CCL/ACL Injuries
CCL = Cranial Cruciate Ligament
ACL = Anterior Cruciate Ligament
(most commonly seen in dogs)
What is the ACL/CCL?
• It’s one of the two ligaments connecting the
femur and tibia bones.
• These ligaments are there to keep the bones
from rubbing across each other.
How does the injury occur?
• Specifically – the knee twists too much and
the ligament ruptures.
– Examples:
• Slipping on a floor
• Excessive running
• Trauma (i.e. hit by car)
• Degeneration of the ligament
• Obesity
Breeds Affected
• These breeds are seen to
have increased risk of
degeneration.
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Labrador Retriever
Newfoundland
Rottweiler
Bichon Frise
St. Bernard
Boxer
West Highland White
Terrior
• Remember: ANY dog can
rupture their ACL/CCL
• Most that are
predisposed will get it in
both knees.
• In small breeds, a luxating
patella may predispose
them.
Symptoms of these injuries
• Variable lameness on
one or both hind feet
• Lameness in affected
limb (especially after
exercise) that gets
better with rest
• Abnormal posture
• Reluctance to run,
jump, or rise from
sleep.
• Morning stiffness
• When sitting, one leg
sticks out to one side
• Swelling around the
knee joint
• Slight deterioration of
the muscles on the
affected limb
*If symptoms are very minor,
it may be because of slight
deterioration.
How is it diagnosed?
By watching and touching the
animal.
• Veterinarian views a limp with
paw slightly touching the
ground
– Dog will not put any weight on
the affected foot.
With Radiography
• Only used to access the
amount of arthritis present
in the knee joint.
• Veterinarian manipulates the
affected knee feeling for
‘drawer movement’
– The movement of the femur
across the tibia
• This is the only way to confirm
the presence of rupture.
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•
http://www.youtube.com/watch?v=9jg9E2nBt_E
Picture taken from University of Liverpool website
How X-rays are used for this injury
• Important because they will
help evaluate the secondary
conditions
– Osteoarthritis
– Joint cartilage injury
– Accumulation of fluid around
the joint.
Picture taken from
University of
Liverpool website.
X-ray technique:
• Area that x-ray is taken at to
get view of ACL/CCL = the
stifle/knee joint
• Best view is lateral but CaCr
also necessary.
• Measurement taken at the
area of the widest part of stifle
joint.
• Beam centered over the stifle
joint.
• Veterinarian will measure the
slope of the tibia to help
choose which surgery to do
How to fix this injury…
• Surgery is the best most definitive option for medium
to large size dogs.
• There are various types of surgery.
• Surgery will correct the ligament problem only
• Majority of the time will also have to treat the
accompanying issues
– Arthritis
– Joint fluid
• But these problems may not happen for years.
• Nylon bands can be used to correct a small dog’s
rupture.
• Some claim restricted activity for a long period of time
after diagnosis will allow the joint to realign itself.
Surgical Correction Options
• 1. TPLO – Tibial Plateau Leveling Osteotomy
– Most recommended for large breed dogs.
– Procedure:
• Surgeon checks the cartilage of the knee to determine
if it is also torn
• There is a cut made into the plateau of the tibia
• It is rotated to make the slope more level with the
femur
• A plate and screws are inserted to make sure that it
stays in place.
– Much of the success of this option depends on the
owners post-op care.
TPLO – before and after x-rays
Surgical Correction Options
• 2. TTA – Tibial Tuberosity Advancement
– a slightly less invasive procedure with slightly
quicker recovery time
– Results very similar to the TPLO option
– Procedure:
• Cut is made into the front part of the tibia (the
tuberosity)
• This part is pushed forward to remove the abnormal
sliding of the bone
• A specialized bone spacer in placed in the space that
was created. Plate and screws also used to secure the
bone in place.
TTA – x-rays post surgery.
Nylon Band Treatment
• Most commonly used in small dogs and cats
• A suture material made of nylon is passed
between the back of the femur to the tibia
crest
• Scar tissue develops over time to stabilize the
joint
Prognosis?
• With proper care, animal will return to regular
activity.
• Will most likely need to be on NSAIDs for the
osterarthritis.
• If only one side was affected/corrected the
other one is more likely to eventually rupture
Sources:
• Degner, Daniel DACVS. “Cranial Cruciate Ligament Rupture – Lateral
Fabellar Technique (Extrascapular Technique).” Vet Surgery Central
Inc. 8 September 2010.
http://www.vetsurgerycentral.com/cruciatelrt.htm.
• Degner, Daniel DACVS. “Tibial Plateau Leveling Osteotomy.” Vet
Surgery Central Inc. 8 September 2010.
http://www.vetsurgerycentral.com/tplo.htm.
• Degner, Daniel DACVS. “TTA for Cranial Cruciate Ligament Rupture
in Dogs.” Vet Surgery Central Inc. 8 September 2010.
http://www.vetsurgerycentral.com/ortho_TTA.htm.
• Innes, John RCVS. “Cruciate Ligament Rupture.” University of
Liverpool Small Animal Teaching Hospital. 8 September 2010.
http://www.liv.ac.uk/sath/conditions/cruciate.htm.
• Nash, Holly DVM, MS. “Ruptured Anterior Cruciate Ligament.” Pet
Education.com. Doctors Foster and Smith. 8 September 2010.
http://www.peteducation.com/article.cfm?c=2+2084&aid=474.