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Cranial Cruciate Ligament (CCL)

Cranial Cruciate Ligament (CCL)

Cranial Cruciate Ligament (CCL) Rupture among Dogs

Dr. Jim Turpel is known in the Niagara region for his keen interest in orthopedic veterinary surgery. Up to 80% of the veterinary orthopedic surgeries we perform at Upper Canada Animal Hospital focus on CCL ruptures. Here’s what you need to know as a pet owner:

CCL Tears

  • CCL tears are the number one cause of serious hind lameness in dogs.  These tears can occur suddenly or gradually.  Resulting in persistent or recurring bouts of lameness.
  • With a CCL tear, many patients initially hold up their leg for 1-3 days, followed by a moderate improvement in lameness that worsens with increased activity and time.
  • Factors that contribute to CCL injury include obesity, breed, activity type, and activity level.
  • CCL tears are an extremely painful condition.
  • If a CCL tear is left untreated, serious long-term complications typically occur, including further damage to additional joints, pain, and arthritis.
  • The vast majority of patients with a CCL tear require surgery.
  • Our surgical outcome is excellent in well over 95% of patient cases.
  • Our definition of success includes the return to normal, pain-free activity in the short and long term.
  • Treatment for small less active dogs: Typically involves extracapsular techniques to stabilize the knee, however other factors may result in a TTA recommendation.
  • Treatment in larger dogs:  we adopt an advanced surgical technique called the Tibial Tuberosity Advancement (TTA).  Please see our TTA page for additional information.

The Good and Bad of CCL Disease

I frequently tell owners the bad news is that CCL disease is a serious problem requiring surgery in the overwhelming majority of cases but the good news is that if your pet is going to have a serious orthopedic condition CCL disease is the one you want since our success rates with surgery are excellent.

Keeping your pet dog in the best of health requires devotion, quick action, and an excellent veterinarian. Upper Canada Animal Hospital can help give your pet resume a healthy, active and pain-free life; especially if he/she has a ruptured cranial cruciate ligament (CCL).

Causes of CCL Ruptures

    • Obesity: While most people can appreciate that being overweight places strain on joints, many are unaware that recent studies have indicated the excessive body fat also releases hormones that result in inflammation throughout the body.  With respect to our pets joints, this means that they are more prone to developing arthritis and with respect to the stifle torn CCLs.  Excessive weight and obesity dramatically decrease a pet’s quality of life and their life expectancy.
    • “Weekend Warrior” Syndrome: Dogs that are fairly sedentary most of the time that undergoes periods of very strenuous activity that place excessive strain on the joints and muscles.
    • Conformation (shape of the leg): Dogs with very straight legs (ankles and stifles)
    • Concurrent joint disease: Unstable kneecaps and bad hips
    • Sometimes, it is simply the result of an athletic injury; however, it typically is a slow degenerative problem that occurs over weeks to months.

    Certain breeds seem predisposed. For instance:

    • Golden retriever
    • Labrador retriever
    • Rottweiler
    • Mastiff breeds
    • Bernese mountain dog
    • German shepherd
    • Saint Bernard

    Signs that your dog may have a cruciate ligament rupture are:

    • Reluctance to climb stairs, jump into the car or onto furniture
    • Difficulty in rising and sitting
    • Sudden onset of holding up a hind leg, or recurring bouts of lameness in one or both hind legs
    • Decreased activity and weight gain
    • Sitting with the affected leg held out to the side (lazy sit)

    Unfortunately, many of these signs are consistent with hip displaysia/arthritis as well, possibly resulting in a misdiagnosis of hip disease.

    Diagnosis of a ruptured CCL

    • History involving severe lameness (holding the foot up) or recurrent bouts of lameness in one or both hind legs
    • Lazy sit (holding the leg extended and out to the side when sitting)
    • Pain on manipulation of stifle (knee)
    • Positive drawer sign or tibial compression test (associated with instability) on manipulation of stifle, however, approximately 50% of dogs with partial or chronic tears do not have any appreciable instability.  (These cases can often be mistaken for hip problems)
    • Swelling associated with the knee joint, “water on the knee”
    • Enlarged, firm, knee joint (medial buttress)
    • Swelling within the joint on x-rays
    • MRI
    • Exploratory surgery

First Class Treatment for Cranial Cruciate Ligament (CCL) Rupture

If your dog has a cruciate ligament rupture, there are several choices of treatment. The veterinarians at  Upper Canada Animal Hospital will guide you every step of the way.

Our goal is to provide you with all the information you need so you can make the best decisions for you and your pet.  We’re here to listen and help you.

