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.

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Consider the human knee for example, you’ve all probably heard of torn or ruptured ACL’s (meaning the ligament is entirely severed), and you’ve also heard of partially torn ACL’s (meaning the ligament is still intact, but has definiate damage. Now, let’s consider a pro athlete, surgery will be necessary for either case - torn ACL or partially torn ACL. However, let’s say we have a 40 year old man with a desk job who doesn’t do too much physical activity. Surgery would be the best bet for a torn ACL, however he could probably get through the rest of his life with a partially torn ACL, and using a brace and conservative management in situations where any further damage to the ligament could occur.

The same hold true for dogs, however, the unfortunate thing is that we don’t have the option of giving a dog an MRI, which will actually show the extent of ligament damage. With dogs, we can have an x-ray, and we can have veterinarians check for instability (drawer movement), but we will not not for sure if the ligament is completely torn, or just partially torn. This is where conservative management comes in. Depending on the size of your dog (conservative management is typically not an option for large dogs - 40+ lbs), the amount of instability (drawer movement) in the stifle (knee) joint and the amount of lameness your dog displays in the injured limb, your veterinarian may recommend conservative management rather than a surgical procedure.

For conservative management, these principles must be strictly adhered to, otherwise the stifle joint will be unable to recover naturally:

1. Weight management / Diet control
2. Complete restriction of movement in the beginning, along with rest
3. Use of anti-inflammatory medications

Weight Management is not only something that will be recommended in the case of conservative management, but it will often be recommended following surgical procedures as well. Our dog dropped 1/3 of her body weight after surgery through diet control and weight management.

Rest & Restriction is required to allow the knee joint to heal in any way if its going to. This process can take 4-8 weeks, and at the end of this period, if the dog is still exhibiting lameness in the limb, surgery might be the best option.

Anti-Inflammatory Medications can be used in combination with weight management and rest & restriction to help remove the swelling in the limb and let it recover.

Before beginning a conservative management regimen, it is always best to contact your veterinarian and have the CCL injury professionaly diagnosed. After seeing a friend of mine try conservative management with a Labrador, I’d recommend seeing a vet ASAP after the injury.

The TPLO surgery procedure is a fairly invasive surgery that actually involves cutting the bone to change the angle at which the knee joint rests. Learn more about cranial cruciate ligament repair through TPLO.

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.

At the ER, they told us that to diagnose the problem with her knee they were going to have to do 2 things:

1. Take x-rays of the stifle (knee) joint to make sure that there is no bone damage and/or arthritis.
2. Manipulate the joint while the dog is sedated to check for instability (drawer movement)

So we left our dog at the emergency clinic so that they could sedate and diagnose her injury, and when we next heard back from them, they told us that she most likely has a torn cranial cruciate ligament (CCL; misspelling: cranial crucial ligament) and that we should take her to her primary care veterinarian to discuss repair options.

Cost of X-Rays
Prior to determining the type of surgery that should be performed, an x-ray is needed to determine the angle of the stifle joint. Since the angle of the stifle (knee) joint plays a role in the type of surgery available, it is an importatant step in CCL repair. My wife and I spent the number on the high range because we rushed our dog to the doggie emergency room on a Sunday evening, I’m assuming an x-ray can be done for much less.
Unexpected Cost of CCL Repair #1 - X-Rays - $100-$500

Cost of Medications
After surgery, you’ll be giving your dog heavy doses of pain killers, and depending on the activity level of your dog, you may be giving it some sort of sedatives as well. We didn’t use the entire prescription of pain killers, but we did have to renew the prescription for sedatives because our dog didn’t seem to think anything was wrong with her.
Unexpected Cost of CCL Repair #2 - Medication - $150-$350

Cost of Follow-Up Visits
I should have expected this one, but for some reason, I overlooked it. The day we left the veterinary clinic, we rescheduled for the following week. We had about 5 follow up visits in the next 2 months, and not only were we paying for each visit, but we were also being upsold on joint health medications, arthritis medications, weight management diets, joint health diets, and just about everything else that you can think of. We just spent $2,700 on surgery, now we’re being nickle and dimed for all sorts of other stuff? Really not necessary, but don’t be surprised if it happens to you too!
Unexpected Cost of CCL Repair #3 - Follow-Up Visits - $200-$500

From start to finish, you can expect to be 2-3 thousand dollars in when all is said and done, but you can keep this amount much smaller if you do your research and go through the entire rehab process on your own.

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.

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.