Cranial Cruciate Ligament (CCL) is one of the most common veterinary orthopedic injuries in dogs. In most cases, this type of injury is chronic in nature, resulting from repetitive overuse which eventually leads to severe damage, pain and osteoarthritis. It can also be the result of direct trauma, such as a dog/dog collision, a slip or fall. Studies show that genetic factors, height, gender and early spay/neuter also influence this injury.
The CCL ligament is responsible for stabilizing the knee joint and connects the lower limb (tibia) to the thigh(femur) . It helps limit rotation between the femur and tibia as well as restrict forward thrust of the tibia during weight bearing.
Symptoms include:
- Intermittent lameness – This lameness can be varying in degree from barely noticeable to fully non weight bearing. Often, it is worse after rest and then will improve slightly after your dog has been moving around.
- Changes in posture
- Reluctance to sit or inability to sit with the rear limbs tucked in.
- In a stand you might notice your dog slightly lifting the heel of the affected leg while shifting more weight to the unaffected leg.
- Increased effort to get up from laying down. You might notice that your dog isn’t bouncing up quite as quickly when you grab the leash.
- Changes in behavior – In many cases, changes in behavior associated with this injury are very subtle. In fact, it is not uncommon for dogs with this injury to continue to have the desire to run and play, making rehabilitation even more important. Dogs are very adept at using (or overusing) the other three legs to try to convince you that they are just fine!
Physical Rehabilitation
- Medically managed CCL injury.
- If surgery isn’t an option for your dog, either in the immediate or distant future we can help! The outcome of physical rehabilitation is very dependent on the level of injury your dog has sustained. The sooner you get started, the better the overall outcome and long term prognosis.
- Mild strains without instability – Grade I
- If your dog has sustained this type of injury, you might have observed intermittent lameness after activity. Usually, pain easily resolves with rest and a short term prescription of prescribed anti inflammatory medication. If your goal is to avoid surgery and minimize chronic osteoarthritis, this is the IDEAL time to start a rehabilitation program.
- Strains with mild instability – Grade II
- If your dog has this type of injury a custom orthotic and dedicated rehabilitation program can be effective measures to prevent further damage to the CCL and other supportive structures that help stabilize the knee.
- Strains with significant or full instability – Grade III
- We aren’t going to pull the wool over your eyes. If your dog has this level of damage, their quality of life will be significantly improved with surgical stabilization. Often, when the injury to the CCL is this severe, concurrent damage to other structures of the knee is likely. However, if surgery is absolutely not an option, a custom orthotic is the next best solution.
Prehabilitation
Seeing patients prior to surgical intervention, also known as prehab, is beneficial for several reasons. Early intervention improves joint health and introduces necessary strengthening exercises. It also allows us to develop a relationship with you and your dog at a time when your dog is more comfortable. This creates a positive learning history and builds trust with our team, in addition to providing treatments that support the healing process.
Surgical Rehabilitation:
The most common CCL surgical procedures we treat include TPLO, TTA and Extracapsular Stabilization (ECS). At Stride, our broad experience in veterinary physical rehabilitation results in unmatched care with proven outcomes time and again.
While your dog might believe they can heal without help we know better! Our physical rehabilitation programs are expertly designed to focus on your dog’s individual healing timeline and functional ability, keeping the road to recovery clear of obstacles that can impede healing and delay return to normal activities.
Rehabilitation Follow Up sessions:
Our CCL rehabilitation recommendations are crafted around you and your dog’s needs and goals. Each member of our team understands the challenges of this journey. We take a personal and professional interest in keeping you as involved as possible, every step of the way, explaining exercises and treatments. Our detail oriented sessions will have a big impact on your dog’s recovery because we understand that rehabilitation is not just about doing the exercises, it’s about doing them right!
FAQ:
When is the best time to start physical rehabilitation for a ruptured CCL injury or CCL surgical stabilization?
- Now! It is not necessary to see your general practitioner or surgeon prior to scheduling physical rehabilitation. We can’t wait to get a head start on your dog’s treatments and healing process. It also allows us to develop a relationship with you both at a time when your dog is more comfortable. This helps foster a positive learning history for your dog and builds trust with our team.
What is the typical process for rehabilitating a CCL injury or surgery?
- The first step is to schedule an evaluation with us so that we can put together a plan that works for you and your dog. We often recommend a multimodal approach with a strong focus on joint health, appropriate exercise and pain management. Our follow up sessions are comprehensive, including a variety of treatment options
How long before my dog can “be a dog”
- If dogs could read textbooks and follow directions, they would all be back to their normal antics between 3-6 months post injury or surgery, with peak function returning at about month 12. But their reading skills are lacking and many of them would tell you they are good to go at 4 weeks – so we’ll just settle on about 4 months.
What is the difference between a healing timeline and a return to function timeline?
- Healing timeline is based on physiology. Under ideal conditions, healing will nearly always take place at the same rate, relative to the type of injury or surgery. A functional timeline is based both on a healing timeline as well as all of the external influences that can affect healing rate. No two dogs will have the same functional timeline.
- Severity
- Duration/Chronicity
- Strength
- Age
- Fitness level
- Post op complications
- Infection
- Pain control
- Physical rehabilitation
- Activity control
- Concurrent orthopedic or medical conditions
What is the likelihood of my dog’s other knee sustaining the same injury?
- Most dogs will go on to injure the other knee within 2 years.
How can I reduce the risk of a CCL strain in my dog?
- Doing fantastically athletic feats such as chasing squirrels, balls, frisbees and other dogs all increase the likelihood of this injury. and the best way to reduce the risk of injury is to closely monitor these activities. Repetitive hard stops and turns, running over uneven terrain, especially when fatigued are surefire ways to strain a CCL. Keeping your dog lean and appropriately fit will also help reduce this risk.
How much does physical rehabilitation cost?
- Physical rehabilitation costs can be a bit of a moving target so it is best to reach out directly so that our staff can better understand your individual needs.
What is the success rate of rehabilitation without surgical intervention?
- This is really dependent on defining success. Studies show that 63% of medically managed dogs versus 75% of surgically managed dogs can go on to regain 85% of function in the affected limb at 12 months post injury. We can help you sort through what success means for you and your dog so that you can move forward with a plan that fits your needs.