Dog Knee Surgery & CCL Ligament Repair » CCL

Dog Knee Infected After CCL Knee Surgery – Infection Caused by Surgical Hardware

Kenneth — Wed, 22 Dec 2010 07:09:49 +0000

The following story and questions came from reader Nina through our Contact Page. I haven’t had any experience with these problems, so I’m hoping that some of our readers can help answer some of Nina’s questions.

My Boxer mix had tight rope surgery on his knee April 2010. I did all the slow rehabilitation like the vet requested. His knee still gave him problems and after several more vet visits has been placed on anti-inflammatory and antibiotic medications which do not seem to help. Recently a digital x-ray showed that two things may be the problem:

The hardware is causing an infection that will not go away unless the hardware is taken out

The cushioning in between the joints is damaged

Either way I was told the hardware must come out. Then the possibility of repairing the knee with the top of the line hardware with all the metal may be needed. How can the hardware cause an infection that no antibiotic will help and if its the hardware causing the infection how can another piece of hardware be different? Also is there anything else I can do to help this poor dogs knee besides another costly surgery and more hardware?

My guesses were as follows: the only way that the hardware could cause an infection is if the hardware that was placed inside the knee during surgery was not sterile. If that were the case, then the veterinarian would be responsible for cost/replacement/etc. Other than surgery, the typical options are conservative management, weight management, drugs and medications, and/or dietary supplements.

Cruciate Ligament Injury In Dogs – Cost & Repair Options

Kenneth — Sun, 24 Oct 2010 19:50:19 +0000

Cruciate ligament injuries in dogs are very common among active breeds. As a dog owner who has gone through a cranial cruciate ligament injury with my pet, I know for certain that it is not an easy process to go through because we hate to see our pets in pain and it’s also difficult financially because the cost of cranial cruciate ligament repair is not inexpensive. The cranial cruciate ligament in dogs is similar to the anterior cruciate ligament (ACL) in humans and though it is possible to live and move with a torn ACL/CCL it does severly limit activity because that is the ligament that provides stability in the knee joint.

For those of you who are new to the site, here are some previous posts that may help you find some information that you’re looking for.

Cranial Cruciate Ligament Repair Costs

Cranial Cruciate Ligament Repair Options

Whatever your situation, the above posts should help give you some direction in finding answers for cruciate ligament repair costs and cruciate ligament repair options. If you don’t find the answer that you’re looking for, just leave a comment or fill out our contact form and we’ll see what we can do to help.

Diagnosis – How We Determined Our Dog Had A Torn/Ruptured Cranial Cruciate Ligament (CCL)

Kenneth — Wed, 30 Sep 2009 19:38:24 +0000

As with ACL tears in humans, CCL tears in dogs can be sudden and very noticeable, or they can develop slowly over time. When a person injures their knee and suffers a torn ACL, it is normally going to be very painful and the joint will feel very unstable and in most cases, will not be able to be used. The same will hold true for dogs when they injure their CCL. When our dog tore her CCL, she immediately stopped bearing weight on the leg.

Our dogs CCL was torn while at the beach, our other dog was playing and ran into her at full speed while she had her feet set in the sand and was digging. The impact caused an awkward twisting of her rear leg that was planted in the sand and it caused the CCL to give way. After the impact, she immediately held her leg up and began hopping/skipping and only using one rear leg.

This was an extreme situation, and it was obvious when it happened that our dog had suffered some sort of an injury. Whenever anything like this happens, the dog should be taken to the vet immediately, though I’m not sure I’d recommend the emergency vet anymore. If you’re unable to get your dog into the vet within a few days from the injury, the emergency vet may be your best option, but chances are, they’ll have you take your dog to your primary car veterinarian.

There will be cases where the injury slowly develops over time, and ligament will eventually give way, tearing/rupturing partially or completely. In this circumstance, you may notice your dog limping on occasion (not all the time), probably particularly after heavy activity, strenuous activity or prolonged activity. Some breeds of dogs have knee joints that aren’t physiologically great at bearing weight, and any of the above mentioned conditions can aggravate the CCL, and over time it can eventually deteriorate enough to the point where the ligament gives way. In this case, you’ll want to take your pet to the vet to get an opinion as you begin to notice the symptoms – limping, stiffness, sluggishness, less playful, etc. As the owner, you’ll know when your dog isn’t acting normally. If your dog is developing a slowly forming knee injury, it can often be treated by conservative management, weight management, and sometimes even change in diet. Your veterinarian will be able to give you treatment options and recommendations, but hopefully seeing the signs early will be able to prevent a full tear or rupture of the CCL.