Dr. Turpel treats dogs with CCL injuries from throughout Ontario and upstate New York.  Today, having performed over 1500 CCL surgeries, he is excited to say that  “It’s very rewarding seeing these incredibly lame and painful pets recover to the point that the vast majority of owners can’t tell which leg had surgery.”

Surgical Treatment Options for CCL Injuries

There are numerous surgical techniques available to deal with CCL injuries.  At Upper Canada Animal Hospital we typically recommend extracapsular repairs in cats and small dogs, and the TTA procedure for larger patients.  These recommendations are based on over 23 years of surgical experience and provide our patients with excellent outcomes in the overwhelming majority of cases.

Extracapsular repair as the treatment for CCL injuries

There are numerous variations of extracapsular repair that are performed. The two most common types are known as the tightrope and the securos. Despite the slight differences in techniques, the principles involved in all extracapsular repairs is basically the same in that they all employ a type of suture material that loops around the stifle (knee) and is intended to minimize the instability (tibial thrust) that is encountered once the CCL is compromised.

Extracapsular repairs can be an excellent option for smaller, less active dogs and cats less than 30-40 pounds, however as a patient’s size increases the benefits seen with this type of repair dramatically decreases. This decreased success rate is no way attributable to a surgeons lack of ability or skill, rather it is an inherent limitation in the technique itself.

Many surgeons quote a success rate in the 80 to 90% range for extracapsular CCL repairs however it must be understood that this is an average and that dogs less than 40 pounds will typically do far better than those over 40 pounds. As a patients size continues to climbs the rate of success continues to fall to the point where the majority of dogs over 60 pounds will do very poorly when compared to small dogs.  Always inquire as to the surgeon’s definition of success when they quote success rates.  Our definition of success involves a return to a normal active lifestyle with no need for pain medications or restrictions to activity.

Patient selection is extremely important when deciding on an appropriate surgical repair technique (extracapsular vs TTA). While most surgeons will consider size as the main determining factor when recommending one surgical technique over another, other factors such as the pets age, activity level, problems with other legs (including a torn CCL in the other stifle) and an owner’s expectations must all be taken into consideration.  We at Upper Canada Animal Hospital treat each every pet as an individual and provide pet owners with treatment options tailored to their pet.

Dr Turpel has been performing Extracapsular CCL repairs for approximately 23 years. His success rate is considered excellent in over 95% of cases, however, he strongly recommends it be reserved for dogs under 40 pounds, while he recommends TTA’s be performed in patients over 40 pounds. In these larger dogs, the TTA also provides excellent results in well over 95% of our cases. We routinely perform TTAs in dogs up to 180 pounds.

Tibial Tuberosity Advancement (TTA) – New Age Canine Dog Knee Surgery

Upper Canada Animal Hospital is proud to offer some of the more advanced surgical treatments in Niagara. If your dog is suffering from a ruptured cranial cruciate ligament (CCL), our team of expert veterinary surgeons will help your pet.

Click here to see typical results of a TTA Surgery.

How Does Tibial Tuberosity Advancement (TTA) Help Your Injured Dog?

If your pet has torn their CCL, a TTA procedure may be the best option for repair.  Dr. Turpel has performed hundreds of TTAs and was, in fact, one of the first veterinarians in Canada to adopt the procedure.  Tibial Tuberosity Advancement (TTA) success rates associated with this procedure are approximately 98% and with patients typically walking on their leg within 24 – 48 hours after surgery, owners are absolutely delighted as their pets are extremely comfortable.

The TTA is a technically advanced procedure that has a steep learning curve.  23 years of orthopedic experience, combined with intensive training under the esteemed Dr. Tepic (Innovator of the TTA Procedure), ensures that Dr. Turpel has the skillset to perform this surgery proficiently and that your pet is in the best of hands.  If your pet is in need of the TTA procedure, it is important to choose an experienced surgeon for your companion.

Benefits of the TTA Procedure:

  • early weight bearing
  • rapid recovery time (typically 8 weeks as compared to 12 – 16 weeks for a TPLO)
  • low complication rate and reduced severity of complications
  • return to excellent long-term function
  • minimizes progression of arthritis
  • routinely performed in pets from 20 – 180 pounds

See Sasha’s Recovery after her TTA Surgery.

For further background and technical information on the TTA Procedure visit our TTA page.

For information on how to help prevent a second CCL tear, and decreasing post-surgical arthritis visit Dr. Turpel’s article on Tips to Prevent Further CCL Damage.

For a detailed outlook on Dr. Turpel’s surgical background please see his biography.

Our animal clinic treats CCL injuries in Niagara-on-the-Lake and the surrounding areas. Take a virtual tour of our hospital surgery facilities and contact us to learn more about cruciate ligament rupture repair and treatment, including surgery.