Cruciate Ligament Rupture in Dogs
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What is the CCL?
The cranial cruciate ligament (CCL) is one of major ligaments in the stifle or knee joint. In people it is often referred to as the anterior cruciate ligament or ACL.
In a normal dog the stifle is subjected to a force called cranial tibial thrust when bearing weight. This force acts to push the tibia forward in relation to the femur (or thigh bone). The cranial cruciate ligament constrains this and prevents the tibia moving forward maintaining joint stability. If the cranial cruciate ligament ruptures this force is not protected against and the tibia will slide forward during weight bearing making the joint unstable.
What is the cause of CCL injury in dogs?
The most common cause of CCL injury is degenerative change which leads to the ligament decreasing in strength. Over time the ligament will then begin to rupture which can occur as either partial or complete tearing. Partial tearing will usually progress to a full tear. In rare cases a traumatic injury can cause the ligament to rupture.
Any dog breed can be affected but large and giant breed dogs are more commonly seen. These include Labradors, Golden Retrievers, Boxers and Rottweilers. It is also seen frequently in some of the terrier type dogs. This is because they often have stifle anatomy that puts increased strain on the cruciate ligament. Cruciate injury can also be seen in cats.
How do I know if my dog has a CCL injury?
Cranial cruciate ligament rupture is normally manifested as a hind limb lameness, stifle swelling and pain. Some dogs will shift weight off the affected limb when standing. When they sit down they can hold the leg out to the side as they lower themselves. The stifle joint can become thickened. In some cases a clicking noise can be heard from the limb when the joint is flexed.
How is CCL injury diagnosed?
The diagnosis is made by establishing that there is stifle joint instability. Instability can be assessed for by a veterinary surgeon using specific palpation tests. These are called the cranial draw test and tibial compression test. In cases of a partial rupture instability is not always present. If the diagnosis can not be made on palpation then arthroscopy (small joint camera) or an arthrotomy (surgical opening of the joint) may be required to visually inspect the cruciate ligaments.
Other tests that can help corroborate the diagnosis include imaging, usually radiography, and arthrocentesis to collect and analyse the synovial joint fluid.
Radiographs show an effusion or increased fluid in the joint and often osteoarthritic change is present. In some cases the tibial will appear to be positioned in a forward position relative to the femur.
Synovial fluid analysis would show evidence of cytological inflammation.
Treatment options
If your dog has a full or partial rupture of the cranial cruciate ligament then, in most cases, tibial plateau levelling osteotomy (TPLO) surgery would be the preferred technique to stabilise the stifle. This procedure gives the best short and long term outcomes.
There are several alternative managements to TPLO each with its own indications and risk profile. These include tibial tuberosity advancement (TTA), cranial closing wedge osteotomy (CCWO) and lateral fabella tibial suture.
In certain cases, for instance if there are other problems either with the stifle or unrelated issues, then alternative managements may be recommended. In some cases the anatomical shape of the tibia or the steepness of the plateau may make another procedure or even a combined technique preferable. For example in some situations a TPLO and a lateral suture can be combined.
The surgery and alternatives will always be discussed with you prior to admission so an informed decision can made regarding the surgery. Surgery will only be carried out if we believe it is in the best interests of you and your pet.
Some cases of cruciate rupture can be managed conservatively by resting the dog and providing analgesia and anti-inflammatories. Overtime the stifle will develop fibrous tissue around the joint which will give the stifle stability. This is rarely successful in heavy dogs (greater than 10Kg) or very active dogs. In cases of marked instability or pain then surgery is usually preferable. If conservative management is attempted a time limit is always given to have seen adequate improvement by and if this is not achieved then surgery would be indicated. In all cases surgical management offers a faster, more predictable and better outcome.
Potential complications of surgery?
As a general rule TPLO surgery is very successful with over 90% of cases returning to normal activity. Complications are rare but can include infection, implant associated problems, secondary fracture, meniscal injury and osteoarthritis. The risks and benefits of the surgery will be discussed at your consultation prior to surgery.
Arranging a referral for your pet?
If your dog has been diagnosed with a cruciate ligament rupture and you would like to come and see us all you have to do is ask your veterinary surgeon to refer you to us. They can do this easily via our website, by email or by phone call. If you can let us know when you have made the request we will know to expect the referral and can follow it up if required.
Frequently Asked Questions
How long does it take for a dog to recover from CCL surgery?
The majority of dogs that undergo TPLO surgery will be taking some weight on the limb within a few days of surgery and this will gradually improve over the following weeks. Although your pet is able to weight bear it is important that exercise is restricted to some degree for the twelve weeks after the procedure. Initially this is very strict but short lead walks will be started at two weeks and gradually built up from that point. From twelve weeks normal activity can be resumed.
What is the success rate of CCL surgery in dogs?
As a general rule TPLO surgery is very successful with over 90% of cases returning to normal activity. Complications can occur but are rare.
Can a dog live comfortably with a torn CCL?
A torn CCL will not heal and dogs with partial tears almost inevitably progress to full tears. A dog can live with a torn CCL but is likely to have persistent lameness to some degree. This is due to instability in the knee. It is possible the knee might become more stable due to fibrous tissue developing around the joint but osteoarthritis will develop which can also cause lameness. The longer the stifle is unstable then there is a greater chance of secondary meniscal injury occurring which is another cause of pain and lameness. Ongoing medications such as anti-inflammatories may be required.
What are the advantages of surgeries like TPLO?
TPLO improves stifle joint stability meaning your pet will rapidly feel more comfortable and can place more weight on the limb sooner. This will also reduce the risk of meniscal injury and osteoarthritic development may be slower. TPLO allows an earlier and better return to function with over 90% of dogs returning to normal activty. The need for ongoing medications is less likely.
Can a ruptured cruciate ligament heal itself in dogs?
A ruptured CCL can not heal itself and most cases of partial rupture will progress to complete rupture over time.
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Arranging a referral for your pet?
If your dog has been diagnosed with cruciate ligament rupture and you would like us to carry out further investigations and treatment all you have to do is ask your veterinary surgeon to refer you to us.
They can do this easily via our website, by email or by phone call. If you can let us know when you have made the request we will know to expect the referral and can follow it up if required.
The Old Dairy Yard, Welsh Way, Ready Token, Cirencester, Gloucestershire GL7 5SY
