Dogs and Cranial Cruciate Ligament Disease – Nope, ACL injuries aren’t just for people!

If you or someone you know has experienced the pain caused by a ruptured Anterior Cruciate Ligament (ACL), then you probably have a decent idea of how excruciating it can be. The bad news is – this happens to be one of the most common orthopaedic diseases found in dogs. In this blog post we will be discussing Cranial Cruciate Ligament Disease and what causes it in dogs, some of the key topics we will be covering include:

• What is Cranial Cruciate Ligament Disease (CCL)
• What causes Cranial Cruciate Ligament Disease
• What you need to know about CCL in dogs
• Treatment for canine CCL
• Recovery after canine CCL treatment
• Recommendations
• Preventing CCL

What is Cranial Cruciate Ligament Disease?

Known as Cranial Cruciate Ligament (CCL) disease, our beloved pooches can and do suffer through this pain too. Essentially, it affects the same ligament within the knee in both people and dogs.

What causes Cranial Cruciate Ligament Disease (CCL) in Dogs?

Nala, my Doberman, was only 4 years old when she began suffering from this debilitating disease. As a keen veterinary student, I had plenty of questions for her skilled team of vets and nurses.

“So what causes this condition to develop in dogs?” To this question, the vet essentially told me that there is not just a single cause of cranial cruciate rupture. In fact, in many cases, the exact cause remains unknown.

Humans generally obtain an injury to their ACL whilst participating in various sporting endeavours. Unlike humans, CCL rupture in dogs tends to involve a progressive degeneration of the ligament without any trauma or injury. This means that factors such as genetics, conformation and obesity are generally to blame. In fact, only around 20% of CCL cases result from trauma, in which case a complete rupture can occur instantly.

Nala’s CCL was in the later stages of degeneration in the days before her surgical procedure. My reasoning for how it managed to get so out of hand whilst remaining virtually undetected was that my dog is a pretty tough cookie! I could whip out a tennis ball and nothing could stop her from tearing across the park after it. But definitely don’t try this at home. I’m afraid the balls must be put on the shelf until recovery is fully complete, despite how strong the temptation may be to give in to those sad puppy eyes!

Things you must know about canine CCL

And here’s a fun (or not so fun) fact: around 70% of canine CCL patients will rupture the CCL in their other knee shortly after the first one ruptures – potentially within the space of a few weeks! My cousin’s Labrador managed to rupture it’s CCL in one knee. However, when she was brought into surgery a few weeks later, it was discovered that the other knee had ruptured within that short time period. After a VERY long recovery, she is now as good as new! In fact, if treated surgically, the prognosis for most dogs with a ruptured or torn CCL is actually very good.

But even after a full recovery, there is always the possibility of a second CCL rupture in the not-too-distant future. The vet advised me on the most tell-tale symptoms of a CCL tear or rupture to watch out for, which include:

• Lameness or reluctance to put weight on a hind limb (this may occur intermittently, especially in the case of partial tears)
• Swollen knee joint
• Sitting in an unusual position, often with the sore leg held out to the side
• Stiffness, especially when getting up from sitting or lying down
• Reluctance to play/jump onto furniture

If your dog shows several or all of these symptoms, the vet may admit him or her into the clinic for X-rays of the joint, unless there is another obvious cause or one that can be identified using a diagnostic test.

Treatment for Canine CCL

For large dogs, treatment of CCL disease generally involves one of several surgical procedures. Without surgery, 81-100% of large dogs will stay lame. Non-surgical treatment methods are generally only recommended in cases where general anaesthesia is considered to be too risky. This mostly involves limiting activity, administering anti-inflammatory drugs and managing your pet’s weight. However, even in small dogs, non-surgical methods may have a longer recovery period and often don’t result in complete recovery.

Although the exact procedure will depend on the case and your surgeon’s preference, the process of surgical correction generally involves removing pieces of bone from the tibia and inserting a plate and screws. While this sounds scary, the success rates associated with surgical correction methods are pretty impressive.

Recovery after Canine CCL treatment

The 2-month recovery period afterwards is less appealing, and takes away the idea that surgery is simply an “easy fix.”

Some general tips that your surgeon should give you in your after-care notes include:

• Stopping your dog from licking or chewing the wound
• Keeping bedding clean and dry
• Making sure the dressing or bandage remains intact so that the wound is completely covered
• Using an E-collar to ensure that your dog cannot chew the wound or bandage (Elizabethan collar or so-called “cone of shame”)
• Keeping your dog indoors apart from toilet trips
• Not letting your dog’s bandages get wet (so no baths or swimming)

On that last point, it was in fact raining on the day Nala came home. The vet actually gave her a rubber glove to wear over her left hind paw so that her ENTIRE leg – paw inclusive – was kept completely dry. She then attempted to completely obliterate the poor glove AND bandage about 5 seconds into her stint in confinement. She was forced to wear her E-collar from then onwards… And of course wasn’t very happy about it.

Recommendations after Canine CCL Treatment

After such a major surgery, it is recommended to keep your dog confined within a small pen at all times or on a short leash for brief trips to the toilet. It is also important to avoid stairs and increasing activity levels, and should only be done at the recommendation of your vet. Until then, remember the three C’s: comfort, confinement and company. Make sure they are comfortable, adequately confined and have company in the form of their human families. Remember: dogs shouldn’t be introduced until the leg is healed, because furry friends can create way too much excitement!

Preventing Canine CCL

Unfortunately, there isn’t much in the way of prevention that owners can do for their pets when it comes to this condition. Nonetheless, ensuring your pet is at his or her ideal weight and getting regular exercise are preventative factors that can be controlled. But if your dog does develop a tear or rupture, remember that prompt veterinary attention and treatment is a must!

Most importantly, work with your vet and make sure you understand and are 100% on board with your pup’s treatment plan. Don’t be afraid to ask your vet for clarification or even just some reassurance. Establishing clear communication between you and your dog’s veterinary team can make a world of difference for everyone involved!

References

American College of Veterinary Surgeons. (n.d.). Cranial Cruciate Ligament Disease. Retrieved from ACVS: https://www.acvs.org

Daniel C Richardson, R. C. (2010). Developmental Orthopedic Disease of Dogs. In Small Animal Clinical Nutrition (5th ed.). Mark Morris Institute.

Nashville Veterinary Specialists and Animal Emergency. (n.d.). Canine Cranial Cruciate Ligament Rupture. Retrieved from NVS: www.nashvillevetspecialists.com

University of Florida . (n.d.). Cranial Cruciate Ligament Rupture. Retrieved from UF Small Animal Hospital College of Veterinary Medicine: https://smallanimal.vethospital.ufl.edu