Dog Knee Ligament (CCL) Repair

Knee Ligament and Knee Joint Repair Options for Labrador Retrievers

Whether you have a black lab, yellow lab or a chocolate lab, you will typically be looking at 1 of 2 knee repair procedures for larger dogs - TPLO or TTA surgery to repair the torn or ruptured cranial cruciate ligament in your dogs knee. The traditional technique (extracapsular technique) typically isn’t used in large breed dogs, such as Black Labrador Retrievers, Yellow Labrador Retrievers or Chocolate Labrador Retrievers due to the added stress on the joint from the extra weight of the dog.

Cruciate Ligament in Dogs, Canine Cranial Cruciate Ligament (Crucial)

The cranial cruciate ligament in dogs provides stability to the knee (stifle) joint. Any strain, tearing or rupture of the cranial cruciate ligament can, and will, result in knee (stifle) instability. A strained cranial cruciate ligament can, in many cases, be repaired or heal itself without surgery. Strains should be treated with conservative management. Tears and ruptures of the cranial cruciate ligament require more drastic treatments such as orthopedic surgery. When it comes to surgical repair of the CCL, there are multiple CCL surgery options available and it is always best to consult with your veterinarian prior to deciding which option is best for your dog.

The necessity of the cranial crucial ligament (CCL) can be compared to the necessity of the anterior cruciate ligament (ACL) that is found in humans. While there are people who have bypassed having surgery with a torn ACL, their knees are typically less stable for the remainder of their lives and their activity has to be severly limited. The same holds true for canines - should a torn or ruptured CCL be left untreated, the dog will survive, but may display lameness in the limb with the torn ligament, and the dogs activity level will not be the same as that of what it was prior to damaging the ligament.

Lateral Fabellar Technique (Extracapsular Technique) - Cranial Cruciate Ligament Repair

The Lateral Fabellar Technique, or Extracapsular Technique, is a common surgery performed on dogs to stabilize the stifle (knee) joint after a tear or rupture in the cranial cruciate ligament (CCL; misspelling cranial crucial ligament). Normally, the cranial cruciate ligament (CCL) prevents backward-forward movement (drawer movement) of the stifle joint. Untreated instability in the knee/stifle joint due to a turn/ruptured CCL can result in a tearing of the meniscus as well. When it tears/ruptures, the stifle joint becomes unstable and the dog suffers lack of mobility, lameness or loss of use and is subject to chronic and progressive arthritis in the stifle if untreated.

In a Lateral Fabellar (Extracapsular) procedure, heavy suture material (monofilament nylon cord) is passed from the lateral fabella to the tibial crest in order to eliminate joint instability (drawer movement). It is this nylon cord that will act as the CCL ligament in the future by holding the joint together and keeping it stable.

The lateral fabellar surgery will not stop the progression of arthritis that is already present in the joint. Your dog may have some stiffness of the limb and may have some lameness after heavy exercise.  Chondroitin sulfate and glucosamine may be given to help with stiffness.

Typical downtime and rehab:

• First 2 weeks, dog should be crated and only let out on a leash to go to the bathroom.
• After about 2 months, lameness should decrease significantly, but it was recommended by our veterinarian to keep our dog crated still.
• After 3 months, our dog had regained full use of her leg.

Cost of TTA Surgery for Cranial Cruciate Ligament - Cost of Knee Surgery for Dogs

If your dog has suffered a torn or ruptured cranial cruciate ligament injury, you may be starting to look for surgical options and you’re probably also starting to wonder about the cost. Most knee surgeries in dogs can cost as low as $800 all the way up to $3,000+.

The cost to repair the CCL in a dog (equivalent of an ACL in humans), will fluctuate based on the state that you live in, the experience of the surgeon, the weight of the dog, the invasiveness & complication level of the surgery, etc.

Through my experience, and from talking to a few of my friends whose dogs had cranial cruciate ligament repair surgeries, I believe that you should expect to spend somewhere in the range of $1,500. You may end up paying a little more or less depending on the above criteria, but go in expecting somewhere around $1,500.

Don’t forget about the “hidden” costs of a cranial cruciate ligament repair surgery.

