Cruicate Ligaments: What are they, what do they do and why are they important?
Rhea-Anna Price
Aug 29, 2014
Ligaments are bands of fibrous tissues that connect two bones or cartilage at a joint. In the stifle
(knee), there are four main ligaments. The medial (inner) aspect of the knee is the medial
collateral ligament (MCL) and the lateral (outer) aspect of the knee is the lateral collateral
ligament (LCL). There are two cruciate ligaments in the center of the stifle joint that function to
provide joint stability: the Cranial Cruciate Ligament, often referred to as the CCL and the
Caudal Cruciate Ligament. In humans, they are referred to as the ACL or Anterior Cruciate
Ligament and the PCL, or Posterior Cruciate Ligament. These are important stabilizers inside
the stifle joint. These cruicate ligaments connect two long bones called the femur (large bone in
thigh) and tibia (large shin bone). There are cartilage pads in the inside and outside of the joint:
Medial Meniscus and Lateral Meniscus, respectively. They sit between the femur and tibia and
act as shock absorbers or cushions for the joint also providing stability. The CCL originates
from the femur and inserts at the top of the Tibia Plateau between the Medial and Lateral
Menisci. It crosses over the Caudal Cruciate Ligament in the shape of a cross or crucifix, thus
the name cruicate. The Caudal Cruciate Ligament also originates from the femur, but inserts at
the back of the Tibia Plateau to prevent backward movement. These two ligaments can move
independently, but work together to keep the tibia and femur aligned for stability (Broadhurst).
Tendons connect muscles to bones. The Quadriceps Tendon connects the quadriceps muscles on
the front of the thigh to the top of the patella (knee cap), a small sesamoid bone centrally located
on the front of the stifle. It slides up and down in a groove in the femur (the femoral groove) as
the knee bends and straightens. The patellar tendon, attaches to the front of the tibia. The
hamstring muscles on the back of the thigh attach to the tibia at the back of the knee. The
quadriceps muscles are the main muscles that straighten the knee. The hamstring muscles are the
main muscles that bend the knee (ACVS.org / www.orthopets.com).
(http://dogkneeinjury.com/anatomy-of-the-cranial-cruciate-ligament/)
(http://www.endoszkop.com/know-deeper-about-muscles-of-the-knee/muscles-of-the-knee-andhip/)
A torn CCL is one of the most common orthopedic issues in dogs causing hind limb lameness,
pain, and arthritic discomfort (ACVS.org). Cranial cruciate ligament disease is defined as the sudden or
progressive failure of the cranial cruciate ligament, which results in partial to complete instability of the
stifle joint. Cranial cruciate rupture is the tearing of the cranial cruciate ligament; it is the most common
cause of rear-leg lameness in dogs and a major cause of degenerative joint disease (progressive and
permanent deterioration of joint cartilage) in the stifle joint. This can be complete or partial rupture
(www.petmed.com).
When the CCL is torn, stability of the stifle joint is compromised as the tibia can move forward
relative to the femur. This movement can cause damage to the medial and lateral menisci. Dogs with this
type of injury have a lame leg that can touch the ground, but won’t bear full weight. Injury diagnosis is
done at the vet’s office to observe the abnormal joint movement. The vet will try to recreate a “drawer
sign” movement by placing one hand on the tTibia and the other on the fibula to manipulate the joint
(Pienaar). If the tibia can be moved forward like the opening of a drawer, the cruicate has been torn or
ruptured.
A Tibia Compression Test is another way to check for ligament damage. The femur is held steady
with one hand while the other flexes the dog’s ankle. A ruptured ligament allows the tibia to move
abnormally forward (www.whole-dog-journal.com).
Radiographs are taken to see ligaments, as they are not visible on x-rays. But, x-rays are often
taken as a means to observe other potential associated injuries or conditions like arthritis and to rule out
bone cancer. Typically, if the cruciate is completely severed, surgery is the primary treatment, as the
stifle can no longer perform as a stable hinged joint. If the injury is only a partial tear, more conservative
methods are often implemented first (www.whole-dog-journal.com).
Acupuncture, acupressure, chiropractic and massage are holistic therapies used in pre/ post
surgical care as well as non-surgical treatment protocols. “Stimulating specific acupressure points with a
thumb or fingertip can help with pain management, clear the effects of anesthesia, minimize the building
of scar tissue, and reduce swelling. Acupressure can be learned at home and applied whenever needed.”
(Zidonis & Snow)
Veterinary chiropractors facilitate healing by making adjustments to improve skeletal alignment
and muscular-skeletal function. “Chiropractic adjustments help restore normal nerve activity by gently
moving bones, ligaments, and tendons back into alignment, and when ligaments are injured, adjustments
help realign the body to improve balance and speed healing.” (www.whole-dog-journal.com).
Swimming is also considered to be a great therapy for injured joints. It allows the dog a way to
move the joint with gentle exercise and without weight bearing activity. Floatation vests are used for
poor swimmers or older dogs who prefer less exertion. Deep wading is a good alternative for swimming.
This would have the dog in water deep enough to support most of his weight to lighten the burden on the
joint, but still keep his feet on the ground (http://www.tiggerpoz.com/id3.html).
