As our Canine Hydrotherapy Centre grows, we come across more and more dogs each week who suffer from Cranial Cruciate Ligament Disease (CCL) and are at the Post-op stage of their Rehabilitation, yet to have surgery, or may not be required at this stage to have surgery.
But what exactly is CCL and where is it?
There are four main ligaments in the Knee joint of a dog; two outside called the collateral ligaments and two inside the joint called the cruciate ligaments. The cruciate ligament nearest the front of the joint is the cranial cruciate ligament (CCL). The ligament attaches the thigh bone to the shin bone, preventing the shin bone from moving forward relative to the thigh bone. It also helps to prevent over-extension and rotation.
Cruciate damage is an injury to one of the two ligaments, either a little tear or a complete break in the ligament (see image).
What Causes CCL Disease in dogs
In humans, damage to this ligament is generally caused by trauma, but this is not generally the case in dogs and in most cases, it is caused by a degenerative condition.
Although CCL is a common condition, it is not yet fully understand why this condition develops in dogs. Certain breeds are more commonly affected (Labradors, Rottweilers, Golden Retrievers, Boxers). Some small breeds may have conformational abnormalities which can cause this condition, which then increases pressure on the ligament. As this is a degenerative condition, the term ‘cranial cruciate ligament disease’ rather than ‘cranial cruciate ligament rupture is used.
The most common sign of cranial cruciate ligament disease is your dog limping on their back leg. In dogs, this can occur suddenly or it may develop over time. Some dogs cannot put any weight on the leg, whereas with some the limp can be slight and hard to notice. Some dogs show stiffness after rest which can be confused with Arthritis and others get worse after exercise. Occasionally both Hind Limbs can be affected at once meaning that the dog can struggle to even get up which can then be confused with a spinal injury.
Your Veterinary Surgeon should always be your first port of call and a diagnosis can be straightforward if the ligament is completely ruptured and is usually confirmed on examination by your vet. If it is a partial tear, this can be more difficult to diagnose as there is not the same degree of movement in the joint. If this is the case, other tests may be required such as x-rays or assessment under anaesthesia/sedation. The x-rays may show signs consistent with the presence of osteoarthritis which is commonly present in dogs with cranial cruciate ligament disease. In the majority of dogs, exploratory surgery may be used to confirm the ligament is damaged.
On occasions, surgery may not be recommended for a number of reasons by your vet, so the condition may be managed by controlling your dog's weight, exercise control, hydrotherapy rehabilitation, physiotherapy, non-steroidal anti-inflammatory drugs and dietary supplements. Dogs undergoing this non-surgical management may improve in the earlier phases of treatment but longer-term outcomes are often poor. Small dogs may respond better than bigger dogs but again the outcome is unpredictable.
TPLO (tibial plateau levelling osteotomy), seems to be the most common procedure at present by Veterinary surgeons, but there are alternatives that your vet may discuss with you.
This procedure has been shown to be the most likely procedure to return maximum limb function. The TPLO procedure does not rely on the presence of the ligament but instead changes the forces in the joint to create a more stable ‘platform’ when the dog is weight-bearing on the leg. To improve stability in the joint, plates and screws, this procedure is tolerated well, with many dogs weight bearing on the leg within 48 hours of surgery. To know more about what is involved with TPLO surgery and other surgical options please visit https://www.fitzpatrickreferrals.co.uk/orthopaedic/cranial-cruciate-ligament-injury/
Research has shown that 90% of patients to have a good to excellent outcome following TPLO and expect dogs to be able to return to off-lead exercise and be free of medication. The athletic, performance or working dog may not quite achieve the same levels of ability after surgery although some do.
No matter procedure your dog undergoes, dogs who have had cruciate ligament damage nearly always develop arthritis later in life. Because of this, your vet may suggest joint supplements or anti-inflammatory pain killers.
Making sure your dog does not become overweight is very important as this may well put excess pressure on their joints which can increase the development of arthritis.
Once your dog is recovered they should be able to exercise more or less normally. Please try to avoid activities such as chasing a toy or jumping, as this will minimise the risk of further injury.
Physiotherapy & Hydrotherapy:
Once the ok has been given by your veterinary practice, a Registered Physiotherapist can help reduce inflammation using laser therapy and reduce muscular guarding with soft tissue massage techniques.
Your Hydrotherapist may also at this stage start to increase strength with controlled Hydrotherapy in a Hydro pool or underwater treadmill. Hydrotherapy exercise can also help you control your dog's weight to avoid excess weight on the affected joints.
At home, you may be able to start passive movements and stretches with a programme from your Physiotherapist or vet.
During the 6 to 12 week period, you may be able to increase Hydrotherapy exercise to start to increase strength and core stability.
After 12 weeks it is hoped that your dog may return to normal exercise.
*Please note that rehabilitation plans should only be followed under the guidance of a qualified rehabilitation professional, who will be able to provide a tailored plan based on the individual patient’s rehabilitation needs.
If you have any questions or would like to visit our facility to see how Fit4dogs can help your dog, please visit our website www.fit4dogsuk.com or email us at firstname.lastname@example.org.