VOSM: Cranial Cuciate Ligament Insufficiency

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Interested in learning more about the CCL repairs and the TPLO procedure? Check out "Bucca's" surgical experience as featured on Your Life with Dr. Anna Marie.

Orthopedic Surgery > Cranial Cruciate Ligament Insufficiency

The most common canine condition seen at VOSM is a cranial cruciate ligament (CCL) injury. The cranial cruciate ligament is commonly equated to the ACL in humans. As frequently recommended in humans, surgical intervention is typically needed to return your dog back to normal activity. There are multiple procedures that are available to treat this injury and at VOSM we make specific recommendations that are tailored to the individual.

To date, there is no “best” CCL procedure. However, we believe there is a “best” procedure for each individual dog. VOSM’s surgeons have performed thousands of CCL repairs including; tibial plateau leveling osteotomy (TPLO); tightrope (TR); tibial tuberosity advancement (TTA); and lateral suture / extracapsular stabilization. We base our recommendations for stabilization on the following criteria:

· Age
· Weight
· Breed
· Activity level (companion pet vs. performance and working dogs)
· Medical history
· Stifle (knee) anatomy (tibial plateau angle/slope)

The VOSM Approach

At VOSM, we specialize in a minimally invasive approach to the knee joint including arthroscopic techniques or use of a mini-arthrotomy using a key-hole incision into the stifle (knee). We do not perform full arthrotomies (complete opening of the knee joint) due to the increase in pain, inflammation, and prolonged recovery. At the time of surgery, the condition of the meniscus (the shock absorber in the joint) is evaluated. Damage to the meniscus can lead to prolonged pain and lameness as well as the progression of osteoarthritis. It is imperative that the meniscus be thoroughly evaluated and treated appropriately at the time of the surgery.

Recovery & The Role of Physical Rehabilitation

Following knee stabilization, dogs typically return to normal function within 12 weeks with proper physical rehabilitation. We evaluate at 4, 8, and 12 weeks to ensure your dog is progressing well. Both bone healing and muscle mass are evaluated closely by our rehabilitation therapists as unresolved muscle weakness may lead to additional compensatory conditions/injury.

Similar to humans having ACL surgery, physical therapy is an integral part of the recovery for our canine patients. Rehabilitation therapy following CCL surgery includes range of motion, stretching, muscle building activities, massage, therapeutic ultrasound, cold laser, TENS, hydrotherapy, and a home therapeutic exercise program. During each rehab session, patients are reassessed and a tailored program is designed.

Long-Term Prognosis

It is reported that once a dog injures one stifle it has a 50% or greater chance of injuring the other knee. This may be due to the excessive weight bearing of the “good knee” following injury. Therefore, we believe that early surgical treatment and rehabilitation therapy are imperative to help protect the other knee.

Alternative Therapies

Regenerative medicine (stem cell therapy derived from the patient’s own fat) may be considered for patients with very early partial tears. The knee is evaluated arthroscopically and if a small percentage of breakdown is noted (less than 25%), this treatment may be considered.

For canine patients that are not surgical candidates due to age, medical conditions or other concerns, a functional hinged knee brace may be considered. A casting of the knee is created by our therapists, which is then shipped to an orthotist for creation of the custom device. This process typically takes 14 days. Once returned, the canine patient is fitted at VOSM and home instructions are demonstrated by the therapist / technologist.