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Understanding Canine Cranial Cruciate Ligament Disease: A Guide for Pet Owners

Cruciate Ligament Disease, often referred to as a Cruciate Ligament rupture or injury, is a common orthopedic issue that affects dogs of all sizes and breeds and cats.

As a pet owner, it's crucial to understand this condition, its causes, symptoms, diagnosis, and treatment options to provide the best care for your pet. In this article, we will delve into what you need to know about Cruciate Ligament Disease and how to navigate this journey with your beloved canine or feline companion.

What is Cruciate Ligament Disease?

Cranial Cruciate Ligament Disease (CCLD) is a condition involving the tearing or degeneration of one of the ligaments within your pet's knee joint, known as the cranial cruciate ligament (CCL). The cruciate ligaments, named because they cross over each other inside the knee joint, help stabilize the joint during movement, and prevent abnormal forward movement of the shin bone (tibia) relative to the thigh bone (femur).

There are two cruciate ligaments in each of your pet’s knees - the cranial (anterior) cruciate ligament and the caudal (posterior) cruciate ligament.

Image of cruciate ligaments in humans by BruceBlaus

The cranial cruciate ligament (CCL/CrCL) is the most commonly affected, and rupture and tearing can occur due to degeneration or acute injury. This condition is similar to the Anterior Cruciate Ligament (ACL) injuries in humans and can be quite painful for your pet.

Causes and Risk Factors

CCLD can develop for various reasons, but some common causes and risk factors include:

  • Age: Older dogs or cats are more prone to CCL injuries.
  • Breed: Certain dog breeds, like Labradors, German Shepherds, and Golden Retrievers, are more susceptible.
  • Obesity: Excess weight can strain the ligaments and increase the risk of CCL injuries.
  • Genetics: Some dogs or cats may inherit a predisposition to CCLD.
  • Activity Level: Highly active dogs may be more prone to injury.

Recognizing the Symptoms

Early detection is crucial for managing CCLD effectively. Look out for the following signs:

  • Limping or lameness in one of the rear legs, which can be sudden or progressive
  • Swelling and pain around the knee joint
  • Difficulty rising or laying down
  • Reluctance to bear weight on the affceted leg
  • Decreased activity level
  • A popping or cracking sound when the injury occurs

Diagnosis

Your veterinarian will ask you about your pet’s medical history and any recent injuries or changes in behavior. A combination of physical examinations, tests, and gait analysis will be done to assess the integrity of the CCL. To confirm the diagnosis and evaluate the extent of the injury, imaging will likely be done to provide a clear view of the joint’s condition, including any damage to the ligament, the presence of arthritis, and any bone changes.

It is important to consult with your veterinarian promptly if you suspect your pet may have CCL disease. Early diagnosis can prevent the progression of joint damage.

What are the treatment options?

It is important to be aware that CCL Disease in animals is not curable in the sense that the damaged ligament cannot be regenerated or fully repaired to its original state. However, the goal of treatment for CCL disease is to manage the condition effectively, alleviate pain, restore joint stability, and improve your pet’s quality of life. Treatment options can vary.

Conservative Management may be recommended for patients that cannot undergo surgery. It involves non-surgical approaches to manage pain and improve joint stability and may include rest, weight management, physical therapy, and pain management through medications or supplements to alleviate pain and reduce inflammation.

Surgical Management: Surgical intervention is often recommended for patients with complete CCL ruptures, larger pets, and those with high activity levels. There are different surgical techniques, and the choice of surgery depends on the patient’s conditions. It is important to remember that there are various options to treat a CCL injury. Your veterinarian, together with you, will determine which surgical option is best for the patient.

Most common surgical techniques

Depending on the extent of the injury and your pet's specific needs, your veterinarian may recommend one of several treatment options. The most common surgical techniques include:

Extracapsular Repair / Suture Techniques: This type of surgery involves using a srong suture material placed outside the joint to mimic the function of the torn ligament and to stabilize the joint. It is often recommended for smaller pets or those with partial CCL tears. While it may have lower long-term success rates, it is a less invasive and more affordable option.

TPLO (Tibial Plateau Leveling Osteotomy): TPLO involves making a carefully planned semicircular cut at the top of the tibia (or shinbone), and then adjusting the angle of the tibia to “level it off” so that it no longer relies on the damaged CCL to function correctly. It is then held in place using metal TPLO plate and screws. Over time, the bone heals around the implant.

CBLO (CORA-Based Leveling Osteotomy): CBLO focuses on identifying the Center of Rotation of Angulation (CORA) on the dog’s tibia or shinbone, which is the point where the bone naturally rotates or angles. By carefully making a curved cut through this point and repositioning the upper part of the tibia, the surgery changes its angle thereby stabilizing the knee joint. A CBLO plate and screws are then used to hold the repositioned tibia securely.

TTA (Tibial Tuberosity Advancement): In the TTA procedure, the surgeon makes a single, straight cut in the tibia bone and repositions or “advances” the tibial tuberosity (the bony bump in front of the tibia) slightly forward, away from the rest of the tibia. The desired angle is then fixed in place using both a TTA cage and a metal plate. This change in angle reduces the strain on the damaged CCL and allows the knee joint to function rather normally.

