CCL/ACL InjuriesCCL = Cranial Cruciate LigamentACL = Anterior Cruciate Ligament(most commonly seen in dogs)
What is the ACL/CCL?Its one of the two ligaments connecting the femur and tibia bones.These ligaments are there to keep the bones from rubbing across each other.
How does the injury occur?Specifically the knee twists too much and the ligament ruptures.Examples:Slipping on a floorExcessive runningTrauma (i.e. hit by car)
Degeneration of the ligamentObesity
Breeds AffectedThese breeds are seen to have increased risk of degeneration.Labrador RetrieverNewfoundlandRottweilerBichon FriseSt. BernardBoxerWest Highland White Terrior Remember: ANY dog can rupture their ACL/CCL
Most that are predisposed will get it in both knees.In small breeds, a luxating patella may predispose them.
Symptoms of these injuriesVariable lameness on one or both hind feetLameness in affected limb (especially after exercise) that gets better with restAbnormal postureReluctance to run, jump, or rise from sleep.Morning stiffnessWhen sitting, one leg sticks out to one sideSwelling around the knee jointSlight deterioration of the muscles on the affected limb
*If symptoms are very minor, it may be because of slight deterioration.
How is it diagnosed? By watching and touching the animal.Veterinarian views a limp with paw slightly touching the groundDog will not put any weight on the affected foot.Veterinarian manipulates the affected knee feeling for drawer movementThe movement of the femur across the tibiaThis is the only way to confirm the presence of rupture.
With RadiographyOnly used to access the amount of arthritis present in the knee joint.
Picture taken from University of Liverpool website
How X-rays are used for this injuryX-ray technique:Important because they will help evaluate the secondary conditionsOsteoarthritisJoint cartilage injuryAccumulation of fluid around the joint.Area that x-ray is taken at to get view of ACL/CCL = the stifle/knee jointBest view is lateral but CaCr also necessary.Measurement taken at the area of the widest part of stifle joint.Beam centered over the stifle joint.Veterinarian will measure the slope of the tibia to help choose which surgery to doPicture taken from University of Liverpool website.
How to fix this injury
Surgical Correction Options1. TPLO Tibial Plateau Leveling OsteotomyMost recommended for large breed dogs.Procedure:Surgeon checks the cartilage of the knee to determine if it is also tornThere is a cut made into the plateau of the tibiaIt is rotated to make the slope more level with the femurA plate and screws are inserted to make sure that it stays in place.Much of the success of this option depends on the owners post-op care.
TPLO before and after x-rays
Surgical Correction Options2. TTA Tibial Tuberosity Advancement a slightly less invasive procedure with slightly quicker recovery timeResults very similar to the TPLO optionProcedure:Cut is made into the front part of the tibia (the tuberosity)This part is pushed forward to remove the abnormal sliding of the bone A specialized bone spacer in placed in the space that was created. Plate and screws also used to secure the bone in place.
TTA x-rays post surgery.
Nylon Band TreatmentMost commonly used in small dogs and catsA suture material made of nylon is passed between the back of the femur to the tibia crestScar tissue develops over time to stabilize the joint
Prognosis?With proper care, animal will return to regular activity.Will most likely need to be on NSAIDs for the osterarthritis.If only one side was affected/corrected the other one is more likely to eventually rupture
Sources:Degner, Daniel DACVS. Cranial Cruciate Ligament Rupture Lateral Fabellar Technique (Extrascapular Technique). Vet Surgery Central Inc. 8 September 2010. http://www.vetsurgerycentral.com/cruciatelrt.htm. Degner, Daniel DACVS. Tibial Plateau Leveling Osteotomy. Vet Surgery Central Inc. 8 September 2010. http://www.vetsurgerycentral.com/tplo.htm. Degner, Daniel DACVS. TTA for Cranial Cruciate Ligament Rupture in Dogs. Vet Surgery Central Inc. 8 September 2010. http://www.vetsurgerycentral.com/ortho_TTA.htm.Innes, John RCVS. Cruciate Ligament Rupture. University of Liverpool Small Animal Teaching Hospital. 8 September 2010. http://www.liv.ac.uk/sath/conditions/cruciate.htm.Nash, Holly DVM, MS. Ruptured Anterior Cruciate Ligament. Pet Education.com. Doctors Foster and Smith. 8 September 2010. http://www.peteducation.com/article.cfm?c=2+2084&aid=474.
So this is only in the rear legs.The one towards the front of the leg is the anterior/cranial ligament.*Or sudden turn while runningDegeneragion ligament loses strength and ruptures much easierObesity puts much more stress on the ligament so overweight dogs are more prone.*Variable lameness may be chronic or intermittentPet may have one or more of these symptoms at a time.If left untreated these will continue to get even more severe.**Note: may need to adjust kVp slightly to better visualize the area between the femur and tibia
*Each surgeon will argue about which option is better/best.*Although it has been done in some small dogs.Torn meniscus/cartilage usually accompanies the ACL tear. it may tear post surgery too and that would require another surgery to correct that.*Left one: just shows the regrowth of bone.
Right one: you can see the bone cut and movement special spacer piece plate and screws as well as the staples that were used to seal up the incision.
*Nylon will remove the joint instability.
The blue line in the picture is the nylon.*