Cranial Cruciate Ligament disease

The cranial cruciate ligament (CCL) Is one of the main stabilizing structures of the knee (stifle) joint in the hind limbs of dogs. The CCL is a rope like structure inside the joint that acts as a constant stabilizer of the knee, preventing abnormal slipping of the two bones of the knee joint, the femur and tibia. Its main job is to hold the femur and tibia in proper alignment during all forms of activity.

Deficiency of the CCL is the most common orthopedic problem in dogs and results in degenerative disease (arthritis) in the knee joint. It is referred to as a disease because it is typically the result of a degenerative process in dogs, rather than from athletic injury or trauma. Although it is often noticed after running, playing or jumping, the disease process has been present for weeks to months when symptoms occur.

 Symptoms of CCL disease

• Limping
• Holding the hind limb up
• Sitting with the leg stuck out to the side
• Stiffness, especially after exercise
• Pain when the joint is touched or moved
• Swelling of the joint
• Clicking sound when walking

CCL Diagnosis                                                                           

Your veterinarian should review your dog’s medical history and perform a complete examination using tests of the integrity of the CCL including the “cranial Drawer” and “tibial thrust” tests. X-rays should be performed to assess the amount of arthritis present and aid in determining treatment options. Sedation or anesthesia is necessary for making the definitive diagnosis to avoid causing pain to you pet.  

Treatment Options

It is important understand that there is No Cure for CCL disease in dogs. The goal for all treatments is to relieve pain, improve function, and slow down the arthritis. With these realistic goals in mind, a number of treatment options can be very successful in accomplishing all of them.

~Non-surgical treatment entails rest and non-steroidal anti-inflammatory medication for  6-8 weeks. Once the initial pain and inflammation have subsided, than a strength-building exercise program and weight loss (if necessary) should be initiated. Nonsurgical treatment of CCL disease can be successful at accomplishing our goals, however, the success rate for accomplishing all of our treatment goals is not high and typically only small dogs weighing less than 30 lbs may have good long-term results with this approach.

~Surgical treatment includes numerous options and no treatment has been proven to be better than the others. It is vital to remember that complete assessment of the joint with treatment of damaged tissues such as CCL and meniscus, as well as exceptional postoperative management and rehabilitation programs are as, or even more, important than the CCL surgery itself. The decision should be based on the nest available data on safety and success and the surgeon’s experience with the techniques, and individualized for each patient using the information from the exam and discussion with you regarding your goals and concerns.

Most Common CCL Surgery Techniques       

Tibial Plateau Leveling Osteotomy (TPLO) is one of the “bone-cutting” techniques and is designed to change the anatomy of the knee so that it no longer slips without having to try to replace the function of the CCL. A semicircular cut is made at the top of the tibia with a curved saw so that the tibial joint surface is leveled out to prevent forward slipping of the joint. A plate and screws are applied to stabilize the cut bone during healing.

Tibial Tuberosity Advancement (TTA) is the other “bone-cutting” technique which is designated to change the knee anatomy so that muscle forces are rebalanced to limit the tibia from slipping forward. In this procedure, the boney attachment of the quadriceps muscles is cut, moved forward, and held in place with a spacer, plate, and screws during healing.

Lateral Suture Stabilization is the most common technique. It is one of the “extracapsular” techniques, which means the function of the CCL, which is inside the joint, is replaced by placing a suture outside the joint. The suture, most commonly a type of medical grade “fishing line”, is placed around the fabella and through the tibia providing a soft tissue-to-bone stabilizer of the joint during healing. The suture acts as a temporary stabilizer as the dog makes new functional scar tissue around the knee for long term joint stability.

TightRope CCL was developed two years ago to provide, a minimally invasive and improved methods for extracapsular stabilization of the CCL. This technique does not require cutting of bone like the TPLO or TTA procedures, but instead uses small drill homes in the femur and tibia to pass synthetic ligament-like biomaterial through a small incision to provide bone-to-bone stabilization during healing. The biomaterial used for the TightRope CCL is called FiberTape. This is Kevlar-like material that is used extensively in human surgery for many orthopedic applications. This material has properties that make it stronger and less prone to failure than any other suture materials currently being used for CCL reconstructions.

Things to remember

• Your dog has, or will develop, arthritis associated with the cruciate ligament problem – thus will not be cured with surgery or medications so we will need to manage this for the rest of your dog’s life.
• What you do after surgery is more important than what is done in the operating room – you need to commit to all of the instructions in your discharge summary in order to optimize you dog’s outcome.
• In dogs with one cruciate problem, there is a 50-70% chance that the other knee will have the same problem within weeks to years of the first one.
• After surgery, complications or subsequent problems can occur – each procedure has varying complication rates ranging from less than 10% to over 50% depending on many factors – the overall complication rate for TightRope CCL is currently 18.6% with 9.5% requiring further treatment, including: Infection – 4.6%, Instability – 2.7%, Meniscal tears – 2.2%

The very best things you can do to minimize the chances of the aforementioned situations are to: keep your dog at an ideal weight, follow the discharge instructions exactly, keep your follow-up appointment, and continue wellness care with your regular veterinarian.

*Information Courtesy of Arthrex Vet systems, for more information click the link below 

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