Canine Knee Surgery on Both Knees at the Same Time

Kenneth — Fri, 26 Jun 2009 07:11:28 +0000

When your dog tears its cranial cruciate ligament, that is bad news in itself, but what do you do when your dog ruptures both CCLs at the same time? How do you care for the dog? How do you decide what type of surgery to treat it? How do you afford it? Do you have the surgical procedure on both legs at the same time, or do you do one knee, let it recover, then do the other knee? These are all tough questions, and I’ll be the first to admit, we were a bit overwhelmed when our dog first ruptured her CCL, but hopefully the information here on this page will help out for those rare cases when pets rupture both knee ligaments at the same time.

The first step to take if your dog is diagnosed with 2 torn knee ligaments would be restriction. When I say restriction, I mean putting the dog in some sort of crate or pen that will drastically restrict movement. You don’t want the dog to have room to run and jump as sad as that is to say. While confined, icing the dogs knees can help reduce swelling and inflammation – if your dog will actually let you apply ice.

As the dog is confined, you’ll be left with some more questions to answer – Should we have both knees repaired at the same time, or should we do one, let it recover completely and then do the other. And then the next obvious question that comes after that is, can we afford it? I’ll address these questions together because they can tie directly into one another. We’ll look at these questions considering 2 cases. Case 1 – We get both knees operated on at the same time, and, Case 2 – We get one knee operated on, then wait for it to heal and then get the second knee operated on.

Option 1 – Repair both CCLs at the same time
I’m calling this option 1 because I think that this option will be the all around best option for both the dog and the owner(s). In terms of time commitment, this option will require less time because the knees will be recovering together, rather than waiting for one to recover, then waiting for the other. This option, though drastic, will be less harsh on the dog. With this option, the dog will only be required to be confined for 2-5 months (depending on the type of surgery, the veterinarians recommendations, etc.). This will essentially equate to half of the time as the other option. And the final reason that I think this is the better option is that there is greater potential for savings. If both knees are operated on at the same time, chance are you’ll be able to talk your vet into doing 2 for 1, or at least the second at a 50% discount.

Option 2 – Repair one knee at a time
With this option, you’ll be looking at strict confinement not just once, but twice. This was one of the hardest things when our dog had her knee surgery. There are many things that could come into play when deciding which option is best, age, activity level, attitude, etc, but if you have an active dog, I think that repairing one knee at a time would be absolute torture because it would lengthen the amount of time that the dog is penned up in a confined space. Though the possibility is there, I don’t believe the potential for savings is quite as large in this instance, because by spreading the surgeries out by 3-5 months, you’re in essence taking your dog back for an entirely separate surgery, and the veterinarian will probably want to bill you as such. It’s always worth trying to negotiate the price down a bit, but I would anticipate that the vet would be less willing to cut the price in this instance.

As terrible as this situation would be, it does happen, so I hope that this information helps in making decisions about how to treat a dog who does encounter a dual CCL rupture.

How Our Dog Ruptured Her Cranial Cruciate Ligament

Kenneth — Wed, 24 Jun 2009 07:34:23 +0000

We live in Southern California, so the beach is a fun and easy way for us to take our dogs out for exercise. We’re able to just walk along the shore and let our dogs run off the leash and do what they want, it’s far more relaxing than having to worry about taking them anywhere on a leash.

So we were out at the beach and our two dogs were our running around doing their own thing. Roxy (our 5 1/2 year old American Pit Bull Terrier) and our pitbull lab mix puppy happy as clams, Roxy digging holes and the puppy running around everywhere as fast as he could possibly go. Seeing Roxy, the puppy go very excited and ran at her, her back legs were set in the sand from digging, and the puppy never slowed down. He crashed right into her at full speed. She came up limping. She’s had slight hip problems in the past, and had a tendancy to limp a bit after our visits to the beach so we took her home, let her rest and decided to see how she was doing the following day.

The next day there was no change in her leg, she was still unable to put any pressure on it, so we took her into the “Doggie ER”. (Side note – if your dog isn’t suffering from a life threatening condition, don’t bother with a Pet Emergency Clinic – you’ll see why). At the pet emergency clinic, they decided to give her X-Rays to see if her ligament was torn – anyone who has ever had any ligament damage or torn ligaments knows that x-rays do not show ligaments, x-rays can only show bones, so having an x-ray was more or less pointless, unless they were checking for broken bones, which they made no mention of. In addition to the cost of X-Rays ($400) our dog had to be sedated, so that the doctor could “aggressively manipulate the joint” to test for instability. You may read negative reviews of manual joint manipulation, but we really didn’t give ourselves any time to research anything online, so we agreed to go ahead with the procedure. The manual joint manipulation allows the doctor (or vet) to check the stifle (knee) joint for “drawer movement”, this is basically any instability in the joint.

