Canine Cranial Cruciate Ligament Disease – Do we have to do surgery?

Photo of Cece is courtesy of the Willamette Humane Society.
Photo of Cece is courtesy of the Willamette Humane Society.

One of the most common orthopedic injuries affecting dogs today is canine cranial cruciate ligament disease. The cranial cruciate ligament (CCL) in a dog is equivalent to the ACL (anterior cruciate ligament) in people. The CCL is one of the major stabilizers of the canine knee – it’s main job is to prevent front to back motion of the tibia (shin bone) in relation to the femur (thigh bone). Rupture of the CCL results in an unstable and painful joint which causes your dog to limp. Also, approximately 50-60% of dogs with complete CCL tears will have medial meniscal tears which can increase the pain associated with this injury.


While we don’t know exactly why so many dogs tear their CCL, we do know that CCL disease is considered to be a degenerative process - once begun, it will typically progress over time. If your dog is diagnosed with a CCL injury, your vet and most veterinary surgeons (myself included) will recommend surgery to stabilize the knee. Which exact procedure is recommended for your pet will depend on your goals, your pet’s specific anatomy, and which procedures your surgeon is most comfortable performing. Surgery allows us to evaluate the joint, to remove any torn portions of meniscus (if it is injured), and to stabilize the joint. It is the quickest way that we know how to get dogs and cats back to as close to normal as possible after a CCL injury.


ACL tears in people who are not pro-athletes are often treated non-surgically (bracing, rest, physical therapy) and so one of the most common questions I get is “Do I have to do surgery?”


The short answer to the question is no – surgery for CCL tears is highly recommended but not required. Your pet can live with a torn CCL. However, surgery will significantly help your pet slow the progression of arthritis in their knee, and decrease the likelihood of them having a lifelong lameness.


Cece, a dog we recently evaluated for the Willamette Humane Society (WHS), is the perfect example of what happens when CCL tears go untreated. Cece is an adult pit bull and was noted to have an abnormal hindlimb gait when she was surrendered to WHS. The medical staff at WHS wanted to see if surgery would be an option for Cece and brought her to Sunstone for an orthopedic evaluation.


Cece is a happy, friendly girl and can walk on all four of her legs, but she stands and walks with her weight shifted towards her front legs, limps on both hindlimbs and is bow-legged and partially squatting because she has suffered bilateral CCL tears. Based on her physical exam and x-rays, we know that Cece’s CCL tears happened multiple months to, possibly, years ago. Both of her knees are thick with scar tissue and bone spurs from severe progressive arthritis – a natural consequence of her body trying to stabilize her knees. She has a funny posture and gait and her knees are a little creaky and occasionally sore, but she is able to get up and about and to run and play. Is surgery an option? Yes. Would surgery have helped when she was originally injured? Absolutely. Would surgery help her significantly now? I’m not sure. With the amount of arthritis and secondary change to her knees, it is hard to say how much benefit she would get from the traditional surgical procedures we use to stabilize the knees after CCL injury. After further discussion with her care team, we decided Cece would be best off with some concerted efforts in medical management for her arthritic knees rather than surgery at this time.


In general, for small dogs (less than 10-15 lbs) with CCL tears, I give them an approximately 50% prognosis for being able to develop enough scar tissue and arthritis to have a fairly function knee. In larger dogs (more than 40 lbs) that number drops to about 20% or lower. For patients that are not good surgical or anesthetic candidates, medical management or bracing and medical management may be the right choice. All dogs are capable of making scar tissue around their knees and making some improvements on their own, but how well they do is really variable from dog to dog. Most dogs with CCL tears will do much better if we are able to surgically stabilize them sooner rather than later.


If your family vet suspects or has diagnosed your dog with a CCL tear, Dr. Su would be happy to meet with you, to examine your pet, and to discuss your treatment options with you! Our goal at Sunstone Vets is to find the treatment that best fits your pet’s and your family’s needs.

Photo of Cece courtesy of the Willamette Humane Society
Photo of Cece courtesy of the Willamette Humane Society

*Sunstone is thrilled to hear that since her visit, Cece has found her forever home! We wish Cece and her family all the best!*

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