Dog Knee Surgery & CCL Ligament Repair » cranial cruciate ligament

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.

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.

A Majority of Canine Injuries Occur on the Weekend – Here’s the Reason Why

Kenneth — Thu, 25 Jun 2009 18:34:02 +0000

After running this site for over a year now, I’ve heard many stories, some good, some sad, but they’ve all had one thing in common – everyone absolutely loves their dog. This post isn’t necessary going to be helpful, but it is certainly interesting.

As I’ve been maintaining and trying to grow this site to make it as helpful as possible for people who are looking for information on dog knee injuries, I’ve also paid close attention to our web traffic. I use Google Analytics so that I can see where the visitors of this site come from (Google, Yahoo, etc) and how many users are visiting, etc. The interesting part is in the traffic spikes that the site sees on Mondays, and to be honest, it makes a ton of sense. Take a look at the following graph that shows visits to this site, and then take a look at the list of assumptions I’ve written down below. And after doing that, leave a comment and let us know what day of the week your dog was injured on (just because I’m curious to find out).

Click on the Graph for Larger Version

Here are the things we can assume:

People who visit this site are dog owners.
Dog owners are typically active people.
Dog owners are likely not sitting inside on their computers on the weekends.
Dog owners are most likely out on weekends, running, hiking and playing with their pets.
Since dogs and their owners have a tendency to be more active on the weekends, there will be more cranial cruciate ligament injuries in dogs on the weekends than during the week.

Image by Flickr user rpb1001.

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.

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.

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

Kenneth — Sun, 22 Jun 2008 07:46:42 +0000

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.
Tightrope Surgery (Tight Rope Surgery) (Updated June, 2009)
Tightrope surgery is a very new procedure that is based on a similar procedure performed in human ankles. It is far less invasive and is performed through small incisions in the skin, and woven through small holes drilled in the bones of the stifle joint. Tightrope surgery is an arthroscopic procedure and thus far seems to have very positive results.

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

Kenneth — Sat, 07 Jun 2008 22:15:17 +0000

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.

Dog Knee Surgery & CCL Ligament Repair » cranial cruciate ligament

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