Any active dog owner has experienced their dog or a friend’s dog suffering a cruciate tear … a common injury to the cruciate, CCL, or cranial cruciate ligament of the knee or stifle joint.
What Is the Cruciate Ligament?
The CCL or cranial cruciate ligament is a primary stabilizer of the dog’s knee. There are two ligaments that cross in the dog’s knee (cruciate means cross in Latin). They help stabilize the knee joints and prevent osteoarthritis or arthritis from occurring. The cranial cruciate ligament is equivalent to the ACL or anterior cruciate ligament in humans. And cranial cruciate ligament tear is one that’s a common orthopedic injury in dogs.
Causes Of CCL Injuries In Dogs
Most people tear their ACL as an acute injury during an activity like skiing or playing soccer. It’s different in dogs. Cruciate tears in dogs don’t usually happen from trauma but are often a culmination of events.
Factors contributing to CCL tears in dogs include …
- Strength level
Any dog can suffer a CCL tear, but some breeds are more prone to tears than others. Susceptible breeds include Labrador retrievers, Newfoundlands, German shepherds, Rottweilers, and Golden retrievers. Overweight dogs who are not in optimal strength are also more prone to CCL injury.
How Dog Cruciate Ligaments Get Injured
The cruciate ligament consists of fibrous bands – or strands – that run from the upper leg to the lower leg. What commonly occurs with a CCL injury is that one of the strands tears and creates increased movement in the knee. The increased movement places stress on the knee, which in turn creates pain and inflammation. The pain and inflammation send a signal to the muscles to stop working, so weakness or atrophy begins to settle in. This further weakens the knee and begins to lead to more inflammation and pain, and potentially more damage to the fibrous bands in the ligament.
This cycle can keep going until a complete tear occurs. As more strands go, the knee becomes more unstable and osteoarthritic changes occur. The cycle needs to be broken through the reduction of pain and inflammation and encouragement of strength.
The Role Of The Cruciate Ligament In Dogs
Ligaments do more than hold joints together. They assist with balance and proprioception. Proprioception is the way the brain determines where a body part is in space. For example, proprioception helps you place your foot down as you step off a curb on a street. You may have sprained an ankle at some point in your life … and you’re reminded of that sprained ankle with poor balance and difficulty negotiating turns.
Once a ligament is damaged, the ligament only comes back to 60% of its normal strength. Balance and proprioceptive exercises can help with this. Because proprioception is an unconscious action that gives us the sense of the position of the joints in our body, it’s very important to aid in the rehabilitation of a CCL tear.
Is Surgery Necessary For A Cranial Cruciate Ligament Tear?
When a dog tears his cruciate ligament, your vet will often recommend TPLO surgery – Tibial Plateau Leveling Osteotomy … or other surgical choices. But, especially with partial tears, cruciate surgery isn’t always the only option. In fact, research at the University of Georgia found that “the application of evidence-based medicine in analyzing the current available evidence suggests that there is not a single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury.” (1)
Conservative management through physical rehabilitation can be effective as a non-surgical treatment option, as long as your dog makes continuous progress and doesn’t damage the CCL further.
Rehabilitation Of Cruciate Tears In Dogs
The treatment aims to reduce pain and inflammation as well as improve strength. Improving balance and proprioception is also a key component of the rehabilitation process. Again, that’s because ligaments assist with balance and proprioception.
Manage Pain And Inflammation
Pain management is always a priority, so the first steps are to treat the pain and inflammation. While most vets will approach this with anti-inflammatories and pain medication, natural solutions like joint supplements, herbs, and homeopathic remedies can work well … without the harmful side effects of drugs. Physical therapy and acupuncture are other good options. Modalities including laser, ice, and heat can help control pain and inflammation. Once the pain is under control, you’ll notice your dog will place more weight on his rear limb and walk more functionally.
There are two types of muscle fibers in everyone’s body, including dogs.
- The fast twitch fibers are used for running and movement.
- The slow twitch fibers, or the postural fibers, assist with postural control, standing and core strength.
The postural fibers atrophy or weaken quickly. It’s often the reason the dog with a CCL injury can run at high speeds … but when standing, won’t place all of the weight on the affected limb. The initial phases of rehabilitation will focus on increasing the strength of the postural fibers … and will incorporate balance and standing exercises.
Balance And Proprioception
Balance and proprioception exercises are the most important component of the rehabilitation program. Ligaments assist with balance and proprioception, and when they become injured, the movement deficits are noticeable but can be improved. So it’s important to work on continuous balance exercises in your dog with CCL deficits.
Balance exercises are simple to perform – and actually, look easier than they really are. Some balance exercises people do after ankle sprains and CCL injuries include standing on one foot for periods of time and then adding in head movements and altering floor surfaces to further increase function.
