The cranial cruciate ligament, or CCL, is a ligament located in the knee joint of dogs that is responsible for keeping the femur and tibia in proper alignment during movement. This ligament can become damaged or torn, commonly referred to as a torn ACL in humans, leading to pain, instability in the joint, and a reduced quality of life for the affected dog. In this blog, we will be discussing the symptoms and treatment options for CCL injuries in dogs.
Symptoms of a Cruciate Ligament Injury
Dogs with a CCL injury may exhibit a variety of symptoms, including lameness or limping, difficulty standing or walking, stiffness in the joint, swelling or inflammation, and a reluctance to use the affected leg. These symptoms may occur suddenly, as the result of an injury such as jumping or landing awkwardly, or they may develop gradually over time as the ligament wears down with age. In some cases, dogs may experience a partial tear of the CCL that causes mild pain and stiffness while walking, whereas more severe tears can lead to complete hind leg paralysis and require urgent veterinary care.
Diagnosing a Cruciate Ligament Injury
To diagnose a CCL injury, your veterinarian will perform a physical examination and may recommend additional testing such as x-rays, joint aspiration, or arthroscopy to determine the extent of the damage. Your vet will also ask about your pet's medical history, diet, and lifestyle to help identify potential underlying factors that may have contributed to the injury.
Treatment for a Cruciate Ligament Injury
The treatment options for CCL injuries in dogs depend on the severity of the injury and the animal's overall health and lifestyle. For mild to moderate tears or partial tears, your veterinarian may recommend rest, anti-inflammatory medication or supplements, and physical therapy to help strengthen the joint and restore mobility. In more severe cases, surgical intervention may be necessary to repair or replace the damaged ligament.
There are several surgical options for CCL repair, including:
1. TPLO - Tibial Plateau Leveling Osteotomy
TPLO is a surgical procedure that involves altering the angle of the tibia bone in order to stabilise the joint and prevent further damage to the CCL. This procedure is typically recommended for larger dogs or those with more active lifestyles, as it requires an extended recovery period and strict post-operative care to ensure proper healing.
2. TTA - Tibial Tuberosity Advancement
This surgery follows the same principle as TPLO, with a cut being created in the tibia to allow a change in geometry that renders the CrCL redundant. The mathematical principles behind TTA are more complex than those behind TPLO; however, the basic principle is that an altered direction of traction from the quadriceps muscle group produces a force across the knee joint that neutralises the tendency for the femur to roll down the slope of the tibial plateau. In effect, both TTA and TPLO aim to render the tibial plateau perpendicular to the straight patellar tendon and in so doing, neutralise the tendency for the femur to slip down the slope of the tibia.
3. Extra-capsular Repair
Extra-capsular repair is a less invasive surgical procedure that involves using a suture material to stabilise the joint and support the weakened CCL. This procedure is typically recommended for smaller dogs or those with less severe injuries, as it requires a shorter recovery time and is less invasive than other surgical options.
4. Tightrope Procedure
The Tightrope procedure is a newer surgical option that uses a specialised device called a Tightrope to stabilise the joint and support the CCL. This procedure is minimally invasive and requires a shorter recovery time than other surgical options, but may not be suitable for all dogs depending on the location and severity of the injury.
Regardless of the type of surgical procedure selected, it is important to carefully follow your veterinarian's post-operative care instructions to ensure proper healing and minimise the risk of complications such as infection or re-injury.
Hydrotherapy is often recommended post-operativley for a CCLR to help build up the surrounding muscles to support the joint and prevent further re-injury, this is also useful for helping to prevent the rupture of the cruciate ligament in the other hindlimb. Hydrotherapy treatment can also be used to conservatively manage a tear of the cruciate ligament and aid in preventing a full rupture. If your dog has been diagnosed with this condition, there is information through the link above to help you start your dogs journey to recovery.
Pain management
This is where we should always start! In addition to pharmacological protocols which often involve the use of NSAIDs there are non-pharmacological methods for managing pain, such as cryotherapy and the use of various electrophysical agents (EPA’s) like transcutaneous electrical nerve stimulation (TENS) laser therapy and pulsed electromagnetic field therapy (PEMF). You should work alongside the vet to get the best response from the patient. Tissue Healing EPA’s can also directly promote healing in the injured ligament, components of the joint and the supporting soft tissues that have been affected by the surgery and the injury itself. Therapeutic ultrasound is a modality often used for ligament repair. Therapeutic exercise A gradual return to normal activity is not sufficient to regain the strength lost after surgery or injury or to restore normal joint kinematics. To ensure full functional recovery and to reduce the chance of secondary osteoarthritis or re-injury, an exercise rehabilitation programme is necessary - this should be specifically tailored to the individual. The key areas to consider are:
Periarticular and core muscle strengthening: Strengthening the muscles around the affected joint is an important part of the rehabilitation process. Periarticular muscles are those that surround the joint, while core muscles are those that support the spine and pelvis. Strengthening these muscles can help improve joint stability and prevent future injuries. Exercises may include resistance training, balance training, and functional training.
Rhythmic Stabilisation is a type of sensory facilitation exercise that stimulates extensor muscle contraction in response to joint compression.
Correction of proprioceptive deficits: After an injury or surgery, proprioceptive deficits can occur, which can lead to instability and poor joint control. Correction of proprioceptive deficits involves exercises and techniques that focus on improving body awareness and control, such as balance and coordination exercises, joint position sense training, and neuromuscular training.
Restoration of normal range of motion: Restoration of normal range of motion (ROM) is an important goal of the physiotherapy rehabilitation program. This involves exercises and techniques that focus on improving joint mobility, such as active range of movement exercises and again, proprioceptive training. The specific exercises and techniques used may vary depending on the individual case and the type of injury or surgery.
Gradual progression tailored to the individual circumstances: Correct timing of progression is essential to prevent re-injury or complications. For example, if an intracapsular technique has been performed, the graft is weak as it goes through revascularization and bio-integration processes. Therefore, even if rehabilitation is very similar to that for extracapsular techniques, it is imperative to proceed more gradually.
Figure of 8 is a functional exercise which stimulates co-ordination and balance as well as weight bearing, limb abduction and adduction.
Preventing Cruciate Ligament Injury
While not all CCL injuries can be prevented, there are several steps pet owners can take to minimise the risk of injury, including maintaining a healthy weight, providing regular exercise and physical therapy, avoiding activities that place excessive strain on the joints, and providing a well-balanced diet that supports joint health. Regular veterinary check-ups and early intervention for any signs of lameness or joint pain can also help identify potential issues before they become more severe.
In conclusion, CCL injuries can be a painful and debilitating condition for dogs that can significantly impact their quality of life. However, with proper diagnosis, treatment, and care, most dogs can make a full recovery and return to their normal activities. If you suspect your dog may be experiencing CCL-related symptoms, it is important to seek veterinary care promptly to identify the underlying issue and develop an appropriate treatment plan to improve their overall health and well-being.