After all was said and done, the conclusion at the ER was that our dog had ruptured her Cranial Cruciate Ligament (CCL, equivalent to the ACL in humans) and we were then advised to take our dog to its primary care veterinarian within the next 3 days. At the time, we didn’t have a primary care veterinarian, but we lucked out because we were able to get a surgery scheduled in the place of a canceled appointment.

Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament

Kenneth — Tue, 23 Jun 2009 06:17:42 +0000

In reading this blog, you’ve probably come familiar with the 3 main types of surgeries used to treat a torn or ruptured cranial cruciate ligament in a dogs stifle joint. The problem with these 3 main types of surgeries is that they are fairly invasive, large incisions, bone cutting, etc. This may soon be a thing of the past with some of the advancements in medicine as vets and doctors are now using techniques from human surgeries. This new surgical method, called Tightrope CCL Surgery is far less invasive in that it is performed through small incisions and small holes drilled in the bone. A recent University of Missouri press release details this new procedure.

Technique Used in Human Ankle Injuries Modified to Treat Dogs’ Knees

MU veterinary clinician-scientist develops a minimally invasive method to treat torn ligaments

June 16, 2008

COLUMBIA, Mo. – A common sports injury in human knees is even more common in dogs. Each year, more than one million dogs suffer from cranial cruciate ligament (CCL) deficiency, which is comparable to the anterior cruciate ligament (ACL) injury in humans. The common method of treatment by many veterinary surgeons involves cutting the tibia bone to stabilize the CCL-deficient knee in these dogs. Now, a new minimally invasive technique with less severe complications than previous methods has been developed by a University of Missouri College of Veterinary Medicine researcher.

Unlike humans, CCL injuries in dogs typically do not occur because of a single trauma to the knee but are the result of a degenerative process that leads to early and progressive arthritis. For this reason, and the unique biomechanics of the canine knee, techniques used to repair the injury in humans do not work well for dogs. The new technique, known as Tightrope CCL, is modified from a technique used in human ankles and allows placement of a device that stabilizes the CCL-deficient knee through bone tunnels drilled using very small incisions. MU veterinarian James Cook worked with Arthrex Inc. from Naples, Fla., to develop and test the Tightrope device for dogs.

“Other current techniques require major surgery that involve cutting the bone, which can potentially lead to severe complications, such as fracture, implant failure and damage to the joint,” said Cook, professor of veterinary medicine and surgery and the William C. Allen Endowed Professor for Orthopedic Research. “This new technique is minimally invasive, relatively easy to perform and cost effective compared to other techniques. The dogs in the preliminary trial study experienced fewer and less severe complications with outcomes that were equal to or better than those seen with the bone-cutting technique.”

Cruciate ligament tears are five times more common in dogs than humans and cost U.S. pet-owners more than $1.3 billion each year. The new technique is not for every dog. Because surgeons must be able to drill tunnels in the bone, dogs must weigh at least 40 pounds for the Tightrope CCL method to be feasible. In addition, dogs that cannot follow a physical rehabilitation protocol after surgery and dogs with limb deformities are not candidates for this technique. The 10- to 12-week rehabilitation period is very important for any surgical technique for CCL deficiency in order to optimize successful return to pain-free function and reduce complications, Cook said.

“The times the Tightrope CCL technique has failed are when owners did not give their dogs the full rehabilitation period and let their dogs run, play or traumatize the joint before the knees were ready,” Cook said. “A successful operation is dependent on postoperative care so that the dog can heal well and build muscle for long term function. The Tightrope CCL technique is designed to allow this to happen with less surgery and less risk of a major problem arising, and so far, it has been successful.”

The original article can be viewed here.

If any of you readers have had any experience with tightrope surgery, we’d love to hear about it in the comments. It’s still a relatively new procedure, so there really isn’t too much information available on it yet, and there seem to be even fewer stories from our readers (unfortunately). As I learn and hear more from our users, I’ll add new posts and updates about the applications of tightrope surgery, the costs of tightrope surgery and the recovery and rehab procedure involved with tightrope surgeries.

Diagnosing a Cranial Cruciate Ligament (CCL) Injury

Kenneth — Mon, 22 Jun 2009 04:52:21 +0000

The stifle (knee) joint in dogs, is very similar to the knee joint in humans, in that there are ligaments that run through the joint providing stability, and just like in humans, there can be many varying degrees of injuries in the stifle joint which makes it very important to have it properly diagnosed prior to rushing into surgery or treatment.

