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CCL- What it is, what to look out for, and what to do


Chase recently had Tibial Plateau Leveling Osteotomy (TPLO) surgery for a torn cranial cruciate ligament (CCL). 

What that means is he tore the dog equivalent of his ACL and had to have some of his bone cut and placed in the right location with a system of screws.

Chase is an almost 8-year old Staffordshire Bull Terrier. When we first got Chase, we had no idea how prevalent this injury was in his breed. Apparently, it is common in many large breeds. Other breeds that are pre-dispositioned to this injury include: 

  • Labrador Retrievers
  • Bernese Mountain Dogs
  • Bull Mastiffs
  • Rottweilers
  • American Bulldogs
  • Amongst others

By no means does this mean that if you have one of these dogs, that they will have this, but it is something to be aware of! 

*Disclaimer* Before you read too much further- we did include Chase’s pictures that we were taking and documenting for our own knowledge. I wanted to track what his recovery looked like and I wanted to have photo evidence if I had to contact my doctor with questions. That does mean there are images of his staples/incision sites. 

What does this look like?

As crazy as this may sound to some, we didn’t even know where his knee was. So for those who didn’t learn dog anatomy as well, here’s a visual! 

Cruciate ligament damage in dogs - PDSAImage from: PDSA.org.uk

What are the signs of this injury?

We actually missed some of these signs so we wanted to talk about them here! 

  • Decreased range of motion 
  • Hind leg extended when sitting (as seen below)
  • Pain when the joint is touched
  • Stiffness after exercise
  • Swelling in the general knee area
  • Weight shifted to one side when standing up 

 

My dog exhibits these symptoms, now what?

One day, Chase was so stiff after exercise, he couldn’t get out of his crate. He would stand on his leg and immediately shift his weight, almost limping. We went to the vet for some x-rays, although they were almost certain that he had a torn CCL. 

I guess Chase had torn his CCL in his right hind leg. Asking the doctor, it looks like his left may be degenerating in the other. *Don’t be alarmed, but apparently 40% of dogs rupture the other ligament in their leg within 18 months of surgery. 

According to our vet, they often choose to operate on dogs larger than 25 pounds. We chose to go this route with Chase and we’re happy that we did. 

What does the surgery entail?

Now, this is based on our experience. It costs about $3,000 (we have pet insurance, which covers this procedure, and we highly recommend it. Just be aware that most insurance companies will have a 6-month waiting period for this and if ANY of the signs listed above are seen before 6-months, they will not cover it.)

We dropped Chase off at 7:15am for his intake. He was not allowed to eat or drink after 10pm the previous night. He was shaved, cleaned, and then anesthetized before his surgery.
What they actually did was: cut through the top of the tibia, rotate the knee back to the appropriate position, and use a plate to allow the tibia to heal. 

What it looks like to us: he has a bunch of staples, and was extremely drowsy. 

 

What does recovery look like?

I’ll write down our exact recovery plan but also include questions that I called the vet for.

14 days with no exercise. That means no more exercise than what it takes to go to the bathroom. Icing three times a day with Neosporin applied directly afterwards to the incision.

  • Vetprofen twice a day, every twelve hours. 
  • Cephalexin twice a day, with food, every twelve hours. 

He had a plastic cone that he had to wear, however, we would take that off if we were watching him fully so that he could eat/relax without it on. He was getting quite frustrated when running into walls and not being able to navigate our home. So we alternated the cone with a muzzle to ensure that at no time was he licking his incision.

 

The first few days, Chase was on Gabapentin as well. He was prescribed this once we brought him home and he couldn’t relax at all. He was in a lot of pain. We set alarms for him to take this every 8 hours for the first three days. Eventually, he wanted to run on it he felt so amazing that we dropped his dose to twice a day for the next two days, and by day five, he was only taking it once mid-day. 

After 10 days, he was walking the majority of the time applying some pressure to his leg. 

After 14 days, he got his cone removed and he was able to return to mild walks. In about 10 weeks, most dogs no longer have a limp. In four months, he will be able to return to most normal activities (limiting stressful activities). It will take him six months to slowly return to normal exercise. Every two weeks, about a quarter mile can be added to his two walks, until he starts feeling better. 

Until then, we're trying to keep him busy with toys and mental games.

 

Our questions asked?

  • He hasn’t stopped whining since we brought him home- is this normal?
    The answer is no. We were prescribed Gabapentin in addition for the first few days for pain management. 
  • His ankle/hock is extremely swollen- is this normal?
    Yes. The first few days swelling is extremely common. It’s also common for gravity to pull the fluids down. The best things to do here are elevate, small movements of the area, and ice.

  • He was really sleepy, now all the sudden he’s trying to walk on it- is this normal?
    Yes. It is normal, that he’s started to feel better, and he’s on pain medicines so that is blocking some of the pain that he feels. With that being said… try to make him rest, that is the best thing for his recovery.
  • Follow up question- He keeps lifting his leg to pee and standing on the one that just got surgery- is this normal?
    Yes, it is normal. Try to make him go to the bathroom in a place that he will squat (ie. avoid trees, bushes, etc.)

  • He is starting to bruise a lot- is this normal?
    Yes. The first 3-5 days post surgery, bruising most likely will appear, even if it wasn’t there initially.


  • He is now wild because his exercise has been limited- is this normal? What do we do?
    Yes. 
    This is quite normal for them. However, you need to keep him quiet and resting. For an active dog like Chase, this was a chance and he was getting restless and frustrated. We will post another blog on ways that we found to entertain him and mentally exhaust him throughout the day.

Can this be prevented?

Unfortunately, this can be genetic and often cannot be prevented. However, we learned quite a few physical therapy exercises that can be helpful before and after the surgery. The exercises should be done slowly and gently, without causing pain on your pup. If you notice that your dog is in distress, shorten the range of motion.

Try to do 10-15 repetitions of each exercise. In order to do these, we had Chase laying on one side and we would work through all three exercises before switching over. We will release a video of our exercises to help! 

  1. Hock stretches- gently bend the ankle up and down. 
  2. Knee extensions- bend and extend the knee area. If you dog just had surgery here, this range of motion may be extremely limited.
  3. Hip compressions- compress and extend their leg all the way.