciate Ligament Ruptures in Dogs

Here are the signs your dog may have torn their CCL:

  • Sudden pain in the leg
  • Instability in your dog's knee
  • Swelling around the knee
  • Weakness in the back leg
  • Favoring one leg over the other
  • Limping
  • Stiffness after exercise

If you think your dog may have a torn cranial cruciate ligament call your vet and schedule an appointment or contact an emergency vet right away.

Treatment for Dogs With ACL Injuries

ACL injuries typically do not heal themselves. If your pup is showing signs of a torn ACL it's important to see a vet and have the condition diagnosed so that treatment can begin before symptoms become more severe and more painful.

Dogs who experience cranial cruciate ligament ruptures are usually recommended one of the following knee surgeries to address the pain and help them return to an active lifestyle.

TPLO - Tibial Plateau Leveling Osteotomy

TPLO is more complicated than ELSS surgery but typically very successful in treating ACL injuries in dogs. This surgery option aims to reduce tibial thrust without relying on the dog's ACL. The procedure involves making a complete cut through the top of the tibia (the tibial plateau), and then rotating the tibial plateau to change its angle. A metal plate is then added to stabilize the cut bone as it heals. Over several months, your dog's leg will gradually heal and strengthen.

TTA - Tibial Tuberosity Advancement

TTA is similar to TPLO but tends not to be used as often to treat ACL injuries in dogs. This knee surgery involves surgically separating the front part of the tibia from the rest of the bone, and then adding a spacer between the two sections to move the front section up and forward. This helps to prevent much of the tibia thrust movement from occurring. A bone plate will be attached to hold the front section of the tibia in its correct position until the bone has had sufficient time to heal. Dogs with a steep tibial plateau (angle of the top section of the tibia) are excellent candidates for this type of ACL surgery.

ELSS / ECLS - Extracapsular Lateral Suture Stabilization

This ACL surgery is typically used to treat dogs that weigh less than 50 pounds and works by preventing the tibial thrust with a surgically placed suture. The suture stabilizes your pup's knee by pulling the joint tight and preventing the front-to-back sliding of the tibia so that the ACL has time to heal, and the muscles surrounding the knee have an opportunity to regain their strength. ELSS surgery is fairly quick and uncomplicated with an impressive success rate in smaller dogs.

What You Can Expect From Your Dog's Surgery

Your veterinarian will start by assessing your dog's knee to determine the extent of the injury, its severity, and which of the above surgeries your dog may require. Some tests and diagnostics your vet might conduct include:

  • X-rays of the stifle and tibia
  • Palpation (your dog may be sedated or given light anesthesia for this)
  • Laboratory analysis of fluid drawn from the knee

Your dog's surgery might be scheduled for the same day these tests are conducted or at a later date depending on various factors, such as your vet's availability and the severity of your dog's condition.

Your dog will be sedated with anesthesia for their surgery, at this time your vet will also provide your dog with painkillers and antibiotics to help manage pain and prevent infection. In many cases, patients can go home the day after their procedure.

Recovery After CCL Surgery

After their surgery, it could take your dog 16 weeks or more to make a full recovery. It's essential to follow all of the post-operative care instructions your vet gives you carefully. Your vet will probably prescribe a course of antibiotics and painkillers when they send your dog home after their surgery. Your dog will probably be forced to wear the cone of shame after the procedure

You will have to visit your vet during the first couple of weeks after your dog's surgery so they can check in on the recovery process, and remove any sutures.

It's also important to restrict your dog's activity and movements, limiting them to toiletry purposes only. You should keep your dog on a leash to prevent any running, stair climbing, and jumping. After several weeks have passed you may gradually increase your dog's activity and movement.

After approximately 6 to 8 weeks have gone by since your dog's procedure you will have a follow-up appointment with your veterinarian. At this visit, your vet will monitor the function of your dog's leg, take X-rays to assess the healing, and provide you with advice about increasing your dog's daily activity. Additional tests and evaluations may be recommended based on your dog's case.

Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. Please make an appointment with your vet for an accurate diagnosis of your pet's condition.

Is your dog showing signs of an CCL injury? Contact our Novato vets to have your pup diagnosed and treated.

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