What is the CCL in dogs?
The cranial cruciate ligament, commonly referred to as the CCL in dogs, is one of the main stabilizing structures of the knee (stifle) joint in the hind limbs of canines. The CCL is a rope-like structure inside the joint that acts as a static (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.
What is CCL disease or deficiency?
Deficiency of the CCL is the most common orthopedic problem in dogs and inevitably results in degenerative joint disease (arthritis) in the knee joint. It is referred to as a disease because it is typically the result of degenerative process in dogs, rather than from athletic injury or trauma, though it can happen for those reasons as well. Although it is often noticed after running, playing or jumping, the disease process has been present for weeks to months when symptoms occur.
What are the symptoms of CCL disease?
Some of the symptoms your pet may display are:
- Holding the hind limb up
- Pain when the joint is touched or moved
- Swelling of the joint
- Clicking sound when walking
How is CCL disease diagnosed?
Your veterinarian should review your dog’s medical history and perform a complete examination using tests of the integrity of the CCL, including “cranial drawer” tests. X-rays should be performed to assess the amount of arthritis present and aid in determining treatment options. Sedation is necessary for making the definitive diagnosis in some cases. Based on the diagnosis, your veterinarian will then discuss the various treatments options for your dog with you.
What are CCL treatment options for dogs?
First, it is important to know that there is no cure for CCL disease in dogs. The goals for all treatments are 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. These options include both nonsurgical and surgical options. Which option is best for you and your dog will be determined on a case by case basis that takes into consideration the radiographs and other diagnostics that have been done on your dog prior to determining next steps. Each case is individual so it’s important to understand what is best for your dog specific to their situation and medical history.
Nonsurgical CCL treatment for dogs
Nonsurgical treatment of CCL disease and CCL damage in dogs entails rest and nonsteroidal anti-inflammatory medication for 6-8 weeks. Once the initial pain and inflammation have subsided, a strength-building exercise program and weight loss (if necessary) should be initiated. If the tear is less than 50%, often times Platelet Rich Plasma (PRP) therapy can be instituted. At our animal hospital we have an experience staff including, Dr. Courtney Scairpon, that can make an autogenous retrieval and insertion of the PRP into the affected stifle joint using the Companion Procedure and centrifuge equipment. Most dogs only require light sedation or no sedation and must be on no NSAID therapy for 2 weeks before the procedure. Galliprant is the only NSAID that can be administered without interruption before the procedure because the platelet production is adequate for a good harvest of Platelet Rich Plasma.
Surgical treatment options for dogs with CCL damage
There are numerous procedures to address CCL damage in dogs, and it is vital to remember that complete assessment of the joint with treatment of damaged tissues, such as the CCL and meniscus must be taken into account.
In addition, post-operative management and rehabilitation programs such as Class IV Companion Laser are of extreme importance. We prefer that the Class IV laser procedure be done at our hospital so for 3 weeks post-operative, Dr. Spinks and the other doctors can provide consultation and follow up evaluations. Together with your veterinarian, the surgical procedure and post-op follow up can be outlined before anything is scheduled so that you and your dog can adequate prepare for the maximum chance of effectiveness.
What are the most common CCL surgery techniques and how do they work?
There are a few variations of ways to address CCL correction in dogs with surgical intervention, from more invasive to minimally invasive procedures. It’s important to understand the different procedures and why your veterinarian chooses the option(s) that they do before scheduling a surgery for CCL repair on your pup.
Invasive CCL surgical procedures for dogs:
TPLO (Tibial Plateau Leveling Osteotomy) is a highly invasive “bone-cutting” technique 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. It requires a permanent metal plate and 6 screws to stabilize. Over the 38 years of doing small animal practice, Dr. Spinks has found some dogs that developed osteosarcoma around the metal plates probably a result of magnetism resulting in abnormal bone cell irritation and bone cancer development. He has observed infection and loosening of the implants as well, and as such this is not a preferred method of surgical at our practice.
TTA (Tibial Tuberosity Advancement) is another highly invasive “bone cutting” technique which is also a procedure that changes the knee anatomy to prevent “slipping”. Dr. Spinks has also observed complications post-operative as well. If the TPLO and the TTA procedures fail, the results are catastrophic, where the less invasive surgical treatments are correctable by simply replacing the implant with a minimal procedure. This is a very large concern that most clients fear with the invasive TPLO and TTA.
For this reason, similar to TPLO, Dr. Spinks and the Animal Hospital of Sussex County do not recommend either invasive surgical procedure.
Non-invasive surgical procedures for CCL repair in dogs:
Lateral Suture Stabilization is the most common technique used to treat CCL disease. The suture, most commonly a type of medial 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 stabilizer until the dog produces a functional scar tissue around the knee for long term joint stability. This procedure is not as strong as all the other procedures and is only indicated for very small dogs.
Tightrope CCL Procedure in Dogs
Tightrope CCL surgery is the preferred treatment by Dr. Spinks and the other 4 veterinarians at the Animal Hospital of Sussex County. It was developed in 2005 to provide minimally invasive and improved method for extracapsular stabilization of the CCL. The technique does not require cutting of bone like the TPLO and the TTA procedures, and it is stronger than the Lateral Suture Stabilization procedure, making it effective for treating large as well as small dog breeds.
The Tightrope CCL procedure in dogs uses small drill holes in the femur and tibia to pass a 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 a Kevlar-like material that is used extensively in human surgery for many orthopedic applications. The material has properties that make it stronger and less prone to failure than any other suture materials currently being used for CCL reconstructions in dogs. Dr. Spinks has over ten years of experience doing the procedure, often doing 2 surgeries per week, with great success. He would only use this procedure on his own dogs if needed because it is non-invasive and with results that are better than the other procedures with minimal complications. He feels that a ligament should replace a ligament rather than sawing bone and repositioning. In humans, it is standard to use a ligament to replace the torn ligaments in the knees (such as the common ACL ligament surgeries in humans).
So what does this mean for my dog with CCL issues? Does my dog need Tightrope CCL surgery?
Well, first and foremost, every situation is different so it is important to consult with your veterinarian and when necessary, even get a second opinion. Here at the Animal Hospital of Sussex County we offer free consultations and second opinions for just that reason. We want to make sure that whatever option is chosen for your dog works for you and your pet and your lifestyle for the best chance of long term healing and success.
If you are concerned about your dog’s condition and they show any symptoms of possible CCL disease or damage in dogs, please contact us to set up an appointment or see your local veterinarian to determine next steps.Only after a complete examination and diagnostics, can a plan be developed that will accurately address your dog’s specific situation. If your dog does have CCL damage, you can rest assured that whether you opt for the nonsurgical treatment or the Tightrope CCL procedure with Dr. Spinks and the Animal Hospital of Sussex County team, that your dog is in expert hands and we will see you and your pet through from the very first steps through post-operative follow up and rehabilitation.
Read more about Tightrope Cruciate Ligament Surgery Repair in Dogs or contact us to schedule your appointment today!