What is Cranial Cruciate Ligament (CCL) Surgery?

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    What is Cranial Cruciate Ligament Surgery in Dogs? 

    Cranial Cruciate Ligament (CCL) Surgery is performed to repair torn, injured, or ruptured Cranial Cruciate Ligaments (ACL, CrCL, CCL). The CCLs are located in the rear legs of a dog. This surgery is compared to that of an ACL surgery in a human. CCL repair surgery generally begins with an examination of the inside of the dog’s knee. When damaged or torn portions of the CCL are identified, they are removed during the procedure. There are a number of surgical methods that can be used to repair the injured CCL. There are four common surgical techniques executed to repair the CCL.  Your veterinarian will discuss the pros and cons of each CCL surgery option and guide you and your dog in the right direction. You can find a veterinary surgeon in our specialist directory. 

    drawing of TightRope Technique for ccl surgery
    Photo Credit: VCA

    What Happens During CCL Surgery? 

    There are four common surgical methods that may be performed to correct your dog’s torn or injured CCL. The option best suited for your dog is dependent upon a number of factors including size, health condition, the severity of the injury, etc. 

    1. Extracapsular Lateral Suture Stabilization (ECLS) 

    drawing of Extracapsular Lateral Suture Stabilization (ECLS) for ccl surgery
    Photo Credit: VCA

    The ECLS technique is the traditional surgical correction for CCL injury in dogs. This procedure involves stabilizing the joint outside the joint capsule (externally).  When the ECLS method is executed, an artificial ligament is placed from the back of the dog’s knee joint around to the front, anchored right below the knee. The artificial ligament secures the joint to prevent the tibia from rubbing back and forth after the CCL has torn. In order for this procedure to be executed, two holes are drilled; one at the front of the tibia and the other on the outer portion of the femur. These holes allow for the artificial ligament to be passed through. The faux ligament operates like your dog’s natural CCL would, but the range of motion is typically limited to a certain extent. Dogs weighing under 40 pounds may be a good candidate for the ECLS method. This is typically not an option for larger and more active dogs because of the risk of breaking the new artificial ligament.

    2. TightRope Technique 

    drawing of TightRope Technique for ccl surgery
    Photo Credit: VCA

    The TightRope technique is the least invasive of the CCL surgery options. Four holes are drilled into the dog’s tibia and femur, from there the joint is stabilized by lacing the two bones together with a synthetic ligament. This new faux ligament functions like the dog’s original CCL did at one point. This surgical intervention is an option for most small and medium-sized breeds. However, the TightRope Technique is not an option for those dogs who have experienced a previous CCL injury. 

    3. Tibial Plateau Leveling Osteotomy (TPLO)

    drawing of Tibial Plateau Leveling Osteotomy (TPLO) for ccl surgery
    Photo Credit: VCA

    In some cases, a Tibial Plateau Leveling Osteotomy (TPLO) may be the best route. In this surgical correction, the need for a CCL is completely bypassed. Instead, the tibia is cut and rotated to create a sliding movement between itself and the femur. From there, an artificial bone plate is screwed into place along the tibia and femur to secure the new joint. TPLO surgery is often performed on larger breed dogs and very active dogs. It is often performed on dogs who have previously torn or injured both CCLs because the knee is blocked from sliding forward meaning future injury is prevented. 

    4. Tibial Tuberosity Advancement (TTA)

    drawing of Tibial Tuberosity Advancement (TTA) for ccl surgery
    Photo Credit: Life Learn

    Tibial Tuberosity Advancement (TTA) is a less invasive version of the TPLO procedure. When the surgery is performed, the need for the CCL is eliminated by cutting and altering the front of the tibia. In order to provide proper joint motion, an artificial spacer is inserted to relocate the patellar ligament. Following this, a bone plate is stationed to assure the tibia remains in its new position. TTA is often performed in larger and more active dogs. The shape of your dog’s tibia may cause your veterinarian to recommend a TTA over another CCL surgery option. 

    How Do You Care for a Dog Post-CCL Surgery?

    Caring for your dog following CCL surgery is rather involved and timely, as determined by a number of factors and your veterinarian’s instructions. Recovery includes a number of items including but not limited to managing effects of anesthesia, surgical site care, medications, activity restriction, and rehabilitation. Most dogs recover to normal function by 4 or 5 months post-procedure.  

    dog sitting showing stiches on leg after ccl surgery
    Photo Credit: The K9PT

    ​​Managing Effects of Anesthesia 

    Dogs may be nauseous from the anesthesia and they will usually lose their appetite. During this period they should be fed a bland diet of rice and chicken for the first 24 hours after surgery until the anesthesia has worn off to help ease their digestion.

    Surgical Site Care

    golden retriever laying down with a full leg cast from ccl surgery

    Following surgery, it’s critical to keep your dog from chewing, licking, biting, or scratching at their incision site. This is to prevent infection or open up the surgical site.  Your vet may suggest your dog wear a cone (available as in hard plastic or soft version). If your dog is struggling to get used to a standard cone, there are other options such as recovery jumpsuits they can wear and donut-style collars. Consult with your vet on the best route to take if your dog won’t wear a cone.

