Cranial Cruciate Ligament Injuries in DogsLigament injuries are a common cause of lameness in dogs. If your dog is limping or has recently been diagnosed with a cranial cruciate ligament injury, you may be wondering about the cause and the treatment options. Read on to learn all about cranial cruciate ligament disease and what it means for your dog.FirstVet is the #1 online video veterinary service.FirstVet offers video calls with experienced veterinarians for just $35. You can get a consultation within minutes by downloading the FirstVet app for free from the Apple App Store or Google Play Store. Over 500,000 users trust FirstVet to care for their animals. Rating: 4.9 - more than 1600 reviewsRating: 4.9 - more than 1300 reviewsRating: 4.9 - more than 1600 reviews Download app What is the Cranial Cruciate Ligament?The Cranial Cruciate Ligament (CCL) is equivalent to the ACL in people. It is one of four ligaments in the stifle (knee) responsible for maintaining stability. These knee stabilizers are called the medial and lateral collateral ligaments and the cranial and caudal cruciate ligaments.The CCL specifically helps prevent the knee from rotating inwards and hyperextending. All of these ligaments are inside the knee joint, so if the CCL becomes partially or completely torn, it can cause a lot of inflammation in the joint. In addition, the knee becomes unstable, rotating inwards inappropriately, causing further pain. Excess stress is then put on other ligaments, such as the meniscus, which can tear and cause even more pain and inflammation.Facts About Cranial Cruciate Ligament Disease in DogsIt is the most common orthopedic condition in dogs (out of about 40 conditions affecting back legs in dogs)CCL injuries are a relatively rare orthopedic condition in catsDogs can have a partial or complete rupture of the CCLSymptoms can have a sudden onset or be chronic in natureDogs with CCL injuries will show varying degrees of lameness (limping)Osteoarthritis (arthritis) will occur as a result. This is the body’s method to stabilize the knee on its own, but it is slow and painful. This process begins immediately after the injury and worsens over time.Surgical stabilization of the knee can significantly decrease the amount of arthritis that develops.Causes of CCL Disease in DogsTrauma - May occur at a time of high impact activity, accident, or injury. This results in a very unstable knee where your dog will suddenly hold up the leg completely and develop a non-weight-bearing lameness.Genetic - Slow, gradual degradation of the ligament, causing waxing and waning symptoms over time. You may still notice symptoms suddenly, but not be able to relate them to a traumatic event. Unfortunately, genetic causes of CCL disease often lead to tearing of both the left and right ligaments within 2 years of each other.Clinical Signs of Cranial Cruciate Disease in DogsLameness, limping, abnormal gaitLameness is chronic, always on the same leg, and doesn’t get better on its ownHolding up the leg completely, toe-touching, or using the leg with a limpLimping can be worse if your dog is affected by a tick-borne bacterial infection such as Lyme, Anaplasma, and Ehrlichia which can cause joint swellingDog won’t jump up (onto bed or couch, into the car)Decreased activityDiagnosing CCL Injuries in DogsDiagnosis is usually made by a combination of examination and x-rays:Orthopedic exam - A vet can feel the dog’s knee and determine if one or both typical signs of a torn cranial cruciate ligament is present: cranial drawer and tibial thrustRadiographs - X-rays will show any joint swelling, fractures, genetic bony abnormalities, arthritis, and previous injuries (you cannot see the cranial cruciate ligament itself on an x-ray)Treatment of CCL Injuries in DogsTreatment depends on the severity of the condition, the age, weight, and size of the pet, and the time at which it is diagnosed versus when the injury occurred. Surgery is often recommended because, without it, the knee develops far more arthritis, resulting in stiffness and pain that can worsen over time.Strict restOften advised for the first two weeks before slowly increasing daily activity for the following 4 weeksActivity restrictions include cage rest, no running, jumping or high impact activity, no catching balls or frisbees, no walks, just going outside to urinate and defecate on a leash at all timesRestricted areas of movement so there is no running indoors throughout the homeNo stairs, no jumping UP onto couches, beds, or into carsJoint supplementsSupplements such as glucosamine and chondroitin are often given daily for life in any pet who has an injury involving a joint, both with and without surgical treatmentMedicationsMedications such as NSAIDs (non-steroidal anti-inflammatory pain medications), neuromuscular pain medications, and/or synthetic opioid pain medications may be indicated and prescribed by your vet.SurgerySurgery to stabilize the cranial cruciate ligament is often performed by a board-certified veterinary surgeon. However, many general practice veterinarians will perform surgery as well. Surgery is typically recommended in young, large dogs due to their size and weight and the number of years they have left to run and play. Surgery is not always advised in smaller dogs who may manage with only pain medications and strict rest while healing.Unlike in people, the surgeon does not attempt to repair or replace the ligament using a person’s ankle ligament or that of a cadaver. Instead, in veterinary medicine, surgeons stabilize the knee using a different procedure.There are three surgical procedures that can be performed to stabilize the knee. Surgery will always consist of opening up the joint capsule, removing and cleaning out any torn and damaged pieces of the CCL, and closing the joint. Then, one of the following procedures is performed:1. Extracapsular RepairTradition surgical repair method using large gauge, strong suture through portions of the tibia and fabella bones to tighten and stabilize the jointNo hardware is involved, so some general practice vets will perform this surgeryThis procedure is typically better for smaller and/or lighter dogsLess invasive procedure2. Tibial Plateau Leveling Osteotomy (TPLO)The most common surgery of choice for CCL rupture in dogs, especially larger, heavier dogsMore invasive than extracapsular repairRequires a veterinary surgeon with specialized trainingInvolves cutting and rotating tibia and the use of hardware to change the angle at which the femur bears weight onto the flat ‘plateau’ of the tibia3. Tibial Tuberosity Advancement (TTA)More invasive than extracapsular repairRequires a veterinary surgeon with specialized trainingInvolves cutting and repositioning the tibial crest (area of the tibia where the patellar ligament attaches) and the use of hardware to change the angle of the patellar ligamentRehabilitation after surgery may include massage, icing, passive range of motion and stretching exercises, hydrotherapy (water treadmill), slow, controlled walking, laser therapy, acupuncture, and more. Rehabilitation helps manage pain by decreasing inflammation, maintaining good range of motion in the joint, encouraging use of the limb, decreasing muscle atrophy, and increasing proprioception.For information on the four phases of rehabilitation, click here.For easy to understand anatomical diagrams and information about cranial cruciate ligament ruptures in dogs, click here.Read more:Nothing to bark about! Causes of Limping in Dogs (and what you should do!)Joint Supplements for PetsHave more questions about limping or knee injuries in dogs?Schedule a video consult to speak to one of our vets.