The injury could be something that happened suddenly as the result of a stressful event, or the injury could develop over time through normal “wear and tear”. Injuries that develop over time can be the result of many different factors, overuse, incorrect stifle joint angle, high impact activities, and many other things can contribute to cranial cruciate ligament injuries that develop over time. Ligament injuries that happen suddenly can be caused by jumping and landing awkwardly, twisting wierd on the leg, or being run into by another dog.

For the injury that happens suddenly, the dog will immediately stop bearing weight on the leg. Every dogs reaction will be different, as all dogs have different pain threshholds, but you as the owner will definitely be able to recognize that your dog has a problem. In stifle injuries that develop over time, the symptoms may not be so obvious, but they will still be noticeable. In slowly developing injuiries, the dog may limp occasionally, sit awkwardly (sloppy sit – sitting on the side, rather than on its legs), etc.

In both of these situations, it becomes necessary to have the injury diagnosed, and this is where things can get a little bit tricky. When consulting most vets and clinics, there will typically be multiple diagnosis methods available, each of which will be the preference of the practicing veterinarian. These are the typical diagnosis options for the stifle joint:

X-Ray
One recommended course of action will typically be an x-ray. The problem with an x-ray is that ligaments cannot be seen on x-rays (which I’ve learned through injuries of my own). X-rays basically serve one purpose, and that is to see if there are any broken, dislocated or misplaced bones.
Manual Joint Manipulation
Another course of diagnosis is manual manipulation of the joint in which the veterinarian checks for “drawer movement”. Drawer movement is the lamens term for instability in the joint, and comes from the fact that the knee joint will slide back and forth, like a drawer, if there is ligament damage because the ligaments won’t be there to hold the bones in place. Dogs will almost have to be sedated in order to test for “drawer movement” as it would be very painful for the dog to be awake during the procedure.
MRI
A common option in human injuries, having an MRI done is not as feasible for our pets, though it would quickly and easily be able to tell us whether there was a torn or ruptured ligament in the knee. The reason that MRI’s aren’t necessarily available for dogs is that the equipment is very expensive, and the cost of the procedure is highly expensive as well.

Of the above diagnosis options, an x-ray is usually recommended to check that there are no broken bones, and once that is verified, the veterinarian will check for drawer movement to determine if there is ligament damage. I’ve heard stories, and read stories of misdiagnosis online, and I’ll try to address that in another post, as this post will strictly focus on diagnosising cranial cruciate ligament injuries.

In a perfect world, we’d all be able to get MRI’s for our dogs if there was any question that they had a CCL injury, however, it’s not a perfect world, so we use the methods that are available to us. Thus, manual joint manipulation is one of the more common diagnosis techniqes, and with it, we have its drawbacks. The biggest drawback of manual manipulation to check for “drawer movement” is the possibility of furthering the injury. The injury can be worsened by any/all of the following:

Sedation – as mentioned above, the vet will often sedate the dog in order to be able to manipulate the leg without the dog “fighting” it. This can result in over-torquing the joint.
Rough exam – twisting of the joint

These factors can actually lead to injuries to other parts of the joint as there are multiple muscles, ligaments and tendons running through the knee. You may wish to be present durin the manipulation of the knee joint so that you can read your dogs reaction to the twisting.

Conclusion

I understand that all of the above isn’t necessarily great news if your looking for answers about your dogs recent injury, but I’m just trying to provide as much information as possible to allow you to make an informed decision on the treatment of your dog. If I had known a fraction of what I know now, I may have gone an entirely different route at the time of our dogs injury, but on the same note, I’m very glad that we went the surgical route as our dog has been doing great since her recovery. If you haven’t already, make sure you read our story.

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

Kenneth — Thu, 03 Jul 2008 07:06:53 +0000

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.

Conservative Management as a Cranial Cruciate Ligament (CCL) Treatment Option

Kenneth — Tue, 24 Jun 2008 07:14:20 +0000

Though this wasn’t our first choice when dealing with our dogs ruptured cranial cruciate ligament, Conservative Management (or Conservative Treatment) is a non-surgical option of CCL treatment that should be considered by all dog owners prior to surgery.

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:

Weight management / Diet control – Here are some weight management dog foods
Complete restriction of movement in the beginning, along with rest
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. During this period, it’s a good idea to keep your dog in a crate or pen. We actually ordered these two plastic pens for Roxy during her recovery.

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. Here are some natural and over the counter anti-inflammatories that can aid in conservative management.

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.

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

Kenneth — Sun, 22 Jun 2008 17:40:19 +0000

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.