    Your dog will typically have to go back to the vet about 10-14 days post-surgery to have their stitches removed but the vet may also use stitches placed inside the wound which will dissolve on their own. 

    The bandages should be kept dry at all times so if your dog goes outside make sure to keep them covered with cling wrap or a plastic bag to keep it protected from the wet or damp grass. The plastic should be removed as soon as they are inside as keeping it on can lead to infection. 

    Medication

    a hand showing a pill to a black and white dog
    Photo Credit: Intermountain Pet Hospital

    Depending upon which surgery is elected for your dog, you will most likely be sent home with painkillers and anti-inflammatories. These will aid in your dog’s healing and comfort while they recover. Your vet should provide written instructions on the dosage and proper use. Keep to a schedule with medications to ensure efficacy and reduce the chance of side effects. In addition to painkillers and anti-inflammatories, high-energy dogs may be prescribed a mild sedative or anti-anxiety medication to help restrict activity. 

    Restrict Activity 

    Keeping your dog from overextending himself post-operation is crucial. During the first two weeks restrict activity and walks to strictly potty breaks on a short leash. The beginning is most crucial as your dog will have sutures during this time. Restricting activity is more than just walks;  playtime, fetch, climbing stairs, running, and jumping  are all off-limits until your vet advises otherwise. Crating your dog may be helpful during this time in order to restrict their adventuring. Try out interactive puzzle games and other low-activity mental stimulation games to prevent boredom while making a healthy recovery. Activity is typically able to slowly increase over time. 

    Rehabilitation and Physical Therapy  

    Physiotherapy and rehabilitation is often prescribed in aiding the recovery of CCL surgery. Rehabilitation typically begins 7 or 8 weeks after surgery. Your dog will likely require a combination of exercises and activities to enhance strength, mobility, reduce pain and suffering, and regain agility and confidence. You can find a physical therapy and rehab specialist in our specialist directory. Physical therapy comes in many forms including but not limited to:

    Range Of Motion And Stretching Exercises

    dog leg stretching during physical therapy for ccl surgey
    Photo Credit: Tampa Bay K-9 Rehab Center

    Cryotherapy

    In the initial postoperative phase, ice compresses are an effective way to help manage pain and inflammation. Cryotherapy is helpful not only during the acute period of tissue damage and inflammation but also after exercise and throughout rehabilitation when inflammation develops.

    Heat Therapy

    Heat should only be applied to tissues after the acute period of inflammation has passed, which is usually three to five days following surgery or injury. Vasodilation occurs as a result of surface heat, which enhances circulation to the superficial tissues, boosts tissue oxygenation and metabolite transport, and speeds up enzymatic and biochemical processes to aid tissue repair.

    Hydrotherapy

    yellow lab doing hydrotherapy on a treadmill
    Photo Credit: Jupiter Pet

    exercise by taking the weight off of the compromised joints and allowing movement that would otherwise be painful or impossible. The viscosity of the water actually increases the work that the muscles are doing at the same time. There is also pool-based and whirlpool hydrotherapy.

    Laser Therapy

    Laser therapy is a non-invasive photobiomodulation therapy to help in the rehabilitation of different conditions. Laser therapy uses light as a way to increase blood circulation and stimulate cell regeneration. It’s been used on humans for decades but laser therapy has been used on dogs in recent years. It essentially promotes healing while reducing inflammation and pain. 

    Shockwave Therapy

    For shockwave therapy for dogs, a series of focused high-pressure acoustic pulses (sound waves) are generated by the equipment and pass from the probe into the skin and soft tissue. The energy contained in the shock waves is released and interacts with the tissue when it meets tissue interfaces of varying densities, such as where soft tissue, tendons, ligaments, cartilage, and bone meet, creating both mechanical and cellular consequences. 

    How Much Does CCL Surgery Cost?

    The cost of CCL surgery can vary greatly depending upon the specific surgical procedure to be performed, the dog’s size and the health conditions of the dog. The average cost can range anywhere from $1,200 – $6,000.  Typically,  TPLO and TTA operations are on the more expensive end while ECLS and Tightrope tend to be on the less expensive side. A consultation with a veterinarian will be required to determine the best method of CCL surgery determining the estimate. 

    How Can CCL Surgery Be Prevented? 

    CCL surgery can be prevented by taking the proper steps to prevent injury in your dog. However, some dogs are more prone to CCL tears and injuries. Here are some tips to prevent needing CCL surgery based on the common causes of injuries:

    • Maintain a healthy weight:
      • Exercise your dog regularly 
      • Feed a balanced diet 
    • Supplemental care: 
      • Ensure your dog is receiving a suitable amount of healthy oils like Omega-3, as this helps with joint care and development
      • You can find supplements for joint health in our product directory
    • Recognize early signs of a CCL injury: 
      • Swelling of the affected joint
      • An unwillingness to put weight on the affected joint
      • Limping
      • Holding up the affected rear limb
      • Difficulty standing from a sitting or lying position
      • Walking stiffly or unsteadily
      • Stiffness on rising
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