Similar to the human anterior cruciate ligament (ACL), the canine cranial cruciate ligament (CCL) is one of the most important structures that stabilize the canine stifle (knee) joint.1 The cranial cruciate ligament acts to resist hyperextension, internal rotation and cranial drawer motions of the knee; it also guides the knee through its normal range of motion.2 Tearing or rupture of this ligament is one of the most common reasons for hind limb lameness, pain and knee arthritis in dogs.1 Rupture of the cranial cruciate ligament is uncommon in cats.
What Is a Dog ACL (CCL)?
ACL is a human medical term and commonly used incorrectly when discussing similar injuries in dogs. The correct term in veterinary medicine is CCL. Veterinary anatomy uses the terms cranial/caudal whereas human medicine uses the terms anterior/posterior.
While they are similar in function, a human anterior cruciate ligament tear is not the same as a canine cranial cruciate ligament rupture. So while some owners like to think of it as an ACL tear, calling it that wouldn't be accurate.
What Is a Cranial Cruciate Ligament (CCL) Rupture?
A partial or complete rupture of the cranial cruciate ligament occurs due to multiple factors. In most cases, a rupture of this ligament occurs due to a gradual degeneration of the ligament over time, rather than a sudden traumatic injury.1 Factors contributing to CCL injuries in dogs include:1
- Aging
- Obesity
- Poor physical condition
- Conformation
- Breed
Genetic inheritance has been shown in Newfoundlands and Labrador Retrievers.3
It's also important to note that a dog who experiences a CCL rupture in one leg is likely to experience it in the opposite leg as well. About 40% to 60% of dogs with cranial cruciate ligament disease in one knee will, at some point, develop similar problems in the other knee, as well.3 Pet owners should be aware of this probability and prepare for the additional expense.
Treatment Options for a Dog CCL Rupture
There are several treatment options when dealing with a cranial cruciate ligament rupture. The first decision you'll need to make is whether to treat the rupture medically or surgically. The best choice for your pet depends on many factors, including your pet's age, weight, health, activity level and degree of knee instability — as well as your budget and ability to provide follow-up care. Your veterinarian can help you decide which treatment option is best for you and your pet.
If you choose to treat the rupture medically — also known as conservative or non-surgical treatment — your pet will be given non-steroidal anti-inflammatory drugs (NSAIDs) to control pain and inflammation. In addition to this medication, the mainstays of treatment are strict cage rest, weight control and restricted activity. Four months of this treatment regimen will be needed to show maximum improvement.4 If significant improvement is not achieved, surgery should be considered.
There are several surgical treatment options to address a ruptured CCL in dogs. Your veterinarian or veterinary surgeon will help you determine the best option for your dog based on your dog's needs and the surgeon's personal preferences. Because the cranial cruciate ligament does not heal and cannot be repaired, surgical techniques focus on either altering the biomechanics of the knee joint, or using suture material to mimic the function of the cranial cruciate ligament.3
There are four commonly performed CCL surgeries for dogs that may be considered:3
- Tibial Plateau Leveling Osteotomy (TPLO). In this procedure, the top of the tibia bone is cut and rotated, altering the biomechanics of the knee and making the knee joint more stable. The cut surface is then held in place with a bridging bone plate and screws.
- Tibial Tuberosity Advancement (TTA). In this procedure, the front of the tibia (shin) is cut and advanced forward, altering the mechanics of the knee and quadriceps muscles and rendering the knee joint more stable. The cut in the bone is stabilized by a special bone plate and screws. The TPLO and the TTA are similar procedures with similar outcomes, and the choice between the two is largely a matter of the surgeon's preference.
- Extra-Capsular Suture Stabilization. Also called lateral fabellar suture stabilization or "the fishing line technique," this procedure uses suture material to mimic the function of the cranial cruciate ligament. The goal of this procedure is to facilitate the formation of scar tissue around the joint, which will provide stabilization for the joint even if the suture material eventually fails.
- The Tightrope Technique. This is a special suture technique using specifically developed toggle and suture material. Holes are drilled into the femur (thigh bone) and tibia (shin bone) for accurate placement of the toggle implants.
Following any type of CCL surgery, good home care with strict activity restriction is a must to prevent surgical complications and failures. Be sure to follow your veterinary surgeon's instructions for post-operative care and follow-up visits closely!
How Much Does CCL Surgery Cost for a Dog?
The cost of CCL surgery for dogs varies significantly depending on the type of surgery to be performed, the size of your dog and your location. On average, you can expect to pay a minimum of $2,000 to $4,000 for CCL surgery for dogs.
Does Pet Insurance Cover CCL Surgery for Dogs?
Yes, pet insurance typically covers some or all of the cost of cranial cruciate ligament surgery, unless your pet's CCL rupture was considered a pre-existing condition. Be sure to check your policy or contact your insurance provider to find out whether your pet's surgery will be covered.
Most pet insurance companies will require you to pay for the surgery out-of-pocket and will then reimburse you, so you will still need to be prepared to cover the cost of your pet's surgery upfront.
CareCredit Financing for Dog ACL (CCL) Surgery
Yes! The CareCredit credit card is here to help you manage the costs of your pet's veterinary care, including CCL surgery and other costs not covered by pet insurance.* To find a veterinary provider near you that accepts the CareCredit credit card, use our Acceptance Locator or download the CareCredit Mobile App.
Author Bio
Dr. Elizabeth Racine is a small animal general practice veterinarian and freelance writer. She covers both human and veterinary medicine with a special interest in nutrition, internal medicine, and veterinary behavior.