TPLO vs. TTA vs. Lateral Fabellar Traditional Technique - Cranial Cruciate Ligament Repair

Both the TPLO (Tibial Plateau Leveling Osteotomy) and TTA (Tibial Tuberosity Advancement) surgery options involve altering the angle in stifle (knee) joint by cutting and changing the biomechanics of the tibial bone. Through all of my research, I came to the conclusion that TTA will not be an option that is available to all dogs, but that will of course have to be a decision that is made by your veterinarian prior to surgery.

TTA is said to be a newer, less invasive procedure with a quicker recovery time, so if you have a highly active dog, this option may be better for you and your dog should you be able to find an orthopedic surgeon who is willing to perform this technique.

Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)

When it comes to caring for our pets, we all want the best possible option, however, most veterinarians will have a single method that they prefer to perform, thus leaving you to find another vet if you do not agree with having a specific CCL surgery. Prior to committing your dog to a surgery, you’re going to want to find out what option your veterinarian will perform, the recovery time, what percent of normal activity level will the dog return to when fully recovered, etc. Of all the surgery options, I’d say that any would be better than going without the surgery (see my post on my friend who did not get the surgery for his dog), but in the end, the choice is going to be up to you - the dog owner. Without the surgery, your dog will have an unstable stifle (knee) joint, and will probably show lameness terminally.

Cranial Cruciate Ligament (CCL) Surgery Options

• Traditional Repair – Lateral Fabellar Technique
  This technique is typically recommended for smaller dogs (we went with this option on our 60lb pit bull). With this technique, a monofilament nylon cord of about 80-100lb tensile strength is passed from the lateral fabella to the tibial crest, in what was explained to me as a figure 8 pattern, basically wrapping the knee joint to eliminate and prevent joint instability (drawer movement). Scar tissue will, over time, develop around the joint, which will further stabilize the joint, but will also begin to restrict range of motion.
• Tibial Plateau Leveling Osteotomy (TPLO)
  The TPLO CCL repair technique is generally recommended for larger breeds of dogs, as well as active dogs, such as agility dogs. This technique is also thought to cause less degenerative arthritis around the stifle joing. Key things to note about the TPLO surgery are a quicker recovery time, better range of motion, less arthritis and a return to athletic (working) activity levels. TPLO surgery involves cutting the bone and slightly rotating it before re-attaching it with a plate. By rotating the top of the bone, less pressure is put on the joint.
• Tibial Tuberosity Advancement (TTA)
  This is a new, less invasive option to the TPLO surgery, but will not be an option for all dogs. Since this surgical option is less invasive, it allows for a quicker recovery time. TTA also puts a cut in the tibial bone, however it shaves off the front of the bone and extends it with a spacer. Also like the TPLO surgery, the TTA option depends on the angle of the stifle joint and is not recommended for dogs with a steep angle in the stifle.

As you can probably tell, each option has advantages and disadvantages, and all options should be discussed with your veterinarian after x-rays are taken of your dogs knee joint.

TPLO - Tibial Plateau Leveling Osteotomy - Cranial Cruciate Ligament Repair

TPLO, or tibial plateau leveling osteotomy, is a common surgery performed on dogs to stabilize the stifle (knee) joint after a tear or rupture in the cranial cruciate ligament (CCL) (can be compared to the anterior cruciate ligament (ACL) in humans). Normally, the cranial cruciate ligament (CCL) prevents backward-forward movement of the stifle joint. When it tears/ruptures, the stifle joint becomes unstable and the dog suffers lack of mobility, lameness or loss of use and is subject to chronic and progressive arthritis in the stifle if untreated.

In a TPLO procedure, the tibial plateau, the portion of the tibia adjoining the stifle (knee), is cut and rotated so that its slope changes to approximately 5 degrees from the horizontal plane, forever changing the biomechanics of the dogs movement. This prevents the femur from sliding down the slope of the plateau. It is rumored that TPLO surgery generally results in faster recovery times compared to other procedures to stabilize the knee joint. Most dogs (over 90%) are expected to regain a very active and athletic lifestyle with no post-operative complications and without the need for any pain relieving medication.