Balance Exercises For Cruciate Tears
These are exercises you can do with your dog at home. If necessary, ask your veterinary rehab facility to teach you how to do them correctly.
For dogs, balance exercises can begin with weight shifting.
Weight Shifting Exercise
While the dog is standing, shift his weight from side to side. The goal is to place weight on each hind leg and move the weight from side to side, so the weight transfers back and forth from one hind limb to another. This weight shifting will assist with balance and proprioception, as well as strengthen the large core muscles of the limb. Do this exercise until your dog is tired (he’ll usually sit down), and repeat it throughout the day. The more it’s repeated the better, so I encourage owners to perform this exercise as often as possible.
Place your dog in a standing position and lift the opposite hind limb up one inch to increase the amount of weight placed on the (injured) limb. Once your dog starts to have difficulty balancing, let the limb down. Repeat up to 10 times, in 3 or 4 sets.
It’s important to not over-fatigue your dog. Eventually, you’ll progress to lift the front leg (on the same side as the injured leg) and the opposite hind limb together. The opposite hind limb and forelimb should be lifted approximately one inch off the ground. Try to keep your dog in a straight position and don’t allow too much movement in the spine. Hold both limbs up for a few seconds and then place them down as soon as your dog begins to get tired. You can repeat this 10 times for a few sets per day.
To increase the challenge of both these exercises, you can do them on different surfaces to further increase balance and proprioception. These exercises can be done on any uneven surface, such as grass, dirt, carpet, and sand. They may also be performed on discs, foam pads, and peanuts or donuts. Standing on a peanut or two donuts works the static muscle fibers as well as balance and proprioception.
Regular walking (outside or on a treadmill) is a wonderful way to work on strengthening the leg. The goal is to make sure the activity doesn’t aggravate the knee or leg injury. Think quality over quantity! Your dog can walk controlled on a leash as long as he shows no lameness either during the walk or for up to 24 hours afterward.
The distance or time of the walk will depend on your dog. Do your outside walking on a suitable surface for your dog’s condition.
Return To Normal Activity
The ultimate goal is to return your dog to a normal lifestyle. Sometimes, it’s a modified lifestyle with a continued exercise program. As your dog’s rehab progresses, he can start more functional activities. If he hasn’t shown any lameness for 4 weeks, and his strength is improving, you can start introducing him back to whatever his normal activities might be. For example, for a dog who’s normally been active with agility, this is when we might begin jump grids.
Introduce activities slowly. Watch the activity and look for any signs of lameness, but also look for signs of problems afterward. If your dog shows any sign of lameness after the activity, that means he did too much and you need to cut back in the future and progress more slowly.
Stretching the hip flexors and hamstrings is important for your dog with a CCL problem. Ask your rehab facility to show you how to do these stretches and do them before and after activities. Hold each for 15 to 20 seconds and repeat 3 to 5 times. Stretching will increase and maintain the range of motion of the hind limb.
Weight loss, if necessary, is essential to the success of the rehabilitation (6). This story highlights the problem with excess weight. One dog with a cruciate tear was 20 lbs overweight … too heavy for surgery. Her surgeon sent her to rehab and postponed the surgery. When she started rehabilitation, she couldn’t put her weight on her leg. She couldn’t do a five minute walk without lameness. After six weeks of twice-weekly physical rehabilitation (laser therapy, balance work and underwater treadmill, plus homework by the owner), she’d lost seven pounds and was walking with no sign of a limp. The surgeon cancelled surgery because she was doing so well functionally – and now she goes on 90 minute walks without any problems.
The goal is to always progress with a conservative treatment program first. Unfortunately, any damage to the cruciate ligament leads to a higher incidence of arthritis. But proper strength and weight, along with supplements and nutrition, all help with the progress. Balance and proprioceptive exercises will always be a part of your dog’s program.
With a diligent owner, a good dog, and good exercises, there are definitely non-surgical options for a dog with a cruciate tear!
- Aragon et al. Applications of Evidence-Based Medicine: Cranial Cruciate Ligament Injury Repair in the Dog. Veterinary Surgery, Vol 34, issue 2, March 2005.
- Jergler, D. Why You Should Consider Nonsurgical Care For CCL Disease. Veterinary Practice News. June 2015.
- Evelyn Orenbuch, DVM, DACVSMR, CAVCA. Nonsurgical treatment of CCL tears. Veterinary Practice News, August 2018.
- Andrea L Looney, DVM, DACVAA, DACVSMR. Nonsurgical perspectives on CCL disease. Veterinary Practice News, September 2018.
- Sherman O Canapp Jr., DVM, MS, CCRT, DACVS, DACVSMR. Conservative treatment options for partial and complete CCL tears in dogs. Veterinary Practice News, November 2018.
- Katja L. Wucherer, DVM et al. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically JAVMA. May 15, 2013, Vol. 242, No. 10,