Cranial cruciate ligament (CCL, called ACL in humans – anterior vs vet med cranial) disease can occur all of the sudden due to a trauma or more commonly due to degenerative changes in the stifle (knee) over time. One of the most common mechanisms of a CCL tear includes a sudden deceleration coupled with a turning motion (ie: chasing a ball)
The most common indicator is a sudden 3-legged lameness that does not improve with rest or pain medication. Toe tapping, limping, not putting full weight on the injured leg/stifle are common visual signs. There may also be swelling and/or warmth at the joint, “sloppy” sitting or leg everted out and a reluctance to use the affected hindlimb. Dogs will be hesitant to jump into the car or on to the couch as well as hesitate with upstairs/incline walking.
Similar to an ACL tear in humans, this condition causes a weakening of the ligaments within the knee. When the CCL ligament is torn (sprained) or breaks down, it creates instability in the knee joint. Over time, this instability will cause repeated slippage of the tibia forward which will lead to painful inflammation and erosion of the knee joint. Joint thickening (medial buttressing) and bone spurs develop as a result making the CCL more easily prone to injury. The knee/stifle joint is a capsule therefore blood flow is poor, it is important to increase as much blood flow and neovascularization (sprouting of baby blood vessels called capillaries) during the prehab or post-op phase.
Risk factors for CCL injury/degeneration include: early spay/neuter, excessive weight or high body composition score, larger breeds, conformational abnormalities, extremely muscular stocky legs (i.e. bully dogs), lack of conditioning, pre-existing stifle/knee injury on other side. And sometimes it’s just a bit of bad luck with the mechanism of injury in mind.
👉🏻 Should your dog be at risk, getting your dog adjusted prophylactically can help to reduce stress on the knee joints and aid in maximizing comfort and prevent further joint breakdown. Should your dog already have a partial tear, palliative care such as class 4 laser, shockwave, exercise rehab, hydrotherapy and joint manipulation of surrounding joint is recommended as well to prevent further wear on the opposite sided limb, as often dogs will compensate and tear the other side on average within 6-8 months.
👉🏻 The success of animal rehabilitation, modalities and chiropractic care can vary depending on the severity of the problem, the length of time a pet has been struggling with a complaint and the quality of the provider. Please first visit your veterinarian if you suspect your pet may have this condition as x-rays are often helpful to confirm diagnosis and your dog or cat might need anti-inflammatory & pain medication to assist with the acute care process of a newly injured knee.
👉🏻 Animal chiropractic & rehabilitation can be a valuable complementary treatment to help promote better alignment in surrounding areas + reduce painful compensation due to inevitable gait changes that may occur due to the tear. Non-surgical modalities are available if the CCL is not fully torn in effort to help heal the ligament and try to prevent surgery. It’s important to choose a properly trained and certified provider in order to achieve the best outcome for your pet. In many cases, surgical repair is warranted, and rehab/chiropractic care can be of great assistance post-op.
If I (Dr. Mar) am not adjusting spines, I’m working on stifles… it’s a very common condition or injury in dogs, more so than cats, and while the CCL surgery itself is not necessarily that bad it’s the 2-3 month post-op protocol that has most pet parents hesitant as the animals need to be medicated to prevent them from too much movement during the initial 6-12 weeks post-op. Do what you can to prevent but know you have resources like MAR to help guide you post-op as well.