CCL Rupture - FUSION VETERINARY ORTHOPEDICS

Cranial Cruciate Ligament (CCL) Disease

Causes, treatments and other useful information regarding this orthopedic condition.

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What is a
Cranial Cruciate Ligament?

The Cranial Cruciate Ligament (CCL) is an essential stabilizer of the stifle (knee) joint in dogs, preventing hyperextension, internal rotation of the tibia, and tibial thrust in relation to the femur. Rupture of the CCL, analogous to an ACL rupture in humans, is a common orthopedic issue in dogs. Unlike humans, where ACL tears often result from traumatic events, CCL ruptures in dogs are degenerative, typically occurring without significant trauma. Factors such as genetics, obesity, gender, and immune-mediated diseases may contribute to the weakening of the CCL, leading to pain, lameness, and osteoarthritis (OA) upon rupture.

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Diagnosis of a CCL tear involves an orthopedic exam, including tests like the cranial drawer and cranial tibial thrust, rather than relying solely on radiographs. Excessive fluid in the joint and pain upon stifle hyperextension are common findings. Radiographs help rule out other issues and assess joint effusion and OA severity. Treatment options include conservative management and surgical intervention, with surgery generally recommended for faster recovery and reduced OA progression. Conservative management may involve exercise restriction, rehabilitation, and possibly custom-fitted stifle braces, though braces are not a substitute for surgery.

Surgical management at Fusion Veterinary Orthopedics typically involves a minimally invasive arthroscopic procedure to confirm the tear and assess the meniscus and OA degree. The preferred surgical technique is the tibial plateau leveling osteotomy (TPLO), which stabilizes the stifle by altering its biomechanics to eliminate the need for the CCL. This involves making a circular cut in the tibia, rotating it to flatten the slope, and securing it with a locking plate and screws. Dr. David Dycus, an expert in this procedure, has performed over 7,000 TPLO surgeries.

Diagnosis

Initial rest is followed by prescribed home exercises and slow leash walking. Staples or sutures are removed around two weeks post-surgery, with radiographs and orthopedic exams at 8 and possibly 12 weeks to ensure proper healing. Rehabilitation starts two weeks post-surgery, involving formal sessions and at-home exercises to promote quicker healing, maintain muscle mass, and improve outcomes. Long-term management includes joint supplements, omega-3 fatty acids, maintaining a healthy weight, and staying active.

Post-surgery care includes 8-12 weeks of rest and restricted activity, with controlled movements indoors and leash use outdoors.

Are there any complications?

Despite the best care, about 50-60% of dogs that rupture one CCL will tear the other within 15-18 months. Fusion Veterinary Orthopedics aims to restore normal function quickly, but complications can occur, such as implant breakdown, postoperative meniscal tears, infections, and soft tissue injuries. Postoperative meniscal tears are addressed with arthroscopy, while infections are managed with antibiotics and possibly removing the implant once the bone heals. Overactivity can cause implant issues and soft tissue injuries, typically resolving with rest, rehabilitation, and medications. Dr. David Dycus co-edited a textbook on managing complications in canine CCL surgery, aiding veterinarians in addressing surgical challenges.

Are there any complications?

Despite the best care, about 50-60% of dogs that rupture one CCL will tear the other within 15-18 months. Fusion Veterinary Orthopedics aims to restore normal function quickly, but complications can occur, such as implant breakdown, postoperative meniscal tears, infections, and soft tissue injuries. Postoperative meniscal tears are addressed with arthroscopy, while infections are managed with antibiotics and possibly removing the implant once the bone heals. Overactivity can cause implant issues and soft tissue injuries, typically resolving with rest, rehabilitation, and medications. Dr. David Dycus co-edited a textbook on managing complications in canine CCL surgery, aiding veterinarians in addressing surgical challenges.

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