Cruciate Ligament Injuries

The CCL is a band of connective tissue in the knee that connects the femur to the tibia - similar to the ACL in humans. Its main role is to prevent forward and backward movement of the two bones and prevent hyperextension of the knee. 

The most common symptom is for your pet to not be putting any weight on one of their back legs. This is due to the instability and often pain of the joint. Over time, they may start to adapt to a more comfortable position and start to walk with the knee rotated slightly. They may also sit with the leg stuck out to reduce pressure on the knee joint. In more chronic cases, you may find your dog is simply stiff when it gets up or limps after exercise although may appear to run 'normally'. 

The most common and preferred way to treat this condition is using surgery to either mimic the CCL or to stabilise the knee using metal implants. The most common surgeries performed are the TPLO, TTA, MMP and Extra-capsular Repair.

We have surgeons who are able to perform all of these surgeries in house, saving your pet the need to travel elsewhere.

Patient factors such as age, breed, size and concomittent diseases help to determine which surgery to go for and we will always consider our patient's overall health status prior to making any decisions on treatment.

Most CCL surgeries are highly successful when performed by our experienced surgeons. The main complications of surgery are due to the aftercare and involve implant loosening or rejection, infection, late meniscal tears or worst case fracture.

The anaesthetic risk is low due to our experienced team, monitoring equipment and preoperative health checks and blood-work to minimise the chances of any complications during the operation.

Generally, your dog will slowly start use their damaged leg again after a few weeks as they start to adapt and figure out the most comfortable position to stand. The joint will still remain very unstable which causes scar tissue to form around the joint (fibrosis) and osteoarthritis to progress in the joint. You will find that your dog manages to get around and may even start to run again but the joint will always be stiff and will eventually become painful and will need to be managed with pain relieving medication for the rest of your dog's life. There is also a 50% risk that the other CCL in the opposite leg will rupture within 18 months of the first.

The most common cause is gradual weakening of the ligament over time - 'CCL disease'. This can be due to genetics, conformation, activity, weight and immune diseases. A small number of cases however do happen traumatically.

X-rays under sedation or general anaesthetic are the most common and quickest way to diagnose CCL injuries. Although we cannot see the ligament itself, we often find instability (cranial drawer) and swelling (effusion) in the joint, sometimes thickening of the soft tissues around the knee or even signs of arthritic changes in the knee due to the weakening of the CCL.

The recovery after surgery is approximately 12 weeks depending on the surgery that was performed. Exercise restriction is paramount while the surgical wound and bone is healing. We advise crating your pet for the majority of the recovery with strict lead-controlled exercise at regular intervals. Repeat x-rays are generally taken 6-8 weeks after surgery to assess the healing. We also advise hydrotherapy and physiotherapy during the second phase of the recovery as it really helps to speed things up and maintain muscle mass.

Surgery is the preferred treatment option but sometimes we do opt for a more conservative approach. This is on a case-by-case basis but may involve crate rest, controlled activity, pain relieving medication, hydrotherapy, physiotherapy, laser therapy, regenerative medicine and joint supplements. The main downside is the rapid progression of osteoarthritis in the joint if the joint is not stabilised and generally recovery takes a lot longer than if surgery was performed.