Swim and massage therapy can also:
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Maintain an optimum body weight
Support reeducation (or use) of the effected limb
Reduce swelling and inflammation
Provide relief for developing arthritis
Relieve muscle tension
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Increase mobility
Offer pre-surgery support and post-operative recovery
Provide a fun and safe way to exercise
http://blog.wellspringsk9.com/2011/11/11/ouch-the-pain-of-an-injured-cranial-cruciate-ligament/
“Canine massage therapists used to be unusual, but now they play an important role in
maintaining and improving our dogs’ health. Efflurage, passive touch, kneading techniques, and stroking
increase circulation, release muscle tension, reduce pain and soreness, relieve stress, and accelerate the
repair process.” (www.whole-dog-journal.com).
In this rehabilitation plan, massage is recommended as post-surgical treatment.
Rehabilitation Plan for a Cranial Cruciate Ligament Repair
POST SURGERY
Massage: Reduces pain, muscle spasm, swelling and helps your dog to relax.
Using a kneading circular motion, work on the muscles starting from the toes up to the
hip. Work for 5-10 minutes 3 times per day prior to starting exercises. We have a
massage video that is available to teach you how to better massage your dog
(http://thespaw.com/blog/rehabilitation-plan-for-a-cranial-cruciate-ligament-repair).
Although, no breed of canine is in the clear to avoid cruicate injuries, it is believed that larger,
athletic type dogs seem most susceptible. German Shepherds, Rottweilers, Labradores, and Golden
Retrievers are commonly treated for this injury. “Veterinary studies show that up to 60 percent of dogs
who tear one CCL will tear the opposite one in the following 1-2 years.” (http://www.petinsurance.com).
Other sites also include Poodles, Bichon Frises, Bernese Mountain Dogs, Bull Mastiffs, Chows, and Saint
Bernards to the list of susceptible breeds (www.dogheirs.com / (http://www.healthcommunities.com).
Some research indicates that spayed/ neutered dogs over the age of 4 and dogs that have been on
corticosteriod medication for long periods of time are more susceptible to CCL injuries than dogs that are
sexually intact (http://www.ncbi.nlm.nih.gov/pubmed/18598150). “Chronic onset (degeneration and
rupture usually from aging) occurs in 80% of cases and occurs in dogs 5 to 7 years old. Acute onset (tear
caused by injury) is most common in dogs under 4 years old. Young dogs of large breeds are more
susceptible to rupture than young dogs of small breeds” (http://www.healthcommunities.com). Risk
factors for injury include: age, arthritis, stifle joint injury, breed size, overweight, poor muscle structure
near joint, and structural skeletal abnormalities.
The CCL is an important stabilizing ligament in the stifle that is a frequent injury for many dog
breeds. In some cases surgical treatment is necessary and in others rehabilitation and holistic techniques
are recommended. PetMassage can be one of the therapies made available to provide whole dog wellness
following one of these injuries. The stimulation of lymph, increased circulation, tissue manipulation, and
positional release techniques are just some examples of the benefits provided. In this growing industry,
this is another example of how we can make a difference in the lives of many of our fury friends.
References:
http://www.petmd.com/dog/conditions/musculoskeletal/c_dg_cranial_cruciate_ligament
http://www.whole-dog-journal.com/issues/13_2/features/Canine-Ligament-Injury-Options_16198-1.html
http://www.petinsurance.com/healthzone/pet-articles/pet-health/Crucial-Ligament-Tears-and-Dogs.aspx
http://en.wikipedia.org/wiki/Stifle_joint
http://www.orthopets.com/stifleanatomy.htm
http://www.2ndchance.info/cruciate.htm
http://www.ncbi.nlm.nih.gov/pubmed/18598150
http://www.ncbi.nlm.nih.gov/pubmed/16313037
http://www.ncbi.nlm.nih.gov/pubmed/17702611
http://www.dogheirs.com/dogheirs/posts/2309-anterior-cruciate-ligament-acl-injuries-in-dogs-symptomsand-diagnosis
http://www.tiggerpoz.com/id3.html
http://www.yourholisticdog.com/canine-massage-case-study-cranial-cruciate-ligament-ccl-injury/
http://thespaw.com/blog/rehabilitation-plan-for-a-cranial-cruciate-ligament-repair
http://blog.wellspringsk9.com/2011/11/11/ouch-the-pain-of-an-injured-cranial-cruciate-ligament/
http://www.healthcommunities.com/cranial-cruciate-ligament-rupture/overview.shtml
http://www.akcchf.org/canine-health/your-dogs-health/disease-information/cruciate-ligamentrupture.html"
https://www.acvs.org/small-animal/cranial-cruciate-ligament-disease
http://www.embracepetinsurance.com/health/cruciate-ligament-injury
Snow, Amy, Zidonis, Nancy. Whole Dog Journal. “Post-op acupressure: use your hands to help your dog
recover more quickly from surgery.” August, 2006.
http://www.highbeam.com/doc/1G1-149365790.html
Pienaar, Morkel, BVSC Cert Opthal MRCVS. “Cruciate Ligament Rupture in dogs- Symptoms &
Diagnosis.” www.vetstoria.com
Broadhurst, Henry. “Canine Cranial Cruciate Rupture- 3D Animation for Veterinary”
www.youtube.com/watch?v=CNymdzyRavs