Knowing your options when it comes to CCL tears
Updated: 6 days ago
What is the CCL?
CCL stands for cranial cruciate ligament. It is synonymous with the anterior cruciate ligament (ACL) in humans. The first part of its name specifies the ligament's function: cranial (towards the head) stability. The second part of the name relates to the ligament's attributes: in this case, it crosses a joint hence the "cruciate." Put the two together, and you have a ligament that is toward the front part of the knee, crosses the joint in order to hold the bones together.
Regardless of species, the knee is one of the most unstable joints of the body; it is very prone to injury. Specifically, sudden accelerations with sudden twisting/change of direction is a recipe for disaster. (Sounds like chasing squirrels isn't such a good idea!)
Contributing factors and diagnosis
The knee most commonly get torn for several reasons. Like mentioned before, sudden accelerations with sudden change in direction is a common culprit. However, there are other things that can lend to the slow build up for a sudden blow out.
I think this goes without saying that generally certain breeds are more likely to develop this problem. Disproportionately, CCL tears effect larger dogs more than smaller dogs. This is due to a lovely thing called gravity. The further away the body is from the ground, the more likely your dog is to have issues. Breeding responsibly can somewhat help to curb this problem.
The more weight there is on the joints, the more weak they become. Think about yourself hiking: if someone kept adding rocks to your backpack, it would only be a matter of time before your legs gave out. I see so many owners that could easily prevent weight gain with proper diet and exercise.
3) Lack of conditioning
Did you know that olympic athletes train for a long time before they perform at the olympic games? Duh, right? I see a lot of pet parents, though, that forget their dog is not a well trained athlete when they go for that once a month run or that "every once in awhile" visit to the dog park.
4) Biomechanical compensation
A bad hip will make for bad knees, bad knees will make for a bad hip, and a misaligned pelvis and lumbar spine with make for both bad knees and bad hips! A dog that is improper alignment or has pre-existing conditions or ailments can perpetuate a knee problem. The worst part about CCL tears is that, usually within 18 months of diagnosis, the other knee will start to tear, too.
Watch this awesome video above! This is called anterior drawer sign. This orthopedic tests is used in pets and people to diagnose ACL/CCL tears. Notice how the knee flows freely back and forth. This is NOT supposed to happen. Ligaments act as "check" mechanisms to make sure the bones don't slip and slide across each other.
What is common management?
((PLEASE NOTICE: I AM NOT A VETERINARIAN.))
I have an easy to remember rule: If your dog has LESS than a 25% tear and if your pet weighs LESS than 25lbs, the problem is NOT surgical.
Many times, CCL tears will heal if treated diligently and correctly. Unfortunately, they take A LONG time to heal because ligaments have very poor blood supply. I find many pets do great with weight loss, rehabilitative exercises, supplementation, and biomechanical corrections (whether through bracing, adjustments, or both.)
A really great place to start is weight loss. Ask your vet about how to get your pet down to a healthy weight. Once this has been achieved, you can look into doggy rehab! (At the end of this blog, I will post my favorite go to exercises!)
Larger breed dogs that are further along should look into supportive bracing if they cannot afford surgery. I like these kinds of braces as they allow for the most air flow and best support compared to others on the market. A good brace will run you anywhere from $200-600 but is well worth the investment if you cannot afford an expensive surgery.
Supplementation Ask your vet also about supplementation. My favorites for my pets are chondroitin sulfate, omega 3's (fish oil), collagen, glucosamine, and ligaplex from standard process. You can also skip buying pills and make your dog a nice brew of bone broth to pour over their meal. Look up my recipe here: https://www.instridechiropractic.com/post/looking-for-a-supplement-to-boost-your-pet-s-joint-health
My next go to would be GET YOUR PET ADJUSTED!I cannot tell you how many pets have biomechanical issues that need correcting. Through aligning the low back, pelvis, hips, and sacrum, many knee issues are maintained if not corrected altogether.
1. NSAIDs: (AKA carprofen, rimadyl, dermaxx, previcox,meloxicam) Medication designed to prevent the release of inflammatory chemicals in the body. Some pets CANNOT take these as the are harmful in large doses. They can be harmful to the kidneys, liver, stomach, and heart.
2. Muscle relaxers: (AKA flexeril, gabapentin, tramadol, methocarbamol) Medication designed to allow muscles to relax and reduce painful spasm. Can often cause drowsiness, heart problems, and gastrointestinal upset/constipation.
3. Adequan: (AKA polysulfated glycosaminoglycan) This medication and/or injection is designed to target and turn OFF specific enzymes that erode joints. This can come with risk of infection due to the use of needles.
4. Steroids: (AKA prednisone, prednisolone) This medication is designed to stop ALL inflammation of the body. It can cause immune suppression, kidney damage, and weight gain. Long term steroid use is FROWNED UPON. Do not use steroids longer than 3 months if you can prevent it.
5. Stem cell injections: This procedure is designed to inject new cells into the joint so the body can replace the old damaged cells. This does not prevent the new cells from undergoing the same arthritic changes. Can come with the chance of infection due to use of needles.
6. Cold laser: This procedure goes down to a cellular level and tells the mitochondria to make more energy so the cells can heal better and faster. Lasers can cause retina damage if directly shined in the eyes. Do not use on places where you pet could or does have cancer.
7. Acupuncture: This procedure works at clearing "chi." In layman's terms, it corrects the flow of lymph, hormones, and blood flow by stimulating nerves through needle placement and/or electric current. Acupuncture also provides pain relief by stimulating "pressure points" that send endorphins throughout the body.
For dogs with tears over 50%, a surgery is your best option. The most common surgery performed would be a TPLO (tibial plateau leveling osteotomy).
What this surgery does is cuts a dent into the tibia and anchors the new fragment with a giant metal anchor. This creates a shelf in the front and back so there is a 0% chance of the knee ever slipping and sliding out of proper position.
Unfortunately, within 18 months of diagnosis and management, usually the opposite knee will tear and will have a similar issue. It is important to correct the cause so that way these issues heal properly and hopefully can be prevented in the first place!
I hope this article gave you a well educated look at your options for CCL tears. It is my goal to provide you with a well rounded approach to your pet's health and let you know all your options so you can make the best decisions for your pet.
Here are my favorite rehabilitative exercises to help your pet with knee pain. These are easy to do and can be done 1-2x/day. Always start with a quick warm up, whether that be a quick 5-10 min walk or a hot pack to the muscles. Do the exercises in order depicted and finish with 20 min of ice!
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