Cranial Cruciate Ligament Rupture
Rupture of the cranial cruciate ligament
of the knee joint is the most common orthopedic injury in dogs. It
results in hindleg lameness which may appear suddenly or progress slowly
over weeks to months.
Function of the Cranial Cruciate Ligament
The knee joint (or stifle) has a number
of important parts illustrated below:
The CCL prevents the tibia from pushing
forward and rotating inward and provides general stability to the
Rupture of the Cranial Cruciate Ligament
In many dogs, the cause of CCL rupture
is unknown. It often appears to involve premature degeneration of
the ligament and/or abnormal alignment of the knee bones. Occasionally
a traumatic event or vigorous exercise precedes rupture but many dogs “seem
fine one minute and lame the next”. Whatever the cause, rupture results
in instability, pain, lameness, joint swelling and eventually arthritis.
Diagnosis is made by examination of the
knee joint and identifying instability. Sometimes sedation or anesthesia
is required to make a definitive diagnosis. Occasionally, findings
on X-Rays are utilized to support suspicion of CCL rupture and to rule-out
other causes of hind leg lameness.
Initial treatment is usually rest and
anti-inflammatory medications. Most smaller dogs, those weighing
less than 35 lbs, do very well with rest and anti-inflammatory medication.
most dogs weighing greater than 35 lbs (and some less than 35 lbs) require
surgery to have a satisfactory outcome. As a general rule, if
a pet remains lame, or again becomes lame, after 2-4 weeks of initial treatment,
surgery will eventually be necessary.
Surgical Repair of Cranial Cruciate
Goals of Surgery:
Most dogs weighing more than 35 lbs (and some
less than 35 lbs) need surgery for satisfactory outcome.
A successful outcome with surgery is expected
in 90-95% of cases.
Regardless of the treatment, some arthritis
will develop in the knee.
General anesthesia is utilized for the procedure
The faint scar remaining after surgery usually
becomes covered with fur again.
An overnight stay is required so discomfort
can be controlled with injectable pain medication.
Relieve pain associated with the ligament
Stabilize the knee joint in a more anatomically
Decrease the amount of arthritis which will
inevitably develop in the knee.
Limit stress put on the opposite limb and
other limbs and joints.
Many different procedures exist for the stabilization
of the knee joint.
No procedure has been shown to be superior
to the others over the long term.
The ligament itself is typically too damaged
to be repaired or replaced
Repair of the injured knee involves three
Exploration of the joint to confirm
the diagnosis and identify the extent of damage.
Removal of damaged ligament and cartilage.
Stabilization of the knee joint with
a thick nylon suture or artificial ligament. The suture is placed
around the fabella and through the tibia.
The recuperative period typically lasts for
a total of 8-12 weeks.
Pets gradually begin to put weight on the
operated leg over the first 14 days.
Physical therapy comes in the form of progressively
longer leash walks over the following weeks.
Initially, exercise is limited to walks to
Skin sutures are removed 10-14 days after
Exercise on leash is gradually increased over
the following weeks; swimming is also excellent exercise.
Pain medication and antibiotics are administered
for several days after surgery.
No running, jumping or playing is permitted
for at least 12 weeks following surgery.
Outcomes, Complications, and Risks:
Most pets are permitted to resume normal activity
several months after surgery.
As many as 30% of dogs will require surgery
on the opposite knee in the future.
5-10% of dogs have lameness after surgery
which is controlled with medication.
Rarely …the artificial ligament needs
to be removed or replaced …infection after surgery makes additional surgery
(or even amputation) necessary
Cost of the Procedure:
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This typically includes examination, pre-anesthetic
bloodwork, anesthesia, surgery, hospital care, post-operative medications,
and two follow-up examinations.
Please ask your veterinarian for a detailed
surgical estimate for your pet.