Cranial cruciate ligament disease (CCLD) is a common ailment in canines, one that we see often at our clinic. It is one of the most common reasons for hind-leg lameness in dogs. CCLD reduces dogs’ quality of life by hindering movement, causing pain, and leading to arthritis.

The Basics

The cranial cruciate ligament (CCL) stabilizes the knee (stifle) joint in the hind leg and helps prevent the tibia from rotating and the knee from hyperextending. Tears and ruptures of this ligament are common in dogs. Cranial cruciate ligament disease (CCLD) is degenerative, with tearing of the ligament progressing over time, often resulting in a full rupture. This is the most common form of injury. Less common are sudden ruptures due to injurious impact, called cranial cruciate ligament ruptures (CCLR).    

Predisposition

Several biological and biomechanical factors contribute to the prevalence and rate of progression including breed, sex, age, genetics, joint conformation, and muscle strength. Certain breeds, including large breeds, are more predisposed to CCLD because of these factors. Other contributors include obesity and activity levels. Excess weight puts extra stress on ligaments while highly active dogs may suffer accelerated ligament wear.

The prevalence of CCLD in certain breeds, in agility performers, and in the general canine population continue to be studied. Recently, researchers in the Comparative Genetics and Orthopaedic Research Laboratory at the University of Wisconsin–Madison School of Veterinary Medicine developed a genetic screening test that determines if a dog is susceptible to CCLD[1]. This test is available for Labrador retrievers, and researchers are working to develop the test for other predisposed breeds. 

While CCLD and CCLR can occur in any dog, the breeds most susceptible to CCLD include Labrador retriever, Newfoundland, Rottweiler, Neapolitan mastiff, Saint Bernard, Chesapeake Bay retriever, American Staffordshire terrier, Akita, boxer, and bulldog[2].

Signs, Diagnosis, and Treatment

Dogs suffering from CCLD can present with several symptoms which vary with severity of the disease. These include post-exercise limping that improves with rest (early stages of tearing), sitting to one side versus squarely, persistent limping, yelping or whining in pain, refusal to play, difficulty jumping (onto furniture or into vehicles), difficulty rising from sitting position, joint swelling, audible popping or clicking, shifting weight from or inability to bear weight on the affected leg.

Diagnosis of CCLD consists of discussing symptoms with owners, palpating the knee, observing gait and movement, and taking radiographs. 

Surgical stabilization of the stifle, and exploration of further damage, is the preferred treatment. The CCL cannot be repaired otherwise. There are several surgical methods available involving osteotomy (cutting into the bone), reorienting the contact surface of tibial plateau (shin bone), and affixing stabilizing bone plates. Other techniques utilize sutures outside the joint to stabilize the knee. Which surgical method is appropriate depends on the dog’s size, breed, body conformation, activity level, and degree of knee instability. 

To ensure the repair remains successful, implementing a post-surgery care and rehabilitation plan is critical. This will include restricting activity and performing therapeutic exercises, which allow the repair to heal without losing muscle or joint function. Without proper post-surgery care, dogs will likely need secondary repairs, causing further pain and trauma.    

While surgery is the preferred treatment, size, age, health, and other factors may exclude it as an option. In these cases, treatment involves limiting activity, prescribing supplements, managing pain, and treating arthritis. 

Prevention and Risk Reduction

There are measures owners can take to reduce the risk of CCLD. Keeping dogs at a normal weight with proper nutrition and exercise prevents undue stress on joints and ligaments. Owners can also reduce risk by providing dogs with consistent exercise that maintains physical fitness and avoid irregular, strenuous exercise. Being aware of a dog’s predisposition, watching for early symptoms, and getting routine wellness exams can ensure early detection, which can reduce progression and severity of CCLD.   

In conclusion, CCLD is a common and disabling condition in canines. Many factors contribute to the risk and severity of the disease. As with most ailments, and given the trauma and long-term complications this disease causes, risk reduction and early detection are essential. 

References

  1. University of Wisconsin–Madison School of Veterinary Medicine. New genetic test identifies dogs’ risk of common ligament rupture. Published September 13, 2022. https://www.vetmed.wisc.edu/new-genetic-test-identifies-dogs-risk-of-common-ligament-rupture/
  2. Spinella G, Arcamone G, Valentini S. Cranial Cruciate Ligament Rupture in Dogs: Review on biomechanics, etiopathogenetic factors and rehabilitation. Veterinary Sciences. 2021;8(9):186. doi:10.3390/vetsci8090186
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