Many people are familiar with or have heard of ACL (anterior cruciate ligament) injuries in people, particularly athletes. In canines the term CCL (cranial cruciate ligament) is used in place of ACL. Cranial cruciate ligament injury is one of the most commonly diagnosed orthopedic problems in our canine companions. There is no breed or sex predilection for CCL injury, although it is most commonly diagnosed in larger breeds of dogs.

There are two common scenarios involving cruciate injury. In most instances owners will notice an acute non weight bearing lameness that started during activity. There is usually no previous history of lameness associated with the affected limb. Other dogs will have a chronic lameness that involves small tears in the ligament. Diagnosis is achieved through manipulation of the joint; an increase in cranial movement of the joint indicates ligament injury. Initial management of the problem involves medical management with various medications including anti-nflamatory drugs nutritional joint supplements and pain medication.

There are several surgical options for correction of the injury including extra capsular ligament reconstruction, tibial plateau leveling osteotomy (TPLO), and tibial tuberosity advancement (TTA). Both the TPLO and TTA procedures involve a new approach to treating this problem. They both involve cutting the bone in several places, and placing plates to change the angle of the joint. Both procedures are relatively new but hold a great deal of promise for increased joint function following surgery. Extra capsular repair is currently the most commonly performed procedure, and is the technique that we currently use. The ligament is reconstructed using 40 to 100 pound test suture to return stability to the affected knee.

The rehabilitation period following surgery is 8 to 12 weeks. During this time it is most important to restrict the animal to on leash activity only. It is desirable to have the animal using the surgically repaired limb but in a controlled fashion. Physical therapy Is used to help maintain muscle mass and range of motion in the affected joint. Physical therapy can range from simple flexion and extension exercises performed by the owner at home to referral to a physical therapy specialist. The physical therapist may employ a variety of exercises and use of hydrotherapy/underwater treadmills to improve function of the leg.

There are a few possible post operative complications. These include destabilization of the joint from premature suture breakdown, infections, and degenerative joint disease. The goal of any of the available procedures is to have return to pre injury function of the limb. If degenerative changes in the joint are noted at the time of surgery or develop later in life there are a variety of medical management options available.