CCL/ACL Injuries

CCL = Cranial Cruciate LigamentACL = Anterior Cruciate Ligament

(most commonly seen in dogs)

What is the ACL/CCL?

• It’s 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 floor• Excessive running• Trauma (i.e. hit by car)

• Degeneration of the ligament• Obesity

Breeds Affected• These breeds are seen to

have increased risk of degeneration.– Labrador Retriever– Newfoundland– Rottweiler– Bichon Frise– St. Bernard– Boxer– West 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 injuries• Variable lameness on

one or both hind feet• Lameness in affected

limb (especially after exercise) that gets better with rest

• Abnormal posture• Reluctance to run,

jump, or rise from sleep.

• Morning stiffness• When sitting, one leg

sticks out to one side• Swelling around the

knee joint• Slight 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 ground– Dog will not put any weight on

the affected foot.• Veterinarian manipulates the

affected knee feeling for ‘drawer movement’– The movement of the femur

across the tibia• This is the only way to confirm

the presence of rupture.

• http://www.youtube.com/watch?v=9jg9E2nBt_E

With Radiography• Only 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 injury

X-ray technique:• Important because they will help evaluate the secondary conditions– Osteoarthritis– Joint cartilage injury– Accumulation of fluid around

the joint.

• Area that x-ray is taken at to get view of ACL/CCL = the stifle/knee joint

• Best 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 do

Picture taken from University of

Liverpool website.

How to fix this injury…

Surgical Correction Options

• 1. TPLO – Tibial Plateau Leveling Osteotomy– Most recommended for large breed dogs.– Procedure:• Surgeon checks the cartilage of the knee to determine

if it is also torn• There is a cut made into the plateau of the tibia• It is rotated to make the slope more level with the

femur• A 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 Options

• 2. TTA – Tibial Tuberosity Advancement– a slightly less invasive procedure with slightly

quicker recovery time– Results very similar to the TPLO option– Procedure:• 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 Treatment

• Most commonly used in small dogs and cats• A suture material made of nylon is passed

between the back of the femur to the tibia crest

• Scar 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.