Cranial cruciate ligament disease (CCLD) is the most common cause of lameness in the dog. The cranial cruciate ligament is found in the knee (referred to as the stifle) and lies between the femur (thigh bone) and tibia (shin bone). It has a partner, the caudal cruciate ligament. Together they form a “cross” (Afr = kruis ligament) and the function is to stabilise the two bones in relation to each other.
Every time the dog steps on a back leg, the shin bone has a tendency to thrust forward. The CCL holds the tibia in place and prevents the femur from ‘slipping off the back’. Damage to the CCL can be partial or a total
Watch this video to see Sophie's recovery journey following surgery for Cranial Cruciate Ligament Disease.
rupture. Both will present with a degree of lameness. Most dogs with a complete tear of the CCL will be non-weight bearing (or 3-legged) lame. The damage can occur over time as a result of wear-and-tear/degeneration of the ligament or it can occur suddenly - usually after the dog has jumped off a couch or chased a ball.
Treatment of CCLD is usually surgical. There are a number of surgical options.
- Extracapsular (surgeons do not open the joint) which is often called ‘figure of 8’ technique or lateral stabilisation of the knee. The Tightrope ™ procedure is also available in South Africa. These options assist with stabilising the stifle to allow for the body to fibrose or scar around the joint. This creates a type of a biological knee-guard. It can take 6 - 8 weeks for this to occur provided conditions are good for this process to occur. This means no running, jumping or playing while the body heals.
- Intracapsular (surgeons enter the joint) The CCL is recreated using the dog’s own tissue or a synthetic cord. This process is not as common as it was a decade ago.
- Altered Biomechanics of the joint to prevent the slipping of the femur. The most common procedures performed in SA are the TPLO (tibial plateau levelling osteotomy) and the TTA (tibial tuberosity advancement).
Both of these procedures require that bone is cut (surgical fracture) and plates and screws hold the bone in its new position. Management of your dog in the first 6 weeks following surgery are critical for the success of this surgery. No running, jumping or playing during this period. Leash walks only.
In some dogs a conservative approach is a consideration. This is often advised for dogs under 15 kgs of body weight, with partial tears. Older dogs that are an anaesthetic risk or have concomitant metabolic disease may also fall into this category. For the first 6 weeks no running, jumping or playing. A custom stifle brace can stabilise the joint and assist healing. Prolotherapy may also be an option.
Regardless of the chosen route of repair, a physical rehabilitation practitioner can help with advice on how to manage your companion. We are also qualified to perform physical rehabilitation to enhance the recovery of any surgical procedure and ensure success.