Cranial Cruciate Ligament

What is cranial cruciate disease?

The cranial cruciate ligament (CCL) is one of the main stabilizing structures of the knee joint in the dogs hindlimb. The CCL prevents abnormal ‘slipping’ of the two bones of the knee joint, the femur and tibia, holding them in proper alignment during all types of activity.

Cranial cruciate ligament disease is the most common cause of hindlimb lameness in the dog. It is typically the result of a degenerative process in dogs, although it is often noticed after running, playing or jumping. Damage to the cranial cruciate ligament causes instability and pain in the affected limb.

Symptoms of CCL disease

  • Limping
  • Joint pain
  • Swelling of the joint
  • Clicking sound when walking
  • Sitting with leg out to the side
  • Stiffness, particularly after exercise
  • Reluctance to play or exercise

                  

Treatment of CCL disease

Whilst there is no cure for CCL disease in dogs, the goals of treatment are to relieve pain, improve function by stabilization and limit the progression of arthritis.

Many surgical treatment options are available. No one procedure has proven to be superior to another and appropriate procedures will vary depending on each case. During the surgery a complete assessment of the joint is often necessary. Surgical management, in combination with well managed postoperative care and rehabilitation program can significantly improve the outcome and prognosis for dogs with CCL disease.

              

Common CCL surgery techniques

  1. Tibial Plateau Leveling Osteotomy (TPLO)

The tibial plateau leveling osteotomy technique is a bone cutting techniques designed to change the anatomy of the knee so that it no longer ‘slips’, without having to replace the function of the CCL. A semi-circular cut is made at the top of the tibia (shin bone) with a curved saw so that the sloping tibial joint surface is levelled out. A plate and screws are used to stabilize the cut bone during healing. The femur is able to hinge on the horizontal surface of the tibia without slipping backwards.

  1. Tibial Tuberosity Advancement (TTA)

The tibial tuberosity advancement technique is a bone cutting technique designed to change the anatomy of the knee, so that muscle forces are rebalanced to prevent the femur slipping backwards down the sloping top of the tibia. In this procedure, the front of the tibia (shin bone) is cut, moved forwards and held in place with a spacer, plate and screws while the bones heal in their new position.

  1. Cranial Closing Wedge Osteotomy (CCWO)

The Cranial Closing Wedge Ostectomy is a bone cutting technique designed to change the anatomy of the knee, so that muscle forces are rebalanced and the femur no longer ‘slips’ backwards down the sloping top of the tibia. In this procedure, a wedge of bone is cut and removed from the front of the tibia (shin bone). The remaining bone is then brought together and heled in placed with a plate and screws while the bones heal in their new position.

  1. Extracapsular Suture Stabilization (Lateral Suture)

This technique provides a minimally invasive method for extracapsular stabilization. The function of the cruciate ligament, which is inside the joint, is replaced using a tensioned band of nylon outside the joint. Small drill holes in the femur (thigh bone) and tibia (shin bone) are created and a synthetic nylon material is passed from one hole to the other to provide bone-to-bone stabilization that mimics that of the cranial cruciate ligament. The suture acts as a temporary stabilizer as the dog makes new functional scar tissue around the knee for long-term joint stability.

               

Things to remember about your dog’s cruciate problem

1.Your dog will invariably develop arthritis associated with cruciate ligament disease. This will not be cured by surgery or medications. It will need to be managed for the rest of your dog’s life.

2. Post-operative care is as important as the surgery itself. Commitment to the discharge instructions and post-operative rehabilitation is a must for the optimum outcome for your dog.

3. For dogs that have had a cruciate ligament problem in one knee, there is a 50-70% chance that the other knee will have the same problem within 1-2 years.

4. Following surgery, complications or subsequent problems are possible. The most common being late meniscal injury. Each knee has two menisci. These are cartilage pads that sit between the tibia and femur and act as shock absorbers and stabilisers in the knee joint. The menisci can be damaged in association with cruciate ligament rupture either at the time of the initial injury or occasionally weeks to months after surgery (late meniscal injury). A meniscal tear is treated by surgically removing the damaged meniscus.

To minimise the risks of any of the above you should:

  • Keep your dog at an ideal body weight
  • Follow the discharge instructions and rehabilitation program closely
  • Attend all follow up appointments
  • Continue to attend routine clinics for health check ups