When the ligament tears, the stifle becomes unstable. The femur and tibia bones that form the joint then rub back and forth on each other (termed "drawer movement"). This results in pain due to stretching of the joint capsule, potential damage to the meniscus cartilage, and inflammation of the joint (called arthritis). In about half of the patients, the meniscus cartilage on the inner side of the joint (medial meniscus) has been torn and the damaged portion must be removed.

Symptoms of CCL disease:

• Limping

• Holding the hind limb up

• Sitting with the leg stuck out to the side

• Stiffness, especially after exercise

• Pain when the joint is moved or touched

• Swelling of the joint

• Sometimes clicking sound when walking

How is CCL disease diagnosed?

Dog’s medical history and a complete examination using tests of the integrity of the ACL, including the “cranial drawer” and “tibial thrust” tests.

X-rays should be performed to assess the amount of arthritis present and aid in determining treatment options. Sedation or anesthesia is necessary for making the definitive diagnosis, to avoid causing pain to your pet.

All dogs that are going to have cruciate surgery should have a correctly positioned x-ray taken to measure the slope of the tibia so that an informed decision can be made on the appropriate type of surgery that should be performed. In our experience dogs that have a steep tibial slope (especially large breeds) do much better with the TPLO surgery. This may not be an important factor in small breeds even with a steep tibial slope, but the clients should know a steep tibial slope will put much greater force on the synthetic bands we use in surgery (MRIT), therefore they may break.

Surgical Treatment:

"Surgery is generally recommended as soon as possible to reduce permanent, irreversible joint damage and relieve pain."

Several surgical techniques are currently used to correct CCL rupture. Each procedure has unique advantages and potential drawbacks. Your veterinarian will guide you through the decision-making process and advise you on the best surgical option for your pet.

For information on other types of surgery used to correct CCL injuries in dogs, check link to "Cranial Cruciate Ligament Repair: Tibial Plateau Leveling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA) and TightRope® procedure

Expected Recovery period:

• By 2 weeks after the surgery your pet should be touching the toes to the ground at a walk.

• By 8 weeks the lameness should be mild to moderate.

• By 6 months after the surgery your pet should be using the limb well.

Postoperative Care

The limb may or may not be bandaged postoperatively (surgeon’s preference). Very restricted exercise is allowed for the first 8 weeks, with a gradual return to normal activity over the next several weeks. The muscle force across the knee joint is four to five times body weight, and “abuse” of the limb may cause implant failure before the development of strong fibrous tissue. Clinical experience indicates that if the lameness does not improve over the next 8 to 12 weeks, or if it improves but then worsens, there is either a torn meniscus or a suture break or reaction. It is therefore important for the surgeon to know exactly where the knots were placed in order to expedite suture removal. Such removal of the imbricating sutures after 3 months postoperatively does not increase drawer motion because the fibrosis created by surgery provides long-term stability.

Prognosis:

With the extra-capsular techniques, about 85% of the cases are significantly improved from their preoperative state. With the extra-capsular technique, we can expect that 50% of these dogs will have some degree of lameness, whether it is mild or intermittent following heavy activity. On the other hand, about 50% regain normal function of the limb.

Even though these surgeries may not return the limb to perfectly normal function, these dogs usually are greatly improved over their condition prior to surgery.

The extra-capsular techniques will not stop the progression of arthritis that is already present in the joint. As a result, your pet may have some stiffness of the limb in the mornings. In addition, your pet may have some lameness after heavy exercise or during weather changes.

To help with stiffness Chondroitin sulfate, MSM and glucosamine combinations, Adequan injections and NSAID (Non- Steroidal Analgesic Inflammatory Drug) may be given.