Full Title: The Cranial Cruciate Ligament
Author: Colleen Ponzani
Date of Publication: January 21, 2016
Research Paper Text:
If you are reading this and do not know what the CCL is, then I hope I can help you learn something. If you do already know the CCL and are cringing with the pain of experience, know that you have my utmost sympathy and support. My (at the time) 9 month old GSD had a complete tear of his right CCL and a partial of his left. The research/rehab is what brought me to PetMassage™.
The CCL (cranial cruciate ligament) is located in the canine stifle (knee). It is similar to a humans ACL. Injury to the ACL is most common in athletes but seems to be gaining in popularity amongst my neighborhood “walking” crowd. One lady tore her ACL simply stepping over a railroad tie. The ACL injury certainly seems to be a popular injury in the National Football League. I have heard it said by at least 2 veterinarians that CCL injuries are the bread and butter of canine orthopedics.
The CCL sits inside the stifle joint along with the caudal cruciate ligament forming a cross shape. Cruciate comes from Latin, crux for “cross”. It forms a type of hinge that can move forward and back, similar to a door hinge. It does not show up on x-rays and you cannot feel it with your hands. It kind-of looks like this:
Injury can occur running, jumping or even just playing with another dog. Most cases seem to be a sudden onset of lameness with the dog unable to put full pressure on the leg. Imagine a door with a broken hinge and how it scrapes when opening and closing. The CCL injury is very similar.
The bones are no longer aligned and the area becomes swollen and painful. This will also cause cartilage damage within the stifle. Veterinarians will perform what is called a “drawer” test. One hand holds the femur while the other holds the tibia. She will “pull” on the femur and if there is movement similar to that of pulling out a dresser drawer, then there is damage. The only way to know the extent of the damage is through surgery. Surgery is necessary to stabilize the joint, especially if the dog will not put any pressure on that leg. Fortunately there are at least 3 types of surgeries that your veterinarian or canine orthopedist can do, depending on your dog’s age, breed and activity level. They are: TPLO, Extracapular Repair and Tight Rope. Detailing the surgeries could be another paper, but if you are interested there is plenty of information via your local dog doctor or the internet.
Dogs with a CCL injury will develop arthritis. Pretty much guaranteed. Not fair. Surgery will slow its progression, but the joint will never be the same as if the CCL was intact. I have personally known 2 dogs with this injury (minor tear) that elected to not have surgery. They were able to build up the surrounding muscles so they did not limp or obviously favor the leg. External manipulation from the veterinarian showed a tenderness and arthritic symptoms.
A dog with this injury can greatly benefit from many of the PetMassage™ practices and techniques. Prior to surgery because the dog is not using the injured leg and muscles will atrophy. Massage will help the blood flow and muscle tone. I was shocked when, post-surgery, my canine physical therapist measured the size of my GSDs thighs. The injured side was significantly smaller than the un-injured leg. Had I realized or known, I could have massaged his thigh to keep the muscle tone up and help with the recovery. The rest of the dogs body will benefit from massage as well since it is out of balance and pressure is being put on other muscles and joints.
Post-surgery, PetMassage™ will help alleviate swelling and discomfort. Gentle rocking and rolling is fantastic for the lymph system and moving all those (necessary) pharmaceuticals out of the body. Positional release of the stifle should be done with great care in the beginning, possibly doing it with the recommended Range Of Motion exercises as part of rehab.
Post-surgery rehab for us was a multi week process of daily exercises mostly following our doctor’s recommendation of the Top Dog guide found at http://www.topdoghealth.com/home-rehab-guides/cruciate-home-rehab-guides/ as well as goals from our physical therapist. I am including the Top Dog rehab guide so you can get an idea how intensive the rehab can be. Looking back at that information I can see where massage is recommended multiple times a day. I wish I knew then what I know now. I could have been so much more effective in helping the recovery process.
Post-post-surgery and recovery, armed with the knowledge that arthritis is on the horizon, PetMassage is part of our wellness routine. Acupressure treatments are also helpful in keeping the circulation stimulated and decreasing the progression. “Eyes of the Knee” are dimples located on both sides of the knee cap. Gentle holding of these points is helpful.
If it were not for a bouncy GSD puppy and his CCL I never would have known about PetMassage™. As much as I wish I HAD known before the injury, I am grateful that I have the knowledge now to work with my dogs and share my skills with others.
- Canine Knee Surgery – Tibial Tuberosity Advancement for your Dog’s Knee Injury, http://www.caninekneesurgery.com/acl-or-ccl/
- Cranial Cruciate Ligament Repair: TPLO, ECLS & Tight Rope® Procedures
- Schwartz, Cheryl DVM. Four Paws Five Directions. Berkley, Celestial Arts, 1996