Canine CCL Injuries and How We Manage Them

Anterior Cruciate Ligament (ACL) injuries, also known as Cranial Cruciate Ligament (CCL) injuries in dogs, are among the most common orthopedic problems we treat at Santa Ynez Pet Hospital. These injuries can occur for various reasons, including hyperextension of the knee, sudden pivots, steep Tibial Plateau Angles (TPA), and genetic predisposition. Large breeds and overweight dogs are especially prone to these injuries. While some CCL injuries happen suddenly, most cases involve gradual, chronic tearing, particularly in medium to large breed dogs.

Understanding the Role of the CCL

The CCL plays a crucial role in stabilizing the knee joint by preventing the tibia (shin bone) from moving forward relative to the femur (thigh bone). It also limits rotational forces, preventing internal rotation of the knee. When the CCL is damaged, the knee becomes unstable, leading to pain, swelling, and secondary injuries such as:

  1. Osteoarthritis
  2. Tears to the medial meniscus

Managing CCL Injuries

Conservative Management

In some cases, conservative treatment such as rest, pain medications, and rehabilitation exercises may be appropriate. However, surgery is often the recommended approach to effectively address CCL injuries and prevent further complications. Note: External braces are not recommended, as they can cause additional damage to the leg.

Surgical Intervention

Modern veterinary surgery provides a variety of advanced techniques to stabilize the knee joint, with recommendations tailored to each dog’s unique anatomy, activity level, and specific condition, as well as the owner’s preferences and budget. At Santa Ynez Pet Hospital, we combine expert assessment with personalized care to determine the most suitable surgical approach for your pet, ensuring optimal outcomes and long-term joint health. Key elements of CCL surgery include:

  • Joint Exploration: Examining internal structures to address issues like meniscus tears and removing frayed CCL fragments that cause inflammation.
  • Stabilization Surgery: Employing various techniques to restore knee stability

Most Common Surgical Techniques

Extracapsular Stabilization

This technique and its variants involve anchoring a synthetic suture-like material outside the joint capsule to stabilize the knee. By attaching this material to specific biomechanical points on the femur and tibia, it effectively mimics the CCL’s function from outside the joint. This method is particularly suitable for smaller dogs with mild tibial plateau angles, as their lower body weight and reduced joint stress make the procedure more effective and less prone to complications. While cost-effective, it is best suited for small dogs (under 40 lbs) with mild tibial plateau angles. Larger dogs or those with steep TPAs may experience faster joint degeneration with this method, and it is therefore not recommended in these cases.

Tibial Plateau Leveling Osteotomy (TPLO)

When a dog bears weight on a damaged or torn CCL, the femur tends to slide down the back slope of the tibia, causing instability and discomfort. The TPLO procedure addresses this by altering the tibial plateau angle, stabilizing the joint and potentially preserving any remaining healthy CCL fibers. This involves performing an osteotomy (bone cut) to rotate the tibial plateau into a more stable position. Over the last 30 years, TPLO has become the gold standard in specialty CCL surgery for dogs, boasting a high success rate of 90-95% and reliably restoring knee stability and mobility. We have had good success with this technique at Santa Ynez Pet Hospital.

Tibial Tuberosity Advancement (TTA)

The TTA technique moves the tibial tuberosity forward (this is the crest at the front of the shin bone), thereby pulling on the thigh muscles. This effectively pulls the femur forward and reduces stress on the CCL (if partially torn). TTA has limitations in cases with severe slopes or additional joint issues, but is a widely acceptable surgical technique for many cases. We do not perform this surgery at Santa Ynez Pet Hospital, as we do not believe it holds any advantages over TPLO and CBLO.

CORA-Based Leveling Osteotomy (CBLO)

CORA-Based Leveling Osteotomy (CBLO) is a specialized surgical procedure designed to treat CCL injuries in dogs with precision and effectiveness by combining the many aspects of the TPLO and TTA techniques. CORA stands for Center of Rotation of Angulation, a key principle in orthopedic surgery and joint geometry. By pinpointing the CORA, the surgeon can adjust the tibial plateau angle while aligning both the mechanical and anatomic axes of the tibia, which does not occur with any other technique. The CBLO procedure is particularly good for young dogs with active growth plates and for dogs with excessively steep tibial plateau angles.

Other Surgical Techniques

Cranial Closing Wedge Osteotomy (CCWO)

This is the predecessor to the modern day TPLO. It involves making a wedge shaped osteotomy so as to tilt the tibial head forward and change the angle of the plateau. With the advent of the TPLO, it fell out of favor, but is occasionally still combined with a TPLO for more severe tibial plateau angles. A slightly improved variation of this technique is the Neutral Wedge Osteotomy.

Modified Maquet Procedure (MMP)

Similar to TTA, MMP uses an implant to stabilize the knee. This newer technique offers promising results for specific cases, particularly in dogs with mild to moderate tibial plateau angles.

Fibular Head Transposition (FHT)

This method involves altering the fibular head to restore stability. While less commonly performed, it can be a viable option for certain dogs with CCL injuries.

Primary Ligament Repair and Grafting

Techniques such as autografts (using the dog’s tendon) or allografts (donor tissue) aim to reconstruct the CCL. These advanced procedures are typically performed in specialty or research settings and are less common in routine veterinary practice.

The TPLO and CBLO Procedures at Santa Ynez Pet Hospital

Our TPLO/CBLO approach involves:

  1. Pre-Surgical Assessment: Comprehensive examination and X-rays to determine the severity of the injury.
  2. Surgery: Precision adjustment of the tibial plateau angle to restore knee stability.
  3. Post-Surgical Care: Individualized recovery plans with pain management, physical therapy, and follow-up visits.

Partnering in Your Pet’s Recovery

At Santa Ynez Pet Hospital, your pet’s well-being is our priority. Our team provides expert guidance and compassionate care throughout the treatment process. With our advanced surgical techniques and dedicated support, we’ll help your dog return to an active, happy life.

If your dog is dealing with a CCL injury, contact us today to schedule a consultation and explore the best options for their recovery. Let’s work together to get your furry friend back on their paws!