Easily the most common orthopedic injury in dogs, the cranial cruciate ligament (or CCL) is a very important stabilizer in the stifle (knee) joint in the rear leg. Many are familiar with the anterior cruciate ligament (or ACL) in people which is the same ligament but we just call it by a different name in animals. Injury of the CCL, often called cranial cruciate ligament disease (or CCLD), is a painful condition that leads to pain, arthritis, and lameness in dogs.
Cranial Cruciate Disease occurs in dogs of all breeds and sizes (and sometimes in cats as well). Some breeds are more commonly affected. Although any dog can be affected, the most common breeds affected include Labrador Retrievers, Chesapeake Bay Retrievers, Saint Bernards, Newfoundlands, Rottweilers, Akitas, and 
Staffordshire Terriers. Dogs that are overweight or otherwise not at a good level of physical fitness are at a much higher risk of CCLD than regularly exercising, fit, and trim dogs.
CCL injury can range from a partial tear to a complete rupture of the ligament. Many cases are progressive and a “strained” CCL will often eventually rupture. With injury, there is usually a severe and sudden lameness of a back leg that then may appear to improve but never gets fully better. Affected dogs will often limp, lose muscle mass in the affected leg, and no longer sit with the injured leg neatly tucked squarely.
If your dog is lame for more than one day or is in obvious pain, seek out a veterinarian. There are many signs that a veterinarian can test for to diagnose CCLD. Tibial thrust tests and cranial drawer tests will often allow a veterinarian to diagnose the injury. Many times, a sedated orthopedic examination and X-rays will be needed. In some cases, advanced imaging like MRI may be necessary.
Once diagnosed, the treatment for cranial cruciate disease is surgery. Ruptured CCLs WILL NOT HEAL. Untreated dogs will become arthritic and will suffer lameness for the rest of their lives. It is extremely common for a dog to end up rupturing the CCL in the other knee. If your dog has been diagnosed with a CCL tear, schedule to meet with a veterinarian skilled in dog ACL surgery. “Let’s try some pain meds and wait and see how he does” or “Let’s try a brace” will not work and only advances the arthritis that will set in.
There are three primary surgeries (with several additional variations) that are considered excellent treatments for cranial cruciate disease rupture. In the United States,
the most well-known is tibial plateau leveling osteotomy (TPLO) followed by tibial tuberosity advancement (TTA). Cranial closing wedge osteotomy (CWO) is more commonly performed by our European counterparts. During each of these procedures, an osteotomy (a cut in the bone) is performed and the anatomy of the tibia is altered to eliminate the need for a CCL. These provide permanent solutions that gives affected dogs a normal life.
In decades past, numerous extra-capsular stabilization techniques were used to treat dogs with CCLD. Although extra-capsular surgeries are still performed in some areas today, they are no longer recommended. The reason is that extra-capsular repairs WILL EVENTUALLY FAIL. Many of these then require further surgery to remove the old, broken implants and perform one of the now-standard osteotomy procedures such as TPLO or TTA.
At The Hometown Veterinarian, we have extensive experience and skill in the treatment of cranial cruciate injury. Dr. Jacobson has been performing surgeries to treat CCL disease since 1997. At our hospital, TPLO and TTA are performed regularly with very good results.
If your dog has been diagnosed with CCLD or if you suspect an injury, call our Marshalltown, Iowa office at 641-758-3333 to set up an evaluation or click to Request an Appointment