Cranial Cruciate Ligament Rupture in Dogs

I’ve mentioned before that Ginko “blew out” both knees when he was 3 years old. The official name of the injury is a cranial cruciate ligament (CCL) rupture. Often dogs also tear their cartilage (or meniscus) too, which complicates things. For those who aren’t too squeamish, here are details (including photos). Fair warning.

As background, I’ll share that this injury is the most common orthopedic injury dogs suffer. Hands down. It’s similar to the ACL injury in people. I wrote a whole article about the surgical options for The Bark a few years ago. Below is a link to a PDF of that whole magazine article which outlines the 3 surgical options available. Ginko had the one called TPLO (tibial plateau leveling osteotomy).

Ginko’s problem started with a non-descript lameness that came and went, came and went, over about 6 months. What made it hard to pinpoint was that both knees had blown at pretty much the same time. We don’t know why or how. The surgeon said some dogs are just prone to this injury.

If you think something bad is going on in your dog’s knees, watch how he stands. If he shifts his weight off of one leg or the other, that’s a very subtle sign that there is something wrong, even if the acute onset of pain has waned.

I don’t think the board-certified veterinary surgeon we used allows it anymore, but we got to watch both surgeries (done about 3 months apart in late 2003 and early 2004) from first cut to last stitch. We watched them saw off his tibia and reposition it, using several screws. Yep … saws, drills, screws. Saw the whole thing.

Our take-home instructions included these images taken using the arthroscope. We got to see these live on a TV screen during surgery.

{I’m devastated that all these photos got lost in a major blog photo glitch. For the life of me I cannot find the originals to repost. I’m so sorry. They were very neat.}

First, here is what a normal CCL looks like.

This is what the rupture on the left looked like:

And, on the right:

Normal cartilage looks like super smooth moons. Here is a shot of just one of his meniscus tears:

I can’t find images of it, but we also saw gray cobweb-like things inside the knees, which was arthritis already starting.

Essentially, in the surgery we chose, the doctor cleaned up the tears/ruptures with a laser to cut away the damaged tissue, then he cut off and repositioned the top of his tibia bone to change the geometry of the knee joint so that this “bad” ligament wasn’t under as much pressure.

X-ray before:

X-ray after:

It takes about 12 weeks for the cut bone to heal. Some people choose to have the plates and screws removed in another surgery after that. We did not, so Ginko still has all this hardware inside.

The rehab after this surgery (or any like it) is tough. Getting the bone to heal is one thing. Getting the dog’s strength and physical conditioning back is another. There are all kinds of limitations — no running, no jumping, no stairs. The controlled leash walking ramps up over the 12 weeks, until follow-up x-rays show the bone is healed. We also did massage and stretching that a physical therapist taught us.

Three training items made recovery much easier on him (and us):

1. Crate training. I simply do NOT know how you get through something like this without being able to use crate rest.
2. A good DOWN-STAY. The dog needs to be able to sit still for 20 minutes at a time or so, while you apply ice.
3. Decent leash walking skills. Ginko never will be a star heeler, but he is OK on leash.
   

Ginko actually LOVES to be iced. Even now, after we play fetch (only a few throws at a time to keep him from hurting too much from the arthritis), he often plops down in a snow bank.

Lilly (with her recent hip injury) isn’t as keen on the ice thing, but she will stay put thanks to good DOWN-STAY training.

P.S. I do know of one dog (a small terrier) whose leg simply never healed. She ended up having the whole leg amputated after knee surgery, which ended her agility career and began her dirt dog career.