Anterior Cruciate Ligament (ACL) Repair
What is ACL/CCL ?
The cranial cruciate ligament or anterior cruciate ligament (C) is
one of the main stabilizing structures of the stifle joint (in man
this joint would be called the knee). The cranial cruciate ligament
serves to prevent forward movement/Slipping of the tibia bone (shin
bone) relative to the femur bone (thigh bone), to prevent internal
rotation of the tibia bone, and to limit hyperextension of the
stifle. Its main job is to hold the femur and tibia in proper
alignment during all forms of activity.
Two meniscal cartilages (M) located inside of the
joint are crescent-shaped pads that serve as cushions, provide
stability to the joint, and help to push the nourishing joint fluid
into the cartilage of the femur and tibia bones. Several other
ligaments also hold the stifle together, however, infrequently
rupture in dogs
Cranial Cruciate ligament disease
Cranial cruciate ligament disease is the most common
orthopedic condition in dogs and inevitably results in
degenerative joint disease (arthritis) in the knee joint. It is
referred to as a disease because it is typically the result of a
degenerative process in knee joint of dogs, rather than from
athletic injury or trauma. Traumatic CCL rupture may be seen in
less than5-10% of the total CCL ruptures seen in dogs.
It may effect all breeds of the dogs but most common in
Labrador retreivers, Rottweilers and Mastiffs of any age.
The ligament may undergo progressive degeneration and partial
tearing over a period of months, before it suddenly rupture
during normal physical activity and show the symptoms of ccl
The cause is unknown, but conformation of the limbs and
genetics may play a role.
Partial ligament tears may be difficult to diagnose and
frequently occur in both legs at the same time.
When the ligament tears, the stifle becomes unstable. The
femur and tibia bones that form the joint then rub back and
forth on each other (termed "drawer movement"). This results in
pain due to stretching of the joint capsule, potential damage to
the meniscal cartilage, and inflammation of the joint (called
arthritis). In about half of the patients that we operate, the
meniscal cartilage on the inner side of the joint (medial
meniscus) has been torn and the damaged portion must be removed.
Symptoms of CCL disease
Some of the symptoms your pet may display are:
- Holding the hindlimb up
- Sitting with the leg stuck out to the side
- Stiffness ,especially after excercise
- Not wanting to play or excercise
- Pain when the joint is moved or touched
- Swelling of the joint
- Clicking sound when walking
How is ACL disease diagnosed
Your veterinarian should review your dog’s medical
historyand perform a complete examination using tests of the
integrity of the CCL, including the “cranial drawer” and“tibial
thrust” tests. X-rays should be performed to assess the amount of
arthritis present and aid in determining treatment options. Sedation
or anesthesia is necessary for making thedefinitive diagnosis, to
avoid causing pain to your pet.
Surgical Treatment Options Available at Mission Animal Hospital:
- Extra-capsular: ECR/ Lateral suture or TightRope
- Intra-capsular or anatomical correction:With
- Neuteralizing the shearing forces with
Lateral Suture Stabilization (LSS)
- This technique is used most commonly for small dogs and
- It is one of the extracapsular techniques which means the
function of the ccl ,which is inside the joint, is replaced by
placing a suture outside the joint.
- The suture , most commonly a type of medical grade "fishing
line", is placed around the fabella and through the proximal
TightRope Technique (TR)
- This is used for all medium breed dogs, Sometimes in large
breed dogs where tibial plateau angle is less than 25 degrees
and there is no meniscus tear or no DJD (arthritis) yet present
in the joint.
- This is an improved method for extracapsular stabilization
of the ccl.
- This technique uses small drill holes in the femur and tibia
to pass a synthetic ligament-like biomaterial through a small
incision to provide bone-to-bone stabilization. The biomaterial
is called FiberTape and has the properties that make it stronger
and less prone to failure than any other suture materials
currently being used for CCL reconstruction.
- Large or Giant breeds of dogs have a better outcome when the
TPLO is performed.
- We have noted that dogs that have a steeply-sloped tibial
plateau should receive the TPLO instead of the lateral
imbrication technique or TightRope regardless of their size. The
lateral imbrication technique cannot overcome the forces on the
stifle joint caused by a steep slope and frequently the nylon
band will tear or loosen in the postop period.
- All dogs that are going to have cruciate surgery should have
a correctly positioned x-ray taken to measure the slope of the
tibia so that an informed decision can be made on the
appropriate type of surgery that should be performed. In our
experience dogs that have a steep tibial slope (especially large
breeds) do much better with the TPLO surgery. This may not be an
important factor in small breeds even with a steep tibial slope,
but the clients should be aware of the fact that a steep tibial
slope will put much greater force on the nylon bands, therefore
they may break.
Expected convalescent period
- By 3 weeks after the surgery your pet should be touching the
toes to the ground at a walk.
- By 9 weeks the lameness should be mild to moderate.
- By 7 months after the surgery your pet should be using the
- With the extracapsular techniques, about 85% of the cases
are significantly improved from their preoperative state. With
the extracapsular technique, we can expect that 50% of these
dogs will have some degree of lameness, whether it is mild or
intermittent following heavy activity. On the other hand about
50% regain normal function of the limb.
- Even though these surgeries may not return the limb to
perfectly normal function, these dogs usually are greatly
improved over their condition prior to surgery.
- The extracapsular techniques will not stop the progression
of arthritis that is already present in the joint. As a result,
your pet may have some stiffness of the limb in the mornings. In
addition, your pet may have some lameness after heavy exercise
or during weather changes. To help with stiffness chondroitin
sulfate,MSM and glucosamine combinations may be given.
- Anesthetic death can occur, but is rare
- Infection at the surgical site
- Sterile reaction to the nylon bands/FiberTape
- Premature loosening or breakage of the nylon bands in LSS
- If the meniscal cartilages were not found to be damaged at
the initial surgery, it is possible that damage may occur at a
later date, thus requiring a second surgery. The sign of a
meniscal tear is a sudden onset of lameness.
- Entrapment of the peroneal nerve by the nylon sutures(LSS)
is very painful and can result in permanent functional
impairment of limb function.
- Ice pack the stifle three times daily, 10 minutes per
session for the first 2 days to help reduce the swelling and
- Hotpack the stifle starting on the third day after surgery,
10 minutes per session prior to passive range of motion of the
joint. The hotpacking will soften the soft tissues prior to the
range of motion of the joint and will make it less painful to do
- Passive range of motion of the joint involves flexing and
extending the stifle joint, and should be done 10 minutes
following the hotpacking. After the range of motion exercises
have been completed, a cold compress is applied to the stifle
for about 5 to 10 mintues.
- The rehabilitation therapy should be done until your pet is
bearing a significant amount of weight on the limb.
- During the first two months activity is restricted to short
leash walks outside.
- Running, jumping, and rough play are forbidden.
- Gradual increasing the activity during the third month after
surgery allows for a safe return to function.
- Unleashed activity can take place after four months.
For further information or to schedule an appointment,
Please contact Mission Animal Hospital at 818-363-8143 or request an
appointment online by clicking the link below.
Payments made available thru
16907 San Fernando Mission Blvd. Granada Hills, Ca. 91344