Standard TTA

TTA RAPID® Technique: An innovation over the standard TTA, the TTA RAPID® Technique is designed to be a faster and simplified procedure by using a specialized 3D-printed Titanium cage implant, which eliminates the need of a separate metal plate. It’s unique design allows for easy insertion and stabilization of the implant, reducing surgical time - this means lower risk of infection, less anesthesia, and less costs.

The unique structure of the TTA RAPID® cage allows for improved cell attachment, which promotes better bone growth and osseointegration (the process of bone formation around an implant). Made of medical grade Titanium, the implants are very durable and its excellent biocompatible properties not only minimizes the risk of infection, but also promotes rapid healing, therefore accelerating recovery time. As the immediate postoperative recovery is relatively faster, patients that underwent TTA RAPID® surgery tend to have a significantly shorter period of pain and are shown to return to normal activities quickly. (Important: The post-op protocol still needs to be followed for the entire time prescribed by your vet, even when your pet is feeling better.)

TTA RAPID® X-Ray (Image credits to Dr. Caroline Huismann-Wildeman)

TTA RAPID® X-Ray (Different patient, Post-Op X-Ray courtesy of Dr. Wilhelm)

When the patient suffers from a concomitant patella luxation, which happens to about 20% of small patients with CCL injury, both can be treated with a modified TTA RAPID® procedure and is done by simply adding a RAPID LUXATION Spacer to the TTA RAPID® cage.

TTA RAPID® Cage with a RAPID Patella Luxation spacer (Image credits to Dr. Petagna)

Adding a RAPID LUXATION Spacer to the TTA RAPID® Cage

TTA RAPID® Cage with a RAPID Patella Luxation Spacer

What is a patella Luxation? Imagine your pet’s knee cap, or patella, the little bone that sits on top of the knee joint. In patella luxation, the knee cap can pop out of its normal position, causing discomfort and limping. This condition can be congenital (present from birth) or develop over time.

Pets with a CCL injury may change how they use their legs to compensate for the pain. These changes in movement and posture can sometimes affect the alignment of the knee cap. In some cases, the CCL injury can lead to or worsen patella luxation. It’s like a domino effect: the initial CCL injury can indirectly impact the knee cap’s position. 

Post-operative care

Regardless of the chosen surgical treatment, post-opeartive care at home is very critical. Follow your veterinarian’s post-surgery instructions and guidance on medications, activity restrictions, and wound care to ensure a successful recovery and your pet’s well-being.

Rest and Restriction: Keep your pet confined to a small, safe area to limit their movement and to prevent jumping and running. Strictly follow the recommended activity restrictions during the initial recovery period.

Pain Management: Administer prescribed pain medications as directed by your vet. Monitor your pet for any signs of discomfort or distress and report them to your vet.

Wound Care: Keep the surgical incision clean and dry as per your vet’s instructions. Avoid letting your pet lick or chew the incision site. A cone or surgical shirt may be necessary.

Consider physical therapy or rehabilitation exercises recommended by your vet. These exercises can help your dog regain strength, flexibility, and mobility.

Maintain a healthy body weight for your pet to reduce stress on the repaired knee joint. Consult your vet for dietary recommendations if needed.

Attend all scheduled follow-up appointments with your veterinarian. These visits are crucial to monitor your pet’s progress and adjust the treatment plan as needed.

Gradual Increase in Activity: As your pet’s recovery progresses, gradually increase their activity level under your vet’s guidance. Avoid excessive or strenuous exercise during the early stages of recovery.

Monitor for Complications: Keep an eye out for any signs of infection, swelling, or other complications around the surgical site. Contact your vet immediately if you notice anything concerning.

Long-Term Joint Health: Discuss with your vet how to maintain your pet’s joint health to prevent future issues, such as osteoarthritis.

Recovery from CCL surgery can take several weeks to months. Remember that each patient’s recovery process may vary based on factors like their age, size, and overall health. Open communication with your veterinarian is essential. Early intervention and diligent post-treatment care can significantly improve your pet’s chances of recovering well and enjoying a good quality of life despite a CCL injury.

Other points to remember

  • The most common complication caused by CCL Disease is long-term impairment due to arthritis. Even with surgery, some progression of arthritis is expected. It is important to understand that arthritis is a non-reversible disease and hence, everything should be done to prevent its development or progression.
  • Every patient’s situation is unique, and what works best for one patient may not be suitable for another. Your veterinarian is your best partner in managing your pet’s cruciate problem and ensuring their long-term health and comfort.

Studies and Testimonials

There are numerous scientific studies on the TTA RAPID® Technique, and the general results are very promising. Here are some of the key findings from these studies:

TTA RAPID® surgery is effective in reducing lameness and improving function in dogs with CCL ruptures. In a study of 50 dogs with CCL ruptures, 96% had a good to excellent outcome after TTA Rapid surgery at three months.

TTA RAPID® surgery is associated with a low complication rate. In a study of 30 dogs with CCL ruptures, the complication rate was 16.7%. The most common complications were minor problems, such as bone bruising and superficial infections.

TTA RAPID® surgery is a relatively quick and minimally invasive procedure. The surgery typically takes about one to two hours and does not require the use of external fixation.

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