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Cranial Cruciate Ligament (CCL) Surgery

Orthopedic injuries commonly occur due to repeated use of a limb or trauma. Treatment is vital for preventing further complications. Our vets in Eastham talk explain what a CCL (cranial cruciate ligament) is, how it ruptures (tears) and discuss the treatment options including surgery.

What is a CCL rupture in dogs?

The CCL (cranial cruciate ligament) connects and stabilizes the lower leg to the upper leg in the knee by linking a dog's tibia to the femur above. When torn, it causes partial or complete joint instability, pain, and immobility. CCL ruptures (tears) result from a torn CCL in a dog's stifle (knee), equivalent to the ACL in humans.

Signs of a CCL Injury in Dogs

Regarding CCL tears in dogs, 80% are chronic-onset ruptures caused by degeneration and usually occur due to aging. This is most common in dogs between the ages of five and seven.

Acute-onset ruptures are most commonly seen in pups four years of age or younger. These tears are caused by injuries a dog will sustain just running around and living their daily lives.

Symptoms of a CCL rupture may include:

  • Crepitus (crackling noise of bones rubbing against each other)
  • Decreased range of motion
  • Hind leg extension while sitting
  • Pain when the joint is touched
  • Lack of motivation to exercise
  • Irritability
  • Restricted mobility
  • Stiffness after exercising
  • Swelling/Inflammation
  • Thick/firm feel of the joint
  • Weight shifted to one side of the body while standing
  • Popping sound when walking

If you notice any of the listed symptoms above, contact your vet and schedule an examination for your dog.

Diagnosing CCL Injuries in Dogs

To diagnose a CCL injury, your vet will perform a physical examination on your dog while they are standing. During this exam, they will manipulate the limbs to determine their range of motion and any pain points. The vet may also perform an X-ray of the knee to confirm the diagnosis.

Non-Surgical Treatment of CCL Injuries

Dogs weighing less than 30 pounds may recover without surgery if they receive ample rest, anti-inflammatory medications, and physical therapy. The potential for recovery hinges on your pet's size, overall health, and the extent of the CCL injury. Your veterinary surgeon will guide you on the optimal approach for your dog.

Treatment Via Surgery

Cranial cruciate ligament surgery stands as the foremost procedure in canine orthopedics, constituting approximately 85% of all orthopedic surgeries performed annually on dogs. Due to its prevalence, various techniques have emerged over time for ligament repair. Engaging in a discussion with your veterinarian is crucial to identify the optimal procedure tailored to your dog's needs. Below, we outline the primary methods for addressing this injury.


Arthroscopy provides the least invasive means to visualize the structures of the stifle, including the cranial and caudal cruciate ligaments. It enhances visualization and magnification of joint structures. Utilizing this technique, surgeons can make minimal incisions for repairing partial CCL and meniscus tears. However, for completely torn ligaments, this method may not be feasible.

Lateral Suture or Extracapsular

This surgery, which is frequently recommended for small to medium-sized dogs, stabilizes the stifle (knee) by using sutures placed on the outside of the joint. This is one of the most common surgeries for this type of injury, and it is usually performed on dogs weighing less than 50 pounds.

TTA (Tibial Tuberosity Advancement)

TTA is a method of surgery that corrects the need for the CCL by cutting the top of the tibia, moving it forward, and stabilizing it in its new position using a plate. Therefore, the goal with TTA is to replace the ligament entirely rather than repair it.

TPLO (Tibial Plateau Leveling Osteotomy)

TPLO surgery is gaining popularity and is the best option for large dog breeds. The procedure entails cutting and leveling the tibial plateau. The surgeon then uses a plate and screws to stabilize the tibial plateau. The ligament is also no longer required as a result of this surgery.

What to Expect After Your Dog's CCL Surgery

Your dog will be on rest from the moment they are cleared to go home. This means that they should only go outside to use the bathroom and be limited to 5 - 10 minutes, no more than three to four times each day. You will also need to keep them on a leash while they are outside.

CCL Surgery in Dogs: Recovery

The quality of care your dog receives after surgery will directly impact the operation's success, regardless of the specific procedure used to repair the ligament. The first 12 weeks following surgery play a crucial role in the recovery and rehabilitation process. Key factors for a successful recovery include restricting exercise and actively encouraging your dog to regain the use of their legs.

At the two-week mark post-surgery, you can gradually extend the duration of your dog's leashed walks.

By the eighth week, your dog should be capable of participating in two 20-minute walks daily and performing some basic daily activities independently.

Around ten weeks after surgery, your veterinarian will conduct X-rays to evaluate the bone's healing progress. Your dog will gradually regain the ability to engage in normal activities. At Eastham Veterinary Hospital, we recommend implementing a rehabilitation program to optimize your dog's recovery.

When selecting a rehabilitation facility, ensure they have experience in post-operative recovery from orthopedic injuries like the TPLO.

Additionally, some dogs have responded positively to acupuncture treatments and laser therapy.

Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet's condition, please make an appointment with your vet.

Is your dog showing signs of pain while walking? Contact our vets in Eastham to schedule an examination today.

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Eastham Veterinary Hospital is accepting new patients! Our experienced vets are passionate about the health of Eastham companion animals. Get in touch today to book your pet's